If you have come to the emergency department for an assessment, you will be taken to a room where you will be assessed by an emergency department nurse and doctor, and an assessment and referral clinician (masters degree level mental health professional).

The clinician will meet with you and anyone who has come with you to assess how severe your crisis is and to determine the right level of care for you. Meeting with the clinician does not mean you will need to stay in the hospital.

If a child or adolescent is being assessed, family and/or guardian involvement is important. A parent and/or guardian must stay in the emergency department during the assessment process.

The time you stay in the emergency department will vary for each person. Staff members are helping a variety of patients who have a number of medical and mental health emergencies. Assessment and referral clinicians often consult with on-call psychiatrists, insurance companies, outpatient providers and other community agencies.

You may be asked some of the following questions.

• What events led up to a visit to the emergency department?
• Have you recently had a loss or death in your life?
• Are financial/employment issues a concern?
• Are financial/employment issues a concern?
• Do you have pending legal issues?
• Is there a family history of abuse, mental illness or substance abuse?
• How often, and in what quantity, do you use alcohol or other drugs?
• Are you a danger to yourself?
• Are you a danger to others?
• Have you ever been physically, emotionally or sexually abused?
• Have you had recent changes in appetite, sleep, hygiene, interests or activities, social interactions, energy or sexual interests?
• What medicines are you taking now?
• Do you have any major health concerns?

Once the assessment is done, a plan will be made to help you receive the right level of care. The possibilities include (but are not limited to):

• admission to the hospital
• transfer to another hospital
• return home with a crisis plan in place
• an outpatient appointment with a mental health provider
• referral to a day treatment or partial hospital stay program
• information about additional resources.

It is important to know that even though you may feel overwhelmed with mental issues or other conflicts, being admitted to the hospital may not be the best solution.

Admission to a hospital is a medical decision made by the emergency department doctor and the on-call psychiatrist.

An assessment and referral clinician will talk with you about your options.

The number of treatments vary for each patient. In general, a patient may receive two to three treatments a week for a total of three to 12 treatments. If you need more treatments after the initial cycle, you and your psychiatrist will talk about a schedule.

ECT is an effective treatment for patients who have:

• all types of major depression (including catatonia, postpartum and psychotic depression)
• bipolar disorder (both depressed and manic phases)
• schizophrenia (It may not work for all patients.)
• delirium and neuroleptic malignant syndrome.

• You will need to get a physical within days of your scheduled treatment. Your doctor will decide when and which lab work and tests you will need.
• Tell your doctor all of your medical conditions.
• Tell your doctor the medicines you take. Include all prescription, over-the-counter, herbal and natural medicines.
• If you are having the ECT treatment as an outpatient:
  • you will need to arrange to have an adult drive you home (You will not be able to drive.)
  • you will need to have a responsible adult stay with you for up to 24 hours after the treatment.

• Do not eat or drink anything after midnight the night before each treatment.
• You may need to take your regular medicines with a small sip water before your treatment. Follow your doctor's directions.
• Try to avoid using make-up.
• You will be asked to use the bathroom before your treatment.

A psychiatrist, an anesthesiologist and a registered nurse will be in the room with you during each treatment.

• If you are coming to the hospital for treatment, you may be asked to wear a hospital gown. Appropriate consent will be given.
• You will lie down.
• The nurse will:
  • start an intravenous (IV) line in your hand or arm for the anesthesia and muscle relaxer
  • put a blood pressure cuff on your arm to monitor your blood pressure
  • attach a pulse oximeter on your finger to monitor your oxygen levels.
• Electrocardiogram (EKG) monitor patches will be placed on your chest to monitor your heart rate.
• The psychiatrist places the ECT leads to your scalp.
• The anesthesiologist will give you a general anesthesia and a muscle relaxer through the IV. (You may have an oxygen mask around your mouth and nose.)
• After you are asleep, the psychiatrist will give you a brief electrical stimulation through the leads on your scalp. This will cause a seizure in your brain.
• Your body remains still due to the effects of the muscle relaxer.
• The nurse will monitor you in the recovery area until you wake up.
• The ECT leads, IV, blood pressure cuff, oximeter clip, oxygen mask and EKG patches will be removed before you either return to your hospital room (inpatient) or leave for home (outpatient).

• If you are an inpatient (staying in the hospital), you will return to your room.
• If you are an outpatient (returning home), you will need to have someone drive you home. Have a responsible adult stay with you after you return home. (Follow your health care provider's instructions.)
• Follow all directions you receive from your psychiatrist or nurse.

Some common side effects after an ECT treatment include:

• headaches
• jaw tightness
• muscle soreness
• nausea
• problems with distraction and concentration
• short-term memory loss.

Other less common side effects include:

• small risk of injury to the soft tissue in the mouth or to the teeth (such as a nick on the tongue or a chipped tooth)
• severe memory loss (rare). If this happens, the psychiatrist will talk with you about stopping treatment.

If you have any side effects (even those not listed above), please tell your psychiatrist or nurse. Most side effects can be avoided or improved.