ECT audit

Sir: I read with interest the audit on ECT practice (Brookes et al, Psychiatric Bulletin, September 2000, 24, 329-330) and would like to express my appreciation of this important piece of work. As you know, ECT practice is one of the most empirically-based interventions in mental health practice with established efficacy and is nevertheless one of the most controversial, particularly in the public domain. It is also the one area where we have now produced guidance, albeit guidance that is due for review and updating. It is essential that where explicit standards exist, the audit process is implemented at local level to ensure that optional standards are achieved. There is little justification for the present variation in psychiatric practice in the administration of ECT in the face of such clear guidance. This audit and its impact is an example that should be followed elsewhere. The audit process is key to improving practice at local level and we should encourage, as a matter of policy, the publication of many more examples of effective clinical audit.