NEWS

Reduced ECT Access During Pandemic Increased Mental Health Risks

Multi ethnic therapy group during pandemic

Key Takeaways

  • Access to electroconvulsive therapy (ECT) was limited by precautionary measures to limit exposure to the COVID-19 virus.
  • 70% of ECT treatment centers reported that this resulted in decompensation and hospitalization of patients.
  • 80% of institutions reported the need for new acute courses of ECT for patients whose maintenance ECT was disrupted.
  • 15% of ECT treatment sites reported at least one serious suicide attempt during this ECT disruption, and there was one death by suicide.

Electroconvulsive Therapy (ECT) can be useful to address treatment-resistant depression, bipolar disorder, etc. A recently published article in The American Journal of Psychiatry demonstrates how essential ECT services are, given the negative impacts of COVID-19 treatment disruption.

Especially since the pandemic significantly affected mental health, ECT treatment would have been crucial for the well-being of patients struggling with navigating the stress of such unprecedented health uncertainty.

While physical health often takes precedence over mental health in many settings that should prioritize both, such binary thinking can be fatal for patients with severe mental illness who rely on treatment to stay well.

Understanding the Research

According to this survey of 20 ECT treatment centers across the US, 16 sites had reduced their services by less than half between March and June, including 5 that provided less than a quarter of their regular services, while 18 sites limited the frequency of maintenance treatments for ECT.

During this time, one patient died by suicide, while three sites had serious suicide attempts. 70% of ECT treatment sites had patients return to inpatient psychiatric care after relying on outpatient services in the community, and 80% of the ECT treatment centers had to initiate treatment again for patients who had been relying on maintenance ECT.

Daniel F. Maixner, MD

When it is needed, ECT is often lifesaving, and not having access or halting care due to COVID-19, any pandemic or other access-limiting force can come with disastrous consequences.

— Daniel F. Maixner, MD

As with any research that makes use of surveys, weaknesses include inflexibility and limited depth. Despite such potential drawbacks with this study, it demonstrates the negative consequences of classifying ECT treatment as an elective procedure at the beginning of this pandemic, given how essential it can be for patients with severe mental illness.

Essential ECT Treatment

Lead researcher for this study, Clinical Professor in the Department of Psychiatry and Program Director for the University of Michigan Health Systems ECT Program, Daniel F. Maixner, MD, says, "ECT falls in the procedure/surgery zone, and unlike routine psychiatric care where virtual visits quickly ramped up, ECT patients were at risk of having our important procedure deemed ‘elective’ and not essential—with many patients being in dangerous and precarious clinical conditions."

In terms of the data, Maixner highlighted that it only comes from academic centers like the University of Michigan Health Systems ECT Program. Since this does not capture private, non-academic sites that may have shut down, postponed care, or even halted operations, it is likely that there were many more negative consequences for patients than reported in their research.

Maixner says, "There remains longstanding stigma and misunderstanding about psychiatric illness and especially ECT by the public and even by others in the medical field. Nonetheless, when it is needed, ECT is often lifesaving, and not having access or halting care due to COVID-19, any pandemic or other access-limiting force can come with disastrous consequences."

ECT Stigma Remains a Barrier

Hopkins-trained psychiatrist and Regional Medical Director for Community Psychiatry, Leela R. Magavi, MD, says, "Some individuals fear ECT due to historical depictions. ECT has evolved considerably over the years. When I have administered ECT to patients, I have usually observed a toe or finger twitch rather than violent jolts often depicted in movies and by the media."

Leela R. Magavi, MD

Some of the patients I evaluate with severe depression, bipolar disorder, OCD and suicidality have conveyed that ECT saved their life and was the only thing that helped them after years of suffering.

— Leela R. Magavi, MD

With these experiences during the pandemic, Magavi explains that some individuals may have fared particularly poorly during this time without ECT treatment due to familial stress, limited social support, lack of therapy, etc.

Magavi says, "Some of the patients I evaluate with severe depression, bipolar disorder, OCD and suicidality have conveyed that ECT saved their life and was the only thing that helped them after years of suffering."

What This Means For You

As evident from this research, ECT treatment disruption has negative and even fatal repercussions for patients with severe mental illness. It is why Maixner says, "Despite the stigma and misunderstanding of ECT, the public and medical/hospital administrators need to understand the importance of ECT and not consider it some archaic or dangerous treatment, but instead a vital lifesaving treatment that should not be withheld for a pandemic or otherwise."

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

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  1. Maixner DF, Weiner R, Reti IM, et al. Electroconvulsive therapy is an essential procedureAm J Psychiatry. 2021;178(5):381-382. doi:10.1176/appi.ajp.2020.20111647