Selected topics from 2017 Such findings mean that it is important to emphasise that grounds of necessity are never, under any circumstances, a sufficient legal basis for implementing a course of treatment that extends beyond what is strictly necessary to avert an acute risk to a patient’s health. The government decided not to adopt legal provisions for administering ECT by force when the Mental Health Care Act was adopted in 1999. The way in which the practice of administering ECT on grounds of necessity has developed can be seen as a circumvention of the legislators' clear intention. Grounds of necessity or consent? In many cases, the documentation did not make it clear whether each individual treatment was based on grounds of necessity or not. It was found, among other things, that patients who had initially undergone ECT on grounds of necessity, were subsequently deemed to have given their consent, on the basis that they had not actively refused the treatment. Examples were also found of voluntarily admitted patients undergoing ECT after being subject to a range of other coercive measures, without any documentation of the significance of this for the validity of the original consent. Findings were also made at a number of hospitals that led to concerns that patients who had formally consented to ECT did not receive sufficient verbal and written information about the treatment, including about the expected effect and possible side effects. The patient’s right to file a complaint Poor documentation of the decision to initiate ECT on grounds of necessity makes it difficult for patients to exercise their right to complain. It is important that patients are given sufficient verbal and written information about the grounds for and the intervention itself. This is particularly important with respect to this type of intervention, because some patients have difficulty remembering the circumstances surrounding the treatment. 23 Inadequate overview of the scope During the NPM’s visits this year, it also emerged that local hospitals have inadequate overviews of the scope of ECT administered on grounds of necessity. Prior to the visits, the Ombudsman requested documentation of all the cases, within a specific period, in which ECT was administered on grounds of necessity. Several hospitals had to manually go through patient records and/or resort to health professionals’ memory to obtain this information. During one of its visits, it emerged that the actual scope of ECT administered on grounds of necessity was higher than that initially stated. In light of the very invasive nature of ECT, the hospitals should ensure that they have an adequate overview of all cases in which ECT is administered on grounds of necessity. The hospitals are not obliged to notify national health authorities if ECT is administered on grounds of necessity. There is therefore no national overview of the scope. The Ombudsman has pointed out that it is a cause for concern that the national health authorities are not informed when ECT is administered on grounds of necessity. This means that the health authorities are denied access to important information about a practice with far-reaching effects for the patients who undergo such treatment. An overview of the scope of this practice is a precondition for any critical review thereof. The Ombudsman has raised this issue in its dialogue with the national health authorities, most recently at a meeting with the Ministry of Health and Care Services in October 2017.