This project will provide the Director of CMHS with a background paper advising him of the current major concerns and criticisms of electroconvulsive therapy (ECT), and identifying gaps in knowledge and differences in points of view among the medical, legal and lay/patient communities. The background paper will recommend steps for CMHS to take to address the identified gaps and differences (such as the possibility of convening a consensus conference on the topic similar to the 1985 NIMH Consensus Project.) It will provide information on which CMHS can base communications to potential patients and their families to assist them in making informed decisions regarding the use of ECT.

Within approximately nine weeks, Research-Able, Inc. and the Policy Resource Center will complete the following major tasks:

• Summarize the major areas of concern raised by consumers and others since 1985 regarding the validity of research on ECT and the extent to which these concerns have been resolved in previously conducted or active research. (Areas of concern will be identified through literature review and by interviewing up to five national and local consumer organizations.) Research questions still to be addressed will be identified.

   

• Review the methodologies of no more than five major studies of ECT since 1985, (determined by the GPO through input from CMHS staff and the Contractor), identifying and summarizing their strengths and deficiencies. Areas for further study will be identified.

  In the performance of these tasks, we will address a number of related research and policy questions:

  Review of Literature

• 1985 NIMH Consensus Project: To the extent that this information is readily available through CMHS, we will answer the question: What were the major findings of the 1985 NIMH Consensus Project and what comments were received from the field?

   

• Summary Literature Since 1985: What does the major summary literature since 1985 have to say about a range of ECT-related topics? (For this, we will use electronic bibliographic databases currently available at the Mental Health Policy Resource Center (PRC) - to include: Dialog and Medline - and will provide CMHS with a source list. The specific topics to be addressed will be determined among the Contractor, the GPO, and CMHS staff.)

  Current Status of the Issue from Multiple Perspectives

   

• Federal: Which Federal agencies are currently involved in ECT and how?

   

• Research: What major research efforts - medical, legal and others - are currently underway regarding the use of ECT?

   

• Consumers: What are the major issues with regard to ECT that have been publicly debated since 1985? How and to what extent have these issues been resolved?

   

• Demographics: What is known about the demographics of persons receiving ECT since 1985? What are the major strengths and limitations of available information to accurately depict the characteristics of this population? (For this, we will use research studies, consumer reports and other appropriate sources.)

   

• Case Law and Judicial Findings: What major case law and judicial findings have there been since 1985 regarding ECT, and are there notable trends? What State laws regarding the use of ECT are referenced in the case law and judicial findings? Should CMHS engage in a full-blown compilation of State laws?

   

• Policy: What major policy directions and practice trends with regard to ECT are suggested by current literature, Federal activities, and research efforts?

  What next steps should CMHS consider initiating or participating in?

  Upon completion of the foregoing, Research-able, Inc., and the Policy Resource Center will meet with the Government Project Officer (GPO) to discuss the conclusions and design the most appropriate presentation for the materials.

  Project Implementation

  Attached is our budget estimate in accordance with the technical proposal. This project is estimated to be accomplished within nine weeks after approval by CMHS of the technical proposal and budget estimate.

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