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The Practice of Electroconvulsive Therapy in US Correctional Facilities

A Nationwide Survey

Surya, Sandarsh MBBS*; McCall, W. Vaughn MD, MS*; Iltis, Ana S. PhD; Rosenquist, Peter B. MD*; Hogan, Elizabeth MD*

doi: 10.1097/YCT.0000000000000263
Original Studies

Objectives There are little data regarding the practice of electroconvulsive therapy (ECT) in correctional settings in the United States. A survey was conducted to study the current practice of ECT in US prisons. We hypothesize that ECT is underutilized in the correctional setting. We also review the ethical aspects of using ECT for the treatment of mental illness in the prison population.

Methods A 12-question survey via a Survey Monkey link was emailed to chiefs of psychiatry, or the equivalent, of each state's department of corrections. We examined the frequency of Likert-type responses, tabulated individual comments for qualitative review, and grouped for comparison.

Results Email contacts for chiefs of psychiatry, or the equivalent, for the department of corrections in 45 states (90%) were obtained and a survey link was sent. Thirty-one (68.9%) of 45 responded to the survey. Respondent estimates of the number of inmates with mental illness in 31 prison systems varied from less than 500 to more than 4500. Of these 31, 12 (38.7%) had more than 4500 inmates with mental illness. Four systems reported the use of ECT within the last 5 years. Of those, one reported use in the last 1 to 6 months, and 3 reported use in the last 2 to 5 years. Of these 4 prison systems, all felt that they had up to 10 patients who would benefit if ECT continued to be offered or became available in the future. None of these systems provided ECT within the prison. The inmates were referred to a local state psychiatric facility, a university hospital, or other institutions. The reasons for not using ECT as reported by the respondents are grouped under subheadings of stigma, ethical concerns, logistical concerns, and others.

Conclusions Considering the high prevalence of mental illness in prisons, one might expect a high prevalence of ECT responsive mental illness and, hence, provision of ECT to some prisoners with mental illness. However, our survey suggests that the use of ECT in prisons in the United States is low. Stigma, ethical concerns, and logistical concerns were the main hindrances for providing ECT to prisoners with mental illness. Given that ECT is the standard of care in certain clinical scenarios, physicians are obligated to offer such treatment to inmates when necessary. It can be argued that failure of the prison to offer the standard of care is unethical and unconstitutional.

From the *Department of Psychiatry and Health Behavior, Medical College of Georgia, Georgia Regents University, Augusta, GA and †Department of Philosophy and Center for Bioethics, Health and Society, Wake Forest University, Winston-Salem, NC.

Received for publication March 24, 2015; accepted June 10, 2015.

Reprints: Elizabeth Hogan, MD, Department of Psychiatry and Health Behavior, Medical College of Georgia, Georgia Regents University, 997 St, Sebastian Way, Augusta, GA 30912 (e-mail:

Dr Surya received scholarship from American Psychiatric Institute for Research and Education. Dr McCall received a consultation fee from Merck, payment for lectures (including services as a speaker for Global Medical Education CME), expert testimony for various law firms, grants/pending grants from National Institute of Mental Health and American Foundation for Suicide Prevention and royalties from Wolters Kluwer. Dr Iltis, Dr Rosenquist, and Dr Hogan have no conflicts of interest to report.

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