This policy identifies ECT requirements specific for the following: This policy does not describe additional requirements specific to persons eligible for regional center services who may require ECT for a mental disorder (17 CCR § 50801 et seq.). This policy does not cover additional requirements for regional center clients (17 CCR § 50830). ECT services shall not be provided to any minor under the age of 12. The decision to recommend the use of ECT is derived from a risk/benefit analysis for the specific client. This analysis considers: -
Diagnosis of the client -
Severity of the presenting illness -
Client's treatment history -
Urgency for and fast-acting efficacy of ECT -
Medical risks -
Anticipated adverse side effects The following must be in place prior to consideration of ECT: -
Evaluation by a licensed psychiatrist that demonstrates severe symptomatology consistent with a Diagnostic and Statistical Manual (DSM) 5 primary diagnosis known to be responsive to ECT, including major depression, bipolar, mania, schizophrenia, or related psychotic disorder. -
There is an urgent need for a fast-acting efficacious treatment. -
At least two (2) adequate trials of pharmacotherapy have failed to relieve symptoms. -
The client demonstrates a significant risk to self or others. - The client is at significant risk of recurrence of a major mental illness that was successfully treated with ECT in the past.
- There is an agreement from the outpatient treating physician and an outpatient consulting physician that ECT is the treatment of choice for this client.
The ECT treating physician shall document that there is careful monitoring of mood, psychosis, cognitive factors, and physical symptoms between treatments. All outpatient ECT shall require prior authorization from DMH. The standard number of ECT sessions per client shall be: ECT services for minors 12 to 17 years of age may be considered if all requirements specific to involuntary clients and clients under guardianship or conservatorship have been met along with the following: - It is an emergency situation and ECT is deemed a lifesaving treatment.
- The need for and appropriateness of treatment are unanimously certified by a review board of three (3) board-eligible or board-certified child psychiatrists appointed by the local mental health director.
ECT services for minors ages 16 to 17 can be considered if they are voluntary clients. ECT treatment shall be discontinued when: - Consent for treatment is withdrawn.
- It has been determined that involuntary ECT is not a valid legal option.
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The client is not making progress towards treatment goals and ECT is not required to maintain the current level of functioning. -
The client’s physical or psychiatric condition necessitates discontinuation of ECT. When the client can be safely maintained and effectively treated with a less drastic treatment, they shall be excluded from consideration for ECT. |