Quebec's i) surveillance of ECT and ii) large urban areas equitable resources allocation indicator

Alain LESAGE1, Simon LAFRENIÈRE2, Simon PATRY2, Chantal MÉRETTE2, Caroline SIROIS3, Carlotta LUNGHI3,4

1Centre de recherche Institut universitaire en santé mentale de Montréal, Montreal, Canada
2Institut universitaire en santé mentale de Québec , Québec , Canada
3Université Laval, Quebec City, Canada
4Universita di Bologna, Bologna, Italy

Electro-convulsive therapy (ECT) remains now a controversial treatment for refractory severe depression. In 2003 the Quebec’s Health Technology agency (now INESSS) conducted an effectiveness and social acceptability assessment at the request of the Ministry of Health. The report confirmed the evidence of short-term efficacy, comparable utilisation rates internationally and regional diverse rates of utilization. It recommended constant surveillance in real life, collaboration with patients’ groups and continued professional development. In 2011, mental health university institutes created a center of excellence on ECT (CEECTQ) to meet some recommendations. Its advisory committee included the College of Physicians, the Patient Ombudsman, Schizophrenia Society’s parents, patient with lived experience with ECT. Reports and papers by INSPQ and CEECTQ showed a decennial decrease in utilisation: in 2017-2018, 1 000 people received ECT, 14,9 persons/100 000 inhabitants; during the same period, each year, over 900 000 persons out of a population of 8 millions inhabitants, received treatment for mental disorders: ECT is an exceptional treatment.



In a paper on schizophrenia and environment Pr Jim Van Os (also ENMESH2024 keynote speaker) discussed the higher incidence of schizophrenia in large urban areas as not due so much to the higher specialist services availability  or drift to downtown. In any case, the prevalence is higher in urban areas and shall better indicate higher costly psychiatric services needs (hospitalisation; long term care facilities; intensive community care). The CCDSS interactive databases for schizophrenia indicate a 1% prevalence in Canada, with higher prevalence in the 3 provinces with large urban cities (Montreal; Toronto; Vancouver). Comparisons of Montreal (25% of Quebec’s population) with the rest of Quebec indicate 50% higher incidence and 60% higher prevalence of schizophrenia. An indicator of need more easily accessible for planning and allocating financial resources for the array of services required by severely mentally ill.