Involuntary psychiatric patients can now be given electro-convulsive therapy (ECT) without their consent if certain conditions are met. There is no formal requirement for an independent review of the decision.

The study says the right to appeal to an independent tribunal would give patients a voice, and provide greater transparency.

The study found that women made up 80per cent of the 4000 people - 1500 of them in Victoria - who had electro-convulsive therapy in Australia each year. Further research was needed to explain this, though one reason could be that women were more likely to seek treatment for depression. In New South Wales about twice as many women as men get electro-convulsive therapy as involuntary patients.

The study also recommended that psychiatrists administering electro-convulsive therapy be accredited, to ensure adequate training and supervision, and that the procedure be monitored.

``There has been far too little information and research available about ECT in Australia," the study says.

``Thorough audits are required to determine where problems continue to exist."

The study was done by Ian Freckelton, professor of psychological medicine at Monash University, and Beth Wilson, Victoria's Health Services Commissioner. Ms Wilson is a former president of the Mental Health Review Board of Victoria. The study will be published in the next Journal of Law and Medicine. It says electro-convulsive therapy was regarded as safe and effective by psychiatrists for treating depression, but the public viewed it with fear and mistrust.

``Many people see it as a link to the barbarity they associate with treatments used long ago for the mentally ill - blood-letting, dunking and the twirling stool," it says.

Until the quality assurance issues were tackled, it could not be assumed that electro-convulsive therapy was being effectively and appropriately administered.

``Incorrect treatment will not maximise benefits for patients, and will increase undesirable side-effects," the report says.

Electro-convulsive therapy, in which patients have fits induced by electricity passing through their brains, is used for depression where suicide is a risk and where antidepressants have not worked.

The authors say that movies such as One Flew Over the Cuckoo's Nest, which depicted electro-convulsive therapy as it was done in the 1940s and 1950s - where convulsions occurred without anaesthetic or muscle relaxants - had affected public attitudes.

Despite this and exaggerated media portrayals, audits showed that in the 1980s and even the 1990s the therapy was often administered deficiently. ``In short, the anxieties expressed about ECT by some commentators are not without foundation," the authors say.

The study found little up-to-date information existed in Australia on the extent to which electro-convulsive therapy is used.