24 March 2022

Sashidharan lauds Trieste's ‘humane, person-centred and effective’ psychiatric services^{Reference Sashidharan1} but omits to mention that, in common with most Italian cities, it has no electroconvulsive therapy (ECT) service.^{Reference Mezzina2} Indeed, only a handful of Italian centres offer the treatment, a lack of provision that has its basis entirely in politics rather than science.^{Reference Buccelli, Di Lorenzo, Paternoster, D'Urso, Graziano and Niola3} Since ECT was first developed in Rome in 1938^{Reference Buccelli, Di Lorenzo, Paternoster, D'Urso, Graziano and Niola3,Reference Gazdag and Ungvari4} and its lifesaving properties promptly recognised, it has been refined and improved to enhance its safety and effectiveness, while a large evidence base has built up to inform its ongoing use.^{Reference Kirov, Jauhar, Sienaert, Kellner and McLoughlin5} An extremely safe treatment, it is undoubtedly the most effective strategy for moderate to severe depressive illness^{Reference Kirov, Jauhar, Sienaert, Kellner and McLoughlin5} and one of the most effective treatments across the whole of psychiatry.^{Reference Gazdag and Ungvari4} Yet, staggeringly, Sashidharan's fellow ideological proponent of the Trieste model of care, Mezzina, has written positively of the lack of access its patients have to ECT, as though this vast gap in service provision were something of which to be proud.^{Reference Mezzina2} This could not happen in any other branch of medicine: it is akin to an oncologist boasting of an inability to provide patients with chemotherapy. It has been convincingly argued that refusal to provide ECT, when clinically indicated, is an infringement of patients' human rights.^{Reference Gazdag and Ungvari4} Indeed, most low- and middle-income countries strive to provide ECT services, even if access is limited owing to minimal resources. A supposedly ‘humane, person-centred and effective’^{Reference Sashidharan1} psychiatric service in western Europe cannot continue to justify denying its patients such a safe and effective treatment.