17 May 2022

My articleReference Sashidharan¹ was about the political threats facing, arguably, one of the best mental health services in the world and not about use of ECT. In this context, it is specious and misleading for Dr Braithwaite to suggest that Trieste's services somehow fall short of providing effective, humane and person-centred care because ECT is not part of routine clinical practice. This is not unique to Trieste; there are many mental health services and psychiatrists, including in the UK, that do not use ECT. There are others that use it frequently and routinely. This, by itself, does not mean that patients are being deprived of an effective treatment or that they are subject to treatment they may not need. It is perverse to suggest otherwise and to imply that the use of ECT should be considered as a hallmark of good mental healthcare.

Apart from offering the usual paean of praise for ECT, Dr Braithwaite does not provide any evidence which indicates that people in Trieste are being deprived of effective treatment or appropriate care. I am not aware of any clinical evidence of this, nor of any concerns raised by anyone familiar with Triste's mental health services at any time or in any literature relating to the remarkable achievements of the mental health reforms in Trieste over the past 40 years. If Dr Braithwaite has evidence to the contrary, he should present it rather than resorting to a strawman fallacy. The question is not why ECT is not used in Trieste but why there been no need to use ECT in Trieste in the past 40 years.

It is depressing to see the continuing antipathy towards Trieste within British psychiatry. Our rejection of Trieste has never been based on facts or on a detailed understanding of mental healthcare there and its ethos and culture. Dr Braithwaite's comments are in keeping with this, but I am glad that such attempts to discredit Trieste are increasingly at odds with the growing recognition of the value and long-term benefits of the key components of the Trieste model of mental healthcare.Reference Insel²