3,300 electroshock sessions with no national clinical guideline

What it is

Electroconvulsive therapy —electroshock— remains an authorised treatment in Uruguay and is applied at Vilardebó Hospital, at Ceremos and in ASSE's departmental services, as well as in private centres. The National Torture Prevention Mechanism, housed within the National Human Rights Institution (INDDHH), monitors it because it is administered to inpatients, in many cases under involuntary admission. In March 2021 the body published a human-rights assessment of how it is applied, based on visits, staff interviews, document review and observation of the premises.

What is questioned

The INDDHH report, released on 24 March 2021, covered Vilardebó, Ceremos and six ASSE departmental centres —Cerro Largo, Durazno, Paysandú, Rocha, Salto and Soriano— and found that “no clinical guidelines approved and published by the Ministry of Public Health were identified”, the most recent publication dating from 2004; that informed consent, although every centre said it was required, was in most cases signed “by other people (patients' relatives or facility directors)” rather than by patients themselves; that only Vilardebó had a computerised registry; and that it applied the therapy there to five male adolescents aged 15 to 17 between January 2018 and July 2020. It recommended drafting updated national clinical guidelines, guaranteeing effective informed consent, setting up monitoring systems and eliminating its use in under-18s. Two years later, on 26 September 2023, la diaria reported that ASSE had carried out more than 3,300 sessions in 2022. Asked by the paper, the Health Ministry said “the way [this treatment] improves the symptoms of the illness is not fully understood”.

Why it matters to you

This is a treatment the State funds and administers to inpatients, in a large share of cases without the patient's own signature. The INDDHH's central recommendation —a national clinical guideline— requires no building work and no equipment: it requires an administrative decision. Until it exists, each service applies its own criteria.

Where it stands