ECT is as effective a treatment for mood disorders than any other, and using harder outcomes, such as readmission rate, may be better than others. This paper, a comparison of the readmison rate of the 1.5% who got ECT after admission to a psychiatric ward for a mood disorder with those who did not, is in JAMA psychiatry this week, and I will quote from the discussion.
It is worth noting that the average stay was eight days if you did not have ECT and twenty days it you did not.
To our knowledge, this is the first study to examine how initiation of ECT during inpatient stays in US hospitals affects the likelihood of 30-day psychiatric inpatient readmission in a large, multisite sample of hospital inpatients diagnosed with severe affective disorders. Previous studies have found that treatment with ECT is associated with remission from depressive disorders33 and reductions in mortality in individuals with MDD and posttraumatic stress disorder. The results of the present study add evidence that wider availability of ECT may result in up to 46% fewer inpatient readmissions within 30 days of discharge among individuals with severe affective disorders. The effect of ECT on 30-day readmission risk did not differ significantly by age or race/ethnicity but was relatively larger among men than women and among individuals with bipolar disorder and schizoaffective disorder than among those with MDD.
Despite being an effective treatment for patients with severe affective disorders, ECT is either not available or not used as an inpatient procedure in nearly 9 of 10 US hospitals,10 and there are disparities in ECT’s use based on race/ethnicity and insurance coverage. In this study’s sample, ECT was administered among only 1.5% of inpatients with severe affective disorders. Many factors may contribute to ECT’s inconsistent availability, including clinical recommendations not to use the procedure as first-line therapy, managed care preauthorization requirements, limited graduate medical training in ECT, and public ambivalence toward the ECT procedure and its adverse effects. However, reimbursements that hospitals receive for inpatient treatment with ECT, which, in Medicare, are approximately $310 per treatment, also may provide insufficient financial incentive to offer ECT given the procedure’s indirect costs resulting from longer inpatient lengths of stay, screening required for medical risks, and anesthesia.
In New Zealand, we do not need to concern ourselves with the insurance companies. There is one funder of care, and that is the state. The rate of ECT remains fairly consistant and is lower than in the USA. ECT is mentioned in the local college guidelines. Training in ECT to the point where one can treat without supervision is a mandatory requirement for fellowship (qualification) as a psychiatrist.
And ECT is still not used much.
What is known is that recovery staff and access to anesthesia time are barriers in services with annual, fixed budgets. We probably do not do enough ECT. The last Parliamentary enquiry into ECT was a decade ago, and indicated that ECT should only be used as a last resort.
(This is the link to that report: DBSCH-SCR-3911-5617 )
The recent data suggests this was an error. We should defend treatmnts that work. Against all opposition and prejudice.