Geographic Disparities and Socioeconomic Barriers to Electroconvulsive Therapy in the United States

Abstract

Objectives: To quantify the geographic distribution of verified electroconvulsive therapy (ECT) facilities in the United States, analyze the relationship between facility proximity and county-level socioeconomic status, and disseminate these findings using a public-access locator tool at mapofect.com. Methods: A multistage manual audit was conducted between January and April 2026. After exhaustive internet searches, facilities were contacted by telephone to verify active ECT services. Straight-line Euclidean distance was calculated from every US zip code centroid to the nearest verified facility. Distances were merged with 2020 American Community Survey 5-year estimates for socioeconomic analysis. Results: The audit identified 627 potential sites and verified 328 active ECT facilities. Notably, 26% of facilities listed in federal directories as ECT providers were found to no longer offer the service. Socioeconomic analysis revealed a significant negative correlation between median income and distance to care ( r =−0.281, P <0.001). Residents in the poorest quartile of zip codes live an average of 75.3 miles from a facility, compared to 44.4 miles for the wealthiest quartile. Conclusions: Geographic scarcity and data inaccuracies are primary barriers to ECT access. A 30.9-mile “access gap” exists between the wealthiest and poorest Americans. Publicly accessible, verified tools like mapofect.com are necessary to improve mental health equity.

The authors' abstract, as published at the source. Journal of Ect, 2026 · DOI ↗