Controversial change to CT electroshock therapy law weighed. Debate goes beyond the proposed bill

Hartford Courant – Tuesday, February 18, 2025
By Kaitlin McCallum

The Public Health Committee of the Connecticut legislature is weighing a bill to extend the period of authorization to treat a person with electric shock therapy either with or without their consent.

The bill, which has generated impassioned testimony from both those who support and those who oppose it, would amend the current state statutes to extend the period of authorization for the therapy from 30 to 90 days when consent is given by a patient and from 45 to 90 when ordered by a judge for a person who is considered unable to give consent.

What is ECT?

Like many psychiatric treatments, the mechanism of action for electric shock therapy — or electroconvulsive therapy — is not well understood. The therapy involves using controlled electrical shocks to the brain to trigger a seizure. The brain responds by releasing chemicals that are thought to reset pathways or create new connections.

Yale Medicine explains: “ECT was developed in the late 1930s by an Italian neurologist named Ugo Cerletti, who saw that patients in sanitariums … who also had epilepsy seemed to experience mood improvements following their seizures.” Cerletti reportedly found success in treating depression by replicating the effect using electrical currents to induce mild seizures.

According to Yale New Haven Health, the treatment “can significantly reduce or reverse symptoms of severe depression, depression with psychosis and other mood or psychotic symptoms when used appropriately.”

“ECT remains the gold-standard and the most effective treatment for many psychiatric disorders,” according to Yale.

Hartford HealthCare’s Institute of Living, which also offers the treatment, said ECT is “the fastest option to help restore the quality of life for a patient suffering with severe depression.”

ECT is used to treat severe depression, usually after other treatments have failed, as well as bipolar disorder and catatonia.

Under existing Connecticut statutes, ECT can be ordered without a person’s consent under certain conditions: “If it is determined by the head of the hospital and two qualified physicians that the patient has become incapable of giving informed consent, shock therapy may be administered upon order of the Probate Court if, after hearing, such court finds that the patient is incapable of informed consent and there is no other, less intrusive beneficial treatment.”

In recent years, the stigma around the treatment, created both by negative connotations in popular media and by negative experiences with earlier application, has lessened, according to Dr. Robert Ostroff, medical director of the Mood Disorders Unit and co-medical director of the Interventional Psychiatry Service at the Yale Psychiatric Hospital.

In particular, anesthesia and muscle relaxants now common in ECT, were not used in treatment until the 1960s.

“Modern ECT is much safer and more controlled, with rigorous guidelines and patient consent protocols in place,” Ostroff said. “ECT is a treatment that is very burdened by bad publicity and public perception. Our best estimate is that half of the people who could benefit from having ECT are not getting it because of these factors.”

While lower electrical currents used today cause fewer cognitive side effects that in the past, the procedure is still known to cause mild short-term memory loss, according to Yale.

What’s the argument for changing the statute?

Those in favor of a longer authorization period argue it would offer convenience and ease the burden on families having to seek continual authorization from the probate court, as well as reducing the likelihood of delaying treatment due to the administrative process. Supporters, including medical professionals and probate judges, have also testified to the effectiveness of ECT.

“ECT is a life-saving treatment and is only used as a last resort for our most ill patients. Some patients who are especially ill require ECT chronically to maintain functioning or require ECT intermittently and suffer increased morbidity and mortality awaiting ECT judgments,” testified Dr. Sophia Walker, a psychiatrist at Silver Hill Hospital.

Dr. Javeed Sukhera, chair of psychiatry at the Institute of Living, called ECT “too often misunderstood and yet remains essential for some of Connecticut’s most vulnerable patients” in testimony submitted to the committee.

“ECT has been stigmatized, but the reality is simple: ECT saves lives. It is not a first-line treatment, nor is it used lightly. It is reserved for rare and severe cases—patients suffering from intractable depression, catatonia, or other conditions that make them unable to eat, drink, or function. Without intervention, these patients can rapidly deteriorate, facing dehydration, malnutrition, and life-threatening complications,” Sukhera wrote, noting endorsements from the American Psychiatric Association, the American Medical Association, the National Institute of Mental Health and other health organizations.

The issue is of timing, he wrote.

“Currently, the probate court process creates significant barriers for patients who desperately need ECT. These include individuals who have been voluntarily admitted to the hospital but are so severely ill that they can no longer consent to treatment. Their families, along with their doctors, recognize that ECT is their best chance for recovery, yet in our current system, administrative delays create tangible harm that we have the power to prevent. …We cannot stand by and watch patients suffer due to unreasonable administrative delays.”

Dr. Lakshit Jain, psychiatrist at Connecticut Valley Hospital, wrote that patients may experience a recurrence of symptoms if maintenance treatment is disrupted by delays in renewing authorization.

“Like CVH, most hospitals do not have the facilities to provide ECT on site, and once a court order has been received it takes 1-2 weeks to set up ECT appointments so that the patient can start receiving ECT. It takes around 7-12 sessions of ECT in order for the patients to start experiencing relief from symptoms, and the 45-day time duration often is not long enough,” Jain wrote.

Farmington Regional Probate Judge Evelyn Daly shared her story of authorizing ECT for the first time as a new judge 18 years ago. She had reservations from having seen “One Flew Over the Cuckoo’s Nest,” she said, and insisted on observing the procedure, which she found to be “incredibly rapid,” at John Dempsey Hospital.

Her first case involving ECT was that of “Helen” an elderly woman with a diagnosis of malignant catatonia and a bleak prognosis, Daly wrote.

“Medical testimony explained that she would die if she continued much longer in this catatonic state. I ordered the ECT treatment. Several weeks later, when I returned to John Dempsey’s psychiatric ward, ‘Helen’ approached me. She was now walking, talking, and smiling and she said something to me I will never forget: ‘Thank you for saving my life.’”

Daly wrote, too, of a young man with Down syndrome compounded with disintegrative syndrome whose family must seek permission for maintenance ECT every 45 days.

“When treated with ECT every 7 to 9 days, ‘Jaime’ is a joyful, gregarious, and higher functioning young person. … Without ECT treatment, “Jaime” suffers from both bladder and fecal incontinence. They are prone to violent, uncontrollable outbursts and are unable to participate in activities of daily living. With electro-convulsive therapy every 7 to 9 days, ‘Jaime’ functions very differently. They toilet properly, have a good rapport with family, and participate in a day program where they have many friends.

“To a family already burdened with these hardships, I believe having to seek Court permission and go through all the statutory requirements to be granted authority for ECT treatment every 45 days is unfair and unnecessary. Extending the statutory time frame to 90 days is only sensible for “Jaime” and his family. It is important to note that the 90-day extension only affects some ECT patients, but would help lift their burden immensely,” Daly wrote.

What do those opposed say?

Disability rights and civil rights groups have argued against extending the authorization period, saying the bill would erode patients’ rights. They also tend to argue against the safety and effectiveness of electroconvulsive therapy.

Kathy Flaherty, executive director of Connecticut Legal Rights Project, in written testimony questioned why, if one course of ECT was not effective, it would continue to be performed, and whether it worked in the first place.

“It is far from clear that electricity applied to the brain treats a medical biological problem with the brain tissue,” she wrote.

Rather, Flaherty argued for a higher burden of proof that ECT is needed, an automatic stay of treatment order when authorization is appealed and a requirement of informed consent, rather than relaxing the authorization procedure.

“The current statute is being challenged in court as unconstitutional because it does not require the appointment of counsel, does not require clear and convincing proof and does not provide for appointment of a conservator to go through the full informed consent process weighing the benefits against the risks of shock therapy. Maintaining the 45-day limit on a shock order is the least the legislature can do. I urge you to reject this bill.”

Connecticut Legal Rights Project, a nonprofit that provides legal services to low-income people with psychiatric disabilities, represents people who are the subject of shock orders, Flaherty said.

Thomas Behrendt, counsel emeritus of the Connecticut Legal Rights Project, also urged the legislature to reject the bill and instead strengthen “safeguards protecting vulnerable disabled individuals.”

“With a powerful electrical current applied to the patient’s brain, inducing a “grand mal” seizure and resultant memory loss, ECT is uniquely invasive of bodily integrity and individual liberty … and we strongly oppose any attempt to loosen these protections,” Behrendt said.

Thomas Burr, public policy manager of NAMI, said the organization also is concerned about protecting the rights of disabled people.

“We should not diminish this safeguard for the sake of convenience,” he wrote. “These time limits have been in place for decades and work. There are ways to ensure that in the case of maintenance shock therapy, that hearings are timely requested and scheduled so that treatment does not get meaningfully disrupted. But for the vast majority of people subject to shock therapy, the existing time limits are an important protection and should be continued.”

Other electric shock bills

Two other bills on electroshock therapy have been proposed this legislative session. S.B. 1070, submitted by Sen. Catherine Osten, seeks to prohibit the administration of shock therapy without the patient’s written informed consent. H.B. 6167, from Rep. Roland J. Lemar, would require a stay of execution of a probate court order authorizing electric shock therapy if an appeal has been submitted.

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