Australian child and youth psychiatrist James Scott, MBBS, believes that electroconvulsive therapy (ECT) can be lifesaving for some unwell patients, including minors. His view has been shaped partly by his years working on mental health wards. As the director of Ramsay Health Youth Service at New Farm, Queensland, a private 120-bed inpatient unit for youth, Scott says that mental health facilities for young people are “a paradise” compared with adult wards, which he has experienced while visiting a mentally unwell sibling. 

ECT is performed in hospital under general anaesthesia usually for 8-12 sessions. “There are some people who have a mental illness which is truly life-threatening. For such illnesses, it can cause immense distress and result in death if untreated,” Scott told Medscape News Australia. “For these patients whom we look after in public and private clinics without ECT, it’s hard to get them well. It would be months and years in hospital without ECT. ECT has a role when other treatments don’t work.” 

Fears about ECT are unwarranted, Salam Hussain, MBChB, chair of the Royal Australian and New Zealand College of Psychiatrists Section of ECT and Neurostimulation, told Medscape News Australia. “ECT is one of the most effective treatments we have for severe depression and some other serious mental illnesses. 

“Much of the public understanding of ECT has been shaped by outdated, dramatic, and often inaccurate portrayals in film, television, and popular culture,” he said. “Modern ECT is different. We urge journalists to report accurately and responsibly on ECT and not to reinforce outdated or stigmatising narratives that may prevent people from accessing safe and effective care.” 

Australia the Outlier? 

It is unknown how many patients in Australia undergo ECT for severe mental illness (including treatment-resistant depression, psychosis, mania, schizophrenia, and catatonia) as it’s performed in both the public and private sectors. Between July 2024 and June 2025, 27,921 Medicare-funded ECT treatments were given. 

The use of ECT is declining in many other countries. In the United Kingdom, ECT use decreased by 90% between 1985 and 2015. But researchers have found that its use in Australia increased by 87% between 2005 and 2015, including by 191% in Western Australia. 

Researchers have speculated that the increase could be the result of improvements in ECT monitoring and the uptake of right unilateral treatment, which has contributed to increased acceptability and use.

But some experts raised concerns with Medscape News Australia about the involuntary use of ECT. 

A recent investigation found that in 2023-2024, at least 1700 mandatory ECT orders were approved in Australia. The true number is likely significantly higher because some states do not measure or report approvals. 

Recent research, in which Scott collaborated, on ECT use at Royal Brisbane and Women’s Hospital found that the rate of voluntary ECT had declined from 44.9% in 2009 to 16.3% in 2020. 

Scott speculated that the increase in involuntary ECT could result from politics in Queensland, where patients under an earlier Mental Health Act were leaving the hospital and where police have been called to find them. 

“At that time, there was a directive that all psychiatry hospitals in the public sector had to have their doors locked. What that meant was that people didn’t want to stay in hospital: they were locked in wards. Clinicians had to make the situation work the best they could,” he said. 

Human Rights Concerns 

In most Australian jurisdictions, if a person is unable to provide informed consent, approval by a mental health tribunal must be obtained. Bernadette McSherry, PhD, emeritus professor at Melbourne Law School at the University of Melbourne, was a commissioner at the 2019 Royal Commission into Victoria’s Mental Health System, which recommended that compulsory treatment be used only as a last resort. 

The Commission’s final report quoted the chief psychiatrist, who said that “systemic, environmental, staff-related, and clinical issues” could underlie the overuse of compulsory treatment, including ECT. 

“That remains salient as to why some services overuse compulsory ECT. There are checks and balances, but sometimes there is a gap between what human rights law requires and everyday practice,” McSherry said. 

ECT use should be suspended until its effectiveness is established, Tim Wand, PhD, professor of nursing at the University of Wollongong, New South Wales (NSW), told Medscape News Australia. Wand has worked in emergency mental health for more than 25 years. 

“The United Nations is calling out to stop people being forced to have ECT. At the very least, we need to pause its use until we can establish once and for all its effectiveness. If it is going to continue, no one should receive it involuntarily,” he said.

“But in our mental health system, you’re only voluntary if you agree with the psychiatrist’s diagnosis and treatment. If ECT is so lifesaving, why is it declining in so many countries? If it’s so brilliant, it would be used everywhere, rather than being on the decline.”

Wand and his colleagues recently undertook an audit of ECT patient information sheets used in local health districts in NSW. They found that the “risks of ECT were downplayed as minimal and largely temporary, while benefits were touted as ECT providing the fastest, safest and most effective ‘life-saving’ treatment.” They found that sections on risks often only included death, despite other widespread and well-known adverse effects. 

“Patients are being given exaggerated information about ETC’s effectiveness and limited information about the adverse side effects, but the positive impacts are talked up. I’m convinced they’re agreeing to have ECT based on misinformation,” he said. 

The Patient’s Perspective 

But a psychiatrist’s decision to recommend ECT is never taken lightly, said Hussain.

“Psychiatrists must carefully weigh the potential benefits and risks of ECT against the very real risks of leaving a severe mental illness untreated, including ongoing suffering, deterioration, suicide risk, physical decline, and loss of function,” he said. “Wherever possible, ECT should proceed with the informed consent of the person receiving treatment.” 

In 2023, the WHO and the Office of the UN High Commissioner for Human Rights published guidance saying that if permitted, “ECT must only be administered with the written or documented, free and informed consent of the person concerned. International human rights standards clarify that ECT without consent violates the right to physical and mental integrity and may constitute torture and ill-treatment.” 

Scott doesn’t agree with banning its involuntary use. “There are so many times when the sort of patients I’ve described, those with severe illness, don’t have insight into the fact they’re unwell and can’t consent. Their souls die if they don’t get treatment.” 

He said his youngest patient to have ECT was 11 years old. The patient had severe catatonia and made a full recovery after ECT, he said. 

The WHO and the UN, however, stated that ECT was “not recommended for children” and that it “should be prohibited through legislation.” Western Australia and the Australian Capital Territory have banned the use of ECT on children younger than 14 years and 12 years, respectively. 

The lived experience of those who have undergone ECT has traditionally been excluded in favour of biomedical approaches, Karen Wells, PhD, research assistant and lived experience educator at the Faculty of Medicine and Health at the University of Sydney, told Medscape News Australia. 

Wells, who has undergone ECT herself and experienced memory loss and cognitive challenges as a result, said that such issues were minimized in the literature when acknowledged at all.

“It cannot be assumed that clinicians, researchers, and policymakers understand and can speak for people with lived experience,” she said. “My goal is to illuminate and validate the experience of other people who have had ECT and, through the wisdom of lived experience, identify and promote strategies that people can try to manage the impacts.”

Wells would like to see far more investment in Australia’s mental health system. She calls for tailored, individualised support rather than relying on biomedical solutions. “This will minimise involuntary treatments across the board,” she said.

Scott, Hussain, McSherry, Wand, and Wells reported no relevant financial relationships.