A decade of electroconvulsive therapy for minors under Mental Healthcare Act, 2017: Quo Vadimus

Despite its proven safety and effectiveness, Electroconvulsive Therapy (ECT) is seldom utilized in children and adolescents with severe mental illnesses. Using two clinical case scenarios, we aim to illustrate the influence of the Mental Healthcare Act, 2017 (MHCA 2017), on ECT among children and adolescents in India. Either case required emergency ECT per clinical protocols, but access was denied due to MHCA 2017 restrictions-specifically, the requirement for prior approval from the Mental Health Review Board (MHRB). Data was obtained from clinical records, treating psychiatrists, and legal documentation. MHCA 2017's Section 95 prohibits unmodified ECT and restricts ECT in minors unless guardian consent and MHRB approval are obtained. These provisions resulted in impediment of treatment in our cases, leading to clinical deterioration, prolonged suffering, and heightened morbidity risk. While MHCA 2017 aims to protect patient rights, its rigid, regulatory structure regarding ECT in minors may inadvertently obstruct life-saving treatment in critical cases. These barriers prolong illness, increase risk, and reduce access to effective intervention. Reevaluation of current regulations is urgently needed to ensure a balanced framework that safeguards rights without compromising timely care.