A recent joint position paper by leading international professional associations—including the World Psychiatric Association (WPA), the American Psychiatric Association (APA), the European Psychiatric Association (EPA), and a global expert group on electroconvulsive therapy (ECT)—strongly criticizes the portrayal of ECT in current recommendations from the World Health Organization (WHO). The position paper has now been published in the journal Lancet Psychiatry.
The professional associations expressly welcome the WHO’s efforts to strengthen a human rights-based, person-centered, and recovery-oriented approach to psychiatric care. At the same time, they express serious concerns that the guidance contains scientifically inaccurate and misleading statements, particularly regarding electroconvulsive therapy. The Central Institute of Mental Health (CIMH) supports this assessment.
ECT: Effective, safe, and essential for severe cases
“The emphasis on patient rights and participation is a significant step forward,” says Prof. Dr. Alexander Sartorius, senior physician at the CIMH and head of a research group. “However, problems arise when established scientific findings are not given sufficient consideration. Especially when it comes to electroconvulsive therapy, we see a portrayal that distorts the risks and fails to adequately reflect the proven benefits.”
“A rights-based, recovery-oriented mental health policy and the use of evidence-based therapies—that is, therapies proven to be effective—should complement rather than exclude one another,” adds Prof. Dr. David Zilles-Wegner, Senior Attending Physician at the Department of Psychiatry and Psychotherapy at UMG and also an author of the position paper. “At best, patient rights include reliable and equitable access to effective treatments such as ECT, which has not always been the case so far.”
Yet Electroconvulsive therapy is one of the most thoroughly studied treatments in psychiatry and has been used successfully for decades. International guidelines and extensive studies confirm its effectiveness, particularly in cases of severe depressive episodes, bipolar disorder, schizophrenia, and so-called catatonic states—that is, severe conditions in which patients are barely able to speak or move.
ECT can save lives
“In cases of treatment-resistant conditions or acute suicidal ideation, ECT can achieve significant stabilization within a short period of time,” says Sartorius. “In many cases, it is not only effective but life-saving.”
The international statement expressly warns against portraying ECT as harmful or imposing blanket restrictions on its use. Such a perspective reinforces stigma and could significantly impair access to evidence-based care for severely ill individuals. Zilles-Wegner emphasizes that there are still many misconceptions and distorted images of ECT circulating in the public consciousness. “However, these have little to do with how ECT is used today. We would therefore expect an organization like the WHO to provide objective information and education about existing therapeutic methods, including ECT.”
A blanket ban on ECT for adolescents raises ethical concerns
Particular attention must be paid to the question of the extent to which ECT may be used in adolescents and in patients who are currently unable to give informed consent. The undersigned professional associations emphasize that a blanket exclusion of these groups is medically and ethically problematic. In rare, clearly defined situations—such as severe depression, catatonia, or life-threatening symptoms—ECT can also be an absolutely necessary treatment option for adolescents.
“What is always crucial is a careful, case-by-case assessment,” explains Sartorius. “If there is an acute threat and other therapies are not effective, it may be ethically justified to use an effective treatment such as ECT.”
Even for patients with impaired decision-making capacity, treatment must be carried out within the framework of established medical ethics standards, taking into account legal representation, the physician’s duty of care, and the goal of preventing harm. “This is all the more true given that ECT is particularly beneficial for patients whose decision-making capacity is impaired due to the severity of their symptoms,” emphasizes Zilles-Wegner. “If ECT alleviates their symptoms, patients are often able to make decisions for themselves again, thereby strengthening their autonomy.” “A general withholding of effective therapies in such situations would contradict the medical mission,” adds Sartorius.
A biopsychosocial approach as the foundation of modern psychiatry
The CIMH emphasizes that modern psychiatry is based on a biopsychosocial model of illness. “Mental illnesses arise from a complex interplay of biological, psychological, and social factors,” explains Prof. Dr. Andreas Meyer-Lindenberg, Director of the CIMH and Medical Director of the Department of Psychiatry and Psychotherapy at the CIMH. “Modern care must take all these dimensions into account, from social support to highly effective medical interventions.” The one-sided focus on social determinants, as evident in parts of the WHO guidance, falls short and does not do justice to the clinical reality of severe illnesses.
For balanced, evidence-based further development
International professional associations are calling on the WHO to base future recommendations more firmly on robust scientific evidence, as well as on clinical experience and the perspectives of patients. “Modern psychiatry needs both: a clear human rights orientation and a solid scientific foundation. Only in this way can we ensure that patients have access to effective, safe, and responsibly administered therapies,” says Meyer-Lindenberg. The Central Institute of Mental Health therefore advocates for a nuanced and evidence-based further development of international guidelines.
Publication
Joint statement by the World Psychiatric Association, the American Psychiatric Association, the European Psychiatric Association, and the Global Expert Task Force on ECT on the portrayal of electroconvulsive therapy in the WHO Guidance on Mental Health Policy and Strategic Action Plans. Lancet Psychiatry. 2026. DOI: 10.1016/S2215-0366(26)00059-3.
https://doi.org/10.1016/S2215-0366(26)00059-3