To investigate ECT use, independent researchers submitted Freedom of Information requests to all ECT providers across the UK. Responses revealed people living near certain ECT providers were 47 times more likely to receive ECT than people receiving psychiatric care near other ECT providers. Lead researcher, Professor John Read stated "the probability of getting ECT seems to be a postcode lottery based on the personal opinions of one or two local psychiatrists. Such regional variation is found within other countries and also between countries."

Additional auditing problems arose when rather than answering questions frankly with information specific to their ECT use, 12 ECT providing hospitals (known in the UK as "Trusts") omitting critical information specific to treatment outcomes at their facilities by responding to survey questions using "identical sentences to each other, verbatim, in response to one or more questions," answers copied and pasted from data provided by the Royal College of Psychiatrists.' 

An audit of American ECT providers revealed a 34% increase in the number of hospitals providing ECT since 2018. If there's such a dichotomy of ECT use in the UK, how does ECT use differ across American hospitals? We know one hospital in Southern California reported providing 4,055 treatments in 2017. How does that differ across ECT providers internationally?

We recognize that until something is measured, it is not properly valued. We value the lives of people receiving ECT.

In discussing ECT, we acknowledge there are patients who feel ECT helped them. Our object is not to deny personal experiences. Like airline safety regulators who ensure safety of all travelers, investigating crashes to improve all travelers' safety, we feel investigating ECT use and routinely providing comprehensive assessments for every severe adverse event will reduce risks of "permanent brain damage" as acknowledged by Thymatron device manufacturers in their 2018 Regulatory. Given a now formally recognized universal omission of routine comprehensive screening for severe adverse effects, "The absence of evidence is not evidence of absence." Shifting framework to assess negative outcomes improves all outcomes.

It's time to prioritize patient safety by standardizing ECT use, standardizing informed consent materials based on the most recent manufacturers' user manual updates, providing appropriate comprehensive assessments to every ECT recipient for every severe adverse effect listed in device manual warnings and provide brain injury rehabilitation as indicated.

For the full text of the UK audit report: A second independent audit of electroconvulsive therapy in England, 2019: Usage, demographics, consent, and adherence to guidelines and legislation