As of 2001, it was estimated that about one million people received<unk>  annually. There is wide variation in<unk>  use between different countries, different hospitals, and different psychiatrists. International practice varies considerably from widespread use of the therapy in many Western countries to a small minority of countries that do not use<unk>  at all, such as Slovenia. About 70 percent of<unk>  patients are women. This may be due to the fact that women are more likely to be diagnosed with depression. Older and more affluent patients are also more likely to receive<unk> . The use of<unk>  is not as common in ethnic minorities. Sarah Hall reports, "ECT has been dogged by conflict between psychiatrists who swear by it, and some patients and families of patients who say that their lives have been ruined by it. It is controversial in some European countries such as the Netherlands and Italy, where its use is severely restricted". United States<unk>  became popular in the US in the 1940s. At the time, psychiatric hospitals were overrun with patients whom doctors were desperate to treat and cure. Whereas lobotomies would reduce a patient to a more manageable submissive state,<unk>  helped to improve mood in those with severe depression. A survey of psychiatric practice in the late 1980s found that an estimated 100,000 people received<unk>  annually, with wide variation between metropolitan statistical areas. Accurate statistics about the frequency, context and circumstances of<unk>  in the US are difficult to obtain because only a few states have reporting laws that require the treating facility to supply state authorities with this information. In 13 of the 50 states, the practice of<unk>  is regulated by law. In the mid-1990s in Texas,<unk>  was used in about one third of psychiatric facilities and given to about 1,650 people annually. Usage of<unk>  has since declined slightly; in 2000–01<unk>  was given to about 1500 people aged from 16 to 97 (in Texas it is illegal to give<unk>  to anyone under sixteen).<unk>  is more commonly used in private psychiatric hospitals than in public hospitals, and minority patients are underrepresented in the<unk>  statistics. In the United States,<unk>  is usually given three times a week; in the United Kingdom, it is usually given twice a week. Occasionally it is given on a daily basis. A course usually consists of 6–12 treatments, but may be more or fewer. Following a course of<unk>  some patients may be given continuation or maintenance<unk>  with further treatments at weekly, fortnightly or monthly intervals. A few psychiatrists in the US use multiple-monitored<unk>  (MMECT), where patients receive more than one treatment per anesthetic.<unk>  is not a required subject in US medical schools and not a required skill in psychiatric residency training. Privileging for<unk>  practice at institutions is a local option: no national certification standards are established, and no<unk> -specific continuing training experiences are required of<unk>  practitioners. United Kingdom In the UK in 1980, an estimated 50,000 people received<unk>  annually, with use declining steadily since then to about 12,000 per annum in 2002. It is still used in nearly all psychiatric hospitals, with a survey of<unk>  use from 2002 finding that 71 percent of patients were women and 46 percent were over 65 years of age. Eighty-one percent had a diagnosis of mood disorder; schizophrenia was the next most common diagnosis. Sixteen percent were treated without their consent. In 2003, the National Institute for Health and Care Excellence, a government body which was set up to standardize treatment throughout the National Health Service in England and Wales, issued guidance on the use of<unk> . Its use was recommended "only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening in individuals with severe depressive illness, catatonia or a prolonged manic episode". The guidance received a mixed reception. It was welcomed by an editorial in the British Medical Journal but the Royal College of Psychiatrists launched an unsuccessful appeal. The NICE guidance, as the British Medical Journal editorial points out, is only a policy statement and psychiatrists may deviate from it if they see fit. Adherence to standards has not been universal in the past. A survey of<unk>  use in 1980 found that more than half of<unk>  clinics failed to meet minimum standards set by the Royal College of Psychiatrists, with a later survey in 1998 finding that minimum standards were largely adhered to, but that two-thirds of clinics still fell short of current guidelines, particularly in the training and supervision of junior doctors involved in the procedure. A voluntary accreditation scheme,<unk> AS, was set up in 2004 by the Royal College, and as of 2017 the vast majority of<unk>  clinics in England, Wales, Northern Ireland and the Republic of Ireland have signed up. The Mental Health Act 2007 allows people to be treated against their will. This law has extra protections regarding<unk> . A patient capable of making the decision can decline the treatment, and in that case treatment cannot be given unless it will save that patient's life or is immediately necessary to prevent deterioration of the patient's condition. A patient may not be capable of making the decision (they "lack capacity"), and in that situation<unk>  can be given if it is appropriate and also if there are no advance directives that prevent the use of<unk> . China<unk>  was introduced in China in the early 1950s and while it was originally practiced without anesthesia, as of 2012 almost all procedures were conducted with it. As of 2012, there are approximately 400<unk>  machines in China, and 150,000<unk>  treatments are performed each year. Chinese national practice guidelines recommend<unk>  for the treatment of schizophrenia, depressive disorders, and bipolar disorder and in the Chinese literature,<unk>  is an effective treatment for schizophrenia and mood disorders. Although the Chinese government stopped classifying homosexuality as an illness in 2001,<unk>  is still used by some establishments as a form of "conversion therapy". Alleged Internet addiction (or general unruliness) in adolescents is also known to have been treated with<unk> , sometimes without anestheia, most notably by Yang Yongxin. The practice was banned in 2009 after news on Yang broke out.
Electroconvulsive therapy
Brief psychotherapy
Psychotherapy
Cognitive therapy
Suicide intervention
Institutional psychotherapy
Insight-oriented psychotherapy
MDMA-assisted psychotherapy