Table 2.

Key themes and subthemes identified from focus groups directly relating to ECT

Theme	Subtheme	Key quotes
Benefits	Life-saving nature	“ECT is a life-saving therapy.” “It works; it works wonders.”
	Evidence base	“We have robust data to say that unmodified ECT is safer than modified ECT, which is safer than antidepressants.” “We shared data from our institute that we have been using ECT for the last 60 odd years.”
	Vignette or personal story	“Every time he has mania, the only thing he responds to is ECT … But in a manic phase, he will refuse. But after a couple of sessions of ECT, he comes back to himself. Nothing works with him except ECT.”
	In severe cases	“We have to take permission from them [MHRBs], but the patient is violent and highly suicidal. It will take a lot, maybe three to four days.”
Minors	Prohibition	“This Act doesn’t allow it.”
	MHRB role	“They have talked about minors. You need to go to the District Review Board; Fine if you win the review.” “The Review Boards - Who knows what they’re actually going to advise on, what they’re actually going to do.”
Unmodified ECT (i.e., without anesthetic)		“Even in a set up like this, we have serious problems getting an anesthetist because there is a paucity of anesthetists.” “And we have not seen any significant problems with unmodified ECT. In fact, we can say that in many aspects it is better than the modified ECT.”
Acute phase	Emergency treatment	“Of course, there are institutions and psychiatrists who do give ECT within the first 24 h; Now, under the [new legislation], that cannot happen.”
	Early in admission	“That is our concern there: that ECT will be less used and particularly when there is a definite need in terms of emergency.” “You can treat for 72 h, and we are not allowed to give ECT in those 72 h.”

ECT - Electroconvulsive therapy, MHRB – Mental Health Review Board