Electroconvulsive therapy (ECT) remains the most effective treatment for severe, medication-resistant depression and catatonia, yet access to the procedure is declining across the United States. According to Centers for Medicare & Medicaid Services (CMS) data, ECT services billed to Medicare dropped by 50% between 2013 and 2024, leaving patients like Marina Brown in a systemic “Catch-22” where life-saving care is often unavailable due to provider shortages, institutional stigma, and fragmented healthcare networks.
Why is access to ECT declining in the American West?
Regional disparities in mental healthcare access are stark, with the American West lagging significantly behind the Midwest and Northeast. According to an analysis by Willamette Week, Oregon ranks 49th in the nation for the number of Medicare beneficiaries receiving ECT per capita. Dr. Mohamad Matout of Stanford Health Care attributes this decline not to a lack of clinical evidence, but to a “reserve that cannot be explained rationally.” While providers in Maine are 12 times more likely to administer the treatment than those in Oregon, many Pacific Northwest health systems—including Legacy Health and Providence Health & Services—have either discontinued their programs or lack the necessary staffing to maintain them.
Despite the modern use of anesthesia and muscle relaxants, public perception of ECT is still heavily influenced by Ken Kesey’s 1975 film One Flew Over the Cuckoo’s Nest. Experts like Dr. Anna Borisovskaya note that this cultural stigma often discourages clinicians from specializing in the field.
How does catatonia complicate modern psychiatric care?
Catatonia is a severe psychiatric disorder that often mimics dementia, leading to misdiagnoses that can be fatal if left untreated. For Marina Brown, an 83-year-old patient, the path to a correct diagnosis involved months of hospital stays and a broken hip. According to her son, Nick Brown, a child psychiatrist, the medical system frequently treats catatonic patients with skepticism rather than urgency. While a high dose of the anxiety drug Ativan provided temporary relief, the long-term solution for such cases is often ECT. However, as demonstrated by the Brown family’s experience at Oregon Health & Science University (OHSU), hospitals often cite “ethical tensions” or “logistical” risks—such as a previous brain bleed—as reasons to withhold the procedure, even when families and external specialists argue the benefits outweigh the risks.
What are the future trends for psychiatric intervention?
The future of ECT may depend on the willingness of academic medical centers to treat “high-risk” patients who have been turned away by smaller regional hospitals. Dr. Nicholas Telew, who has practiced ECT in Oregon since 1991, emphasizes that teaching hospitals have a duty to handle complex cases that community clinics cannot. As new neural stimulation treatments emerge, the industry is moving toward more refined, targeted approaches. However, the current trend suggests that without legislative or institutional reform to address the “referral desert,” patients will increasingly be forced to seek care across state lines or rely on legal guardianship transfers to access standard-of-care psychiatric interventions.
Pro Tips for Navigating Psychiatric Care
- Seek Second Opinions: If a hospital refuses a standard-of-care treatment, request a formal referral to a facility in a different health system or state.
- Request Multidisciplinary Reviews: Insist on a case conference involving neurology and psychiatry to evaluate the specific risk-benefit ratio of ECT in cases involving prior brain injury.
- Document Everything: Keep detailed logs of medication responses and patient behaviors to provide clinicians with the longitudinal data necessary to distinguish catatonia from dementia.
Frequently Asked Questions
- Is ECT still considered a “barbaric” treatment?
- No. Modern ECT is a highly controlled, medical procedure performed under general anesthesia and muscle relaxants, making it a safe and effective option for treatment-resistant depression and catatonia.
- Why do some hospitals refuse to provide ECT?
- Refusals are often due to a combination of high resource requirements—including specialized staff and anesthesiologists—and a persistent, systemic stigma that leads many providers to avoid the practice.
- What is the difference between catatonia and dementia?
- Catatonia is a treatable psychiatric state characterized by immobility or agitation, whereas dementia is a progressive neurodegenerative condition. Proper diagnostic workups can distinguish between the two, which is vital for effective treatment.
Have you or a loved one struggled to access psychiatric care? Share your experience in the comments below or subscribe to our health policy newsletter for regular updates on regional medical trends.
Related reading
