<Tr> <Td> </Td> <Td> This section needs expansion . You can help by adding to it . (June 2017) </Td> </Tr> <P> Procedures for involuntary ECT vary from country to country depending on local mental health laws . </P> <P> In the US, ECT devices came into existence prior to medical devices being regulated by the Food and Drug Administration; when the law came into effect the FDA was obligated to retrospectively review already existing devices and classify them, and determine whether clinical trials were needed to prove efficacy and safety . While the FDA has classified the devices used to administer ECT as Class III medical devices, as of 2011 the FDA had not yet determined whether the devices should be withdrawn from the market until clinical trials prove their safety and efficacy . The FDA considers ECT machinery to be experimental devices . In most states in the US, a judicial order following a formal hearing is needed before a patient can be forced to undergo involuntary ECT . However, ECT can also be involuntarily administered in situations with less immediate danger . Suicidal intent is a common justification for its involuntary use, especially when other treatments are ineffective . </P> <P> Until 2007 in England and Wales, the Mental Health Act 1983 allowed the use of ECT on detained patients whether or not they had capacity to consent to it . However, following amendments which took effect in 2007, ECT may not generally be given to a patient who has capacity and refuses it, irrespective of his or her detention under the Act . In fact, even if a patient is deemed to lack capacity, if they made a valid advance decision refusing ECT then they should not be given it; and even if they do not have an advance decision, the psychiatrist must obtain an independent second opinion (which is also the case if the patient is under age of consent). However, there is an exception regardless of consent and capacity; under Section 62 of the Act, if the treating psychiatrist says the need for treatment is urgent they may start a course of ECT without authorization . From 2003 to 2005, about 2,000 people a year in England and Wales were treated without their consent under the Mental Health Act . Concerns have been raised by the official regulator that psychiatrists are too readily assuming that patients have the capacity to consent to their treatments, and that there is a worrying lack of independent advocacy . In Scotland, the Mental Health (Care and Treatment) (Scotland) Act 2003 also gives patients with capacity the right to refuse ECT . </P>

Medication and electroconvulsive therapy are both types of