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Access to Electroconvulsive Therapy Services in Canada

Delva, Nicholas John MD*; Graf, Peter PhD; Patry, Simon MD; Gosselin, Caroline MD§; Milev, Roumen MD; Gilron, Ian MD; Martin, Barry MD#; Lawson, James Stuart PhD**; Enns, Murray MD††; Jewell, Mark BA, RPN‡‡; Chan, Peter MD§

Journal of ECT:
doi: 10.1097/YCT.0b013e318222b1b8
Original Studies
Abstract

Objectives: We sought to determine factors governing access to electroconvulsive therapy (ECT) in Canada.

Methods: We contacted all 1273 registered health care institutions in Canada and invited the 175 centers identified as providing ECT to complete a comprehensive questionnaire. To determine geographic access to ECT, we used a geographic information system, population density data, and road network data. Responses to 5 questions from the questionnaire were used to identify local barriers to access.

Results: Approximately 84% of the population in the 10 Canadian provinces live within a 1-hour drive of an ECT center, but 5% live more than 5 hours’ drive away. There was significant province-to-province variation, with all of the citizens of Prince Edward Island living within 2 hours of an ECT center but 12.5% of those in Newfoundland and Labrador living more than 5 hours’ distance away. There are no ECT services at all in the 3 territories, which contain 3% of the Canadian population. Nongeographic barriers to access included inadequate human resources, particularly, a lack of anesthesiologists, in 59% of the centers; logistical impedances (52%); space limitations (45%); strictures on the hiring of adequate staff (29%); imposed limits to number of treatments or to operating or postanesthetic room time (28%); and a lack of funds to purchase up-to-date ECT or related anesthesiology equipment (14%).

Conclusions: Electroconvulsive therapy is geographically accessible for most Canadians. Even when geography is not a factor, however, there are significant barriers to access resulting from inadequate availability of qualified professional staff, treatment areas, and funding.

Author Information

From the *Department of Psychiatry, Dalhousie University, Halifax; †Department of Psychology, University of British Columbia (UBC), Vancouver, BC; ‡Department of Psychiatry, Laval University, Sillery, Quebec; §Department of Psychiatry, UBC, Vancouver, BC; ∥Departments of Psychiatry and Psychology, and ¶Departments of Anesthesiology, and Pharmacology and Toxicology, Queen’s University, Kingston, Ontario; #Department of Psychiatry, University of Toronto, Toronto, Ontario; **Department of Psychiatry, Queen’s University, Kingston, Ontario; ††Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba; and ‡‡Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada.

Received for publication January 3, 2011; accepted January 26, 2011.

Reprints: Nicholas John Delva, MD, Department of Psychiatry, Dalhousie University, Room 8210, Abbie J. Lane Building, 5909 Veterans’ Memorial Ln, Halifax NS B3H 2E2, Canada (e-mail: delvan@cdha.nshealth.ca).

Funding for this study was provided by the Vancouver Coastal Health Authority, which had no further role in any aspect of the conduct of the study.

The authors have no conflict of interest to declare.

© 2011 Lippincott Williams & Wilkins, Inc.