Only a few states in the USA collect data on the use of electroconvulsive therapy (ECT). One of them is California, and someone has written a thesis on Californian ECT statistics. In Effects of funding on electroconvulsive therapy in California Anne Marie McKersie, a Masters student of Public Health and Social Work at San Diego University, set out to look at the impact of the Mental Health Parity Act of 1996 on ECT in California:
“The study seeks to understand how this legislation, which increases annual and lifetime dollars for mental health services impacted a high cost behavioral health treatment (ECT) and how trends in the patient demographics changed from 1996 to 2000.”
The thesis reveals that between 1996 and 2000 the use of ECT in California fell by nearly two-thirds from 1,742 people undergoing the treatment in 1996 to 643 in 2000.
The author studied statistics from the California Office of Statewide Health Planning and Development: “Data includes records for each patient discharged from all California acute care hospitals during the years of 1996 and 2000.” I was left a little puzzled by how this could include everyone given ECT in California, although that was the impression given. What, for example, about long-stay patients? But presumably the figures are comparable for 1996 and 2000. The age, gender, and diagnosis of people undergoing ECT changed little over the period. Just over 70 per cent of patients were women. The most common diagnoses were major depression (about 72 per cent) and bipolar disorder (about 17 per cent). The average age of patients was 57. The youngest patient was aged 9. (I thought the use of ECT on children under the age of 12 was prohibited in California). The oldest was aged 98, although patients over the age of 100 had been omitted on the grounds that they would be unlikely to receive ECT. (It has been known, though, for people over 100 years to be given ECT). The proportion of ECT patients funded by private health coverage increased from 20 per cent in 1996 to 44 per cent in 2000.
There were, in both 1996 and 2000, 388 hospitals in California with mental health admissions. 59 of them performed ECT in 1996 but only 15 in 2000.
California has a population of approaching 37 million and therefore, if these figures are correct, had a very low use of ECT in 2000. Psychiatrists often say that ECT is given annually to 100,000 people in the United States. ECT is subject to large regional variations, so it is impossible to extrapolate from one state to the country as a whole, but the figures from California do suggest that the 100,000 figure should be regarded with caution. Another claim that is often made for ECT is that it is making a comeback; again the Californian figures do not support this assertion.