LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH
  Policy 200.06 Electroconvulsive Therapy
 
  PROCEDURES
  1. Requests for Electroconvulsive Therapy (ECT) shall be submitted to the Managed Care Consulting Physician by the outpatient consulting psychiatrist for authorization accompanied by:
     
    1. Medical records, including a complete assessment of the client and documentation that indicates:
      1. The reason for ECT.
      2. Whether ECT is indicated for this client including a history of at least two prior medication trials.
      3. ECT is the most appropriate treatment modality given the patient's severity of illness.
         
    2. Written and informed consent by the client, conservator, or legal guardian through completion of the Department of Health Care Services (DHCS) ECT Informed Consent (Form 1800).
       
  2. Managed Care consulting psychiatrist shall review all submitted documentation to complete the authorization process.
     
    1. If additional information is needed, the Managed Care consulting psychiatrist shall contact the outpatient consulting psychiatrist for a consult.
       
  3. Once the Managed Care consulting psychiatrist has made a determination of authorization, a decision shall be provided to the outpatient consulting psychiatrist by phone or secure email.
     
  4. If approved, the DMH specialty mental health service (SMHS) linkage staff shall assist with connecting the client to the appropriate ECT treating psychiatrist.
     
  5. If in the judgment of the ECT treating psychiatrist more than the standard number of ECT sessions per client are indicated, prior approval must first be obtained from the review committee of the facility.
     
    1. The ECT treating physician must then submit the information listed below to the Managed Care consulting psychiatrist for review and authorization of additional ECT sessions:
      1. Documentation of the diagnosis.
      2. Clinical findings leading to the recommendation for additional sessions.
      3. Consideration of other reasonable treatment modalities and the opinion that additional sessions pose less risk than other potentially effective alternatives available for the client.
      4. The specified maximum number of additional sessions.
    2. Procedures B - D above shall be followed.
       
  6. Any doctor or facility administering ECT shall report the number of persons who received treatment on a quarterly basis to the Patient’s Rights Office (WIC 5326.15(a)).