Barriers to the Provision of Modified Electroconvulsive Therapy in Resource-Poor Settings

In the US, many people receive electroconvulsive therapy (ECT) for severe mood disorders and other serious neuropsychiatric conditions each year. Standard guidelines require that the procedure be performed under general anesthesia. In other regions of the world, however, the procedure continues to be administered without anesthesia (unmodified ECT). This project sought to determine the extent of this practice worldwide and assess the reasons behind it. Barriers to the provision of anesthesia for the procedure of electroconvulsive therapy need to be identified in order to guide the development of appropriate public health interventions. The goal of improving the practice of electroconvulsive therapy in developing regions is particularly important because the social stigma faced by the severely mentally ill patients who receive this particular treatment may prevent them from acting on their own behalf. It is an ethical imperative that this vulnerable, disempowered group not continue to receive a sub-optimal version of a medical procedure that, when performed in this substandard and outmoded way, carries increased risks, ranging from psychological distress to fractured bones. I argue that from a human rights perspective, there is a need for urgent reform and the development of an international policy prohibiting the practice of unmodified ECT, while promoting the availability of ECT performed according to modern standards of care.