Involuntary electro-convulsive therapy to restore competency to stand trial: a five year study in New York State.

As a result of the recent United States Supreme Court case of Riggins v. Nevada, lower courts are likely to review if, and under what conditions, pretrial criminal defendants may be treated involuntarily with antipsychotic medication. It may also be time to re-consider the similar use of electro-convulsive therapy (ECT), if indeed it is still being used in this context. This is the first known recent study to determine the frequency of ECT among incompetent defendants. Records from the two forensic psychiatric facilities in New York State that receive over 95% of all indicted felony offenders who are incompetent to stand trial were retrospectively reviewed for a five year study period. All requests to the court for authorization for involuntary treatment with ECT were sought. In the study period, out of approximately 1365 total persons committed, there was one case of a request to the court to administer involuntary ECT to an incompetent defendant. This request was granted after a Rivers hearing. This single case, in which involuntary ECT was not effective, is described. This study serves to demonstrate that involuntary ECT is still requested and administered in New York State to incompetent defendants. In light of the concerns raised in Riggins about involuntary medication, it seems reasonable and necessary to re-consider whether and under what conditions ECT should be involuntarily administered to a pre-trial defendant. Several recommendations are suggested.