The Practice of Electroconvulsive Therapy in US Correctional Facilities

Abstract

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.

Electroconvulsive therapy use in the adult U.S. correctional setting: A case report and literature review

“…ECT is potentially an underutilized treatment modality for jail and prison inmates. A 2015 study of 45 state prison systems revealed that only four prison systems had referred inmates for ECT within the last five years (16). One had referred inmates for ECT in the last one to six months, whereas three prison systems had referred for ECT only in the last 2-5 years.…”

“…Other reasons given for the underutilization of ECT in the jail and prison system include stigmatization of ECT, ethical concerns regarding ECT in inmates, and logistical issues such as informed consent, transportation to ECT, and staffing concerns (16). Williams and Arvidson developed a protocol to help correctional providers navigate the ECT process (18).…”

“…The inmate will then need to be transported to a community setting for pre-ECT evaluation (19). This seems reasonable as the few prison systems that provided ECT to inmates had no facilities or equipment within the prison (16). Inmates can be transported to a nearby state psychiatric facility, a public hospital, or a private medical facility for the pre-ECT assessment.…”

“…The ECT psychiatrist will review the ECT referral and make the final decision on whether the inmate is suitable for ECT. When correctional staff were surveyed on the reasons ECT was not offered in their state prison system, stigma of the treatment and concern about coercion of patients were among the reasons given (16). Therefore, it is imperative that the final decision on ECT provision is made by the ECT psychiatrist, who is outside the correctional system.…”

The experience of electroconvulsive therapy and its impact on associated stigma: A meta-analysis

“…In addition to its efficacy, ECT may work faster than medication (Spaans et al, 2015) and is used as a primary treatment for some psychiatric conditions (reviewed in Higuchi, 2010). However, ECT may be one of the most stigmatized therapies in the field of psychiatry (Payne & Prudic, 2009) and may be underutilized despite its demonstrated efficacy and safety (Dowman, Patel, & Rajput, 2005;Surya, McCall, Iltis, Rosenquist, & Hogan, 2015).…”