Electroconvulsive therapy (ECT) is a highly effective treatment for severe mental illness, yet it remains highly misunderstood.
Pop culture has long portrayed ECT as a painful and primitive therapy of last resort. Think of the famous ECT treatment scene in “One Flew Over the Cuckoo’s Nest.” Frightening images like these have understandably led to negative perceptions about ECT.
“I think it’s pretty accepted that one of the biggest barriers to ECT is stigma,” says Marie Fletcher, RN-BC, BSN, BA, who is leading an ECT educational intervention with funding from The Menninger Clinic’s donor-supported Presidential Research and Innovation Fund.
Fletcher, a nurse with Menninger’s Center for Brain Stimulation, explains that ECT has come a long way. After many decades of improvements, ECT is known as the gold standard for treatment-resistant mood disorders, as well as an effective treatment for other psychiatric disorders, such as mania and some forms of schizophrenia.
During the procedure, a small amount of electricity is applied to the scalp to produce a brief seizure in the brain. Like many other medical procedures, ECT is given to a patient who is under general anesthesia. The patient is asleep, and the procedure is painless. ECT often works when other treatments are unsuccessful.
Yet, despite advancements, ECT stigma lingers among the public and even in the medical community.
“For example, we were working to get a patient’s medical history and physical, which is a required health clearance for patients starting ECT, and their primary care physician said, ‘I can’t believe you’re considering doing that,’” Fletcher says. “For those of us who are aware of what a lifesaving treatment ECT is, this is what we’re up against, and it’s really unfortunate.”
That incident and others inspired Fletcher to apply for funding from the Presidential Research and Innovation Fund to support an educational intervention to improve ECT knowledge and attitudes among nurses and nursing students. Such an intervention was long overdue. When searching the literature, Fletcher found only 16 studies on ECT had been published by nurses in more than 40 years.
“That’s a huge gap, because when you go to any kind of ECT service, nurses are the partners working with psychiatrists and the anesthesiologists to provide care,” Fletcher says. “The nurse is there for patient safety. We’re making sure that all the vital signs are stable, that the patient is safe and comfortable. We need to be publishing what we’re doing.”
Newly motivated, Fletcher worked with the Research department at Menninger and nursing colleagues across the nation to develop a comprehensive intervention that uses live instruction, videos, and a discussion component to take nurses step by step through the ECT process and teach them about its benefits.
Participants took a questionnaire before and after the intervention to measure any changes in attitudes and knowledge about ECT.
“One significant finding was that nurses who completed the educational intervention understood that ECT was no longer a treatment of last resort,” Fletcher says.
Fletcher and her fellow researchers have presented their findings at conferences of the American Psychiatric Nurses Association, Anxiety Disorders Association of America, and International Society for ECT. In the future, Fletcher says she would like to open up the intervention to health care professionals beyond nurses, such as social workers, mental health associates, and psychologists, in order to improve care of patients undergoing ECT, both within and beyond Menninger.
“I’m forever grateful for the donors who made developing the educational intervention possible. For me, the experience has definitely opened the door to understanding how research can change the lives of patients for the better.”