Electro convulsive therapy (ECT) is an approved evidence-based intervention and in many cases is a critical service that should be regarded with the same parity as a life-saving intervention in physical health care. The delivery of ECT occurs with support from an anaesthetist either in a dedicated ECT suites within mental health services or from theatre space in general hospitals.

The individuals who require this intervention are likely to have a life-threatening mental health condition including severe depression, severe depression with high suicidal risk, a severe eating disorder with secondary depression, depressive stupor, postpartum psychosis, catatonia or severe intractable mania.

As the COVID-19 pandemic has progressed there have been concerns about the potential for the provision of ECT to be limited or curtailed due to the reduction in availability of staff including anaesthetists, lack of theatre space, lack of adequate PPE supply, the suitability of ECT suites in relation to space available for donning and doffing of PPE and the ventilation requirements to carry out the procedure.

Delay or lack of provision of ECT in urgent cases with severe mental illness can result in further deterioration in mental state with high risk of self-harm, prolonged admission and compromised medical comorbidity.

Considerations

• Where services are challenged due to availability of resources to deliver ECT, mutual support arrangements should be negotiated with other services to support each other and offer a level of provision.
• It may be important to prioritise ECT services for the most urgent cases and take steps to ensure that those in most need are able to access ECT.
• Clinicians could also explore alternatives to ECT such as switching to antidepressant treatments, consideration of high dose antidepressant medications, augmentation with mood stabilising medication, Lithium or Thyroxine, or exploration of neuromodulation techniques such as Ketamine.

Personal protective equipment during the administration of ECT

• P2/N95 respirator for unknown, suspected or confirmed COVID-19 +ve person
• Protective eyewear/face shield
• Gloves
• Disposable fluid repellent gown

P2/N95 masks are more effective than a surgical mask only when fitted correctly and when a seal is maintained.

• See CEC Respiratory Protection Program and education, training, posters and videos for advice on fit checking.
• For general guidance on PPE for mental health staff, please refer to Chapter 4 of the CEC Infection Prevention and Control Manual.
• ECT practice guidelines