HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 255 Psychiatric Treatments
SPONSOR(S): Healthcare Regulation Subcommittee, Amesty and others
TIED BILLS: IDEN./SIM. BILLS: SB 252
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Healthcare Regulation Subcommittee 13 Y, 1 N, As CS Curry McElroy
2) Health & Human Services Committee
SUMMARY ANALYSIS
Electroconvulsive therapy is a medical procedure most commonly used for patients who suffer with major
depression or bi-polar, severe persistent suicidal ideation, mania, or schizophrenia, and who have not
responded to other treatments or medications. Psychosurgery is a type of surgical procedure of the brain used
to treat certain mental health disorders.
CS/HB 255 prohibits electroconvulsive treatments and psychosurgical procedures from being performed on a
person younger than 16 years of age unless a physician certifies in writing that the treatment is medically
necessary and two psychiatrists, who do not work within the same medical practice, agree in writing that that
the treatment is appropriate for the patient.
The bill requires the patient to give informed written consent before receiving an electroconvulsive treatment or
a psychosurgical procedure.
For patients 16 and older, the bill requires electroconvulsive treatments and psychosurgical procedures to only
be performed by a physician, and requires a second physician, not directly involved with the patient, to agree
that a proposed electroconvulsive treatment or psychosurgical procedure is appropriate prior to the treatment
or procedure being performed.
The bill has no fiscal impact on state or local government.
The bill provides an effective date of July 1, 2024.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h0255a.HRS
DATE: 2/2/2024
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Mental Health and Mental Illness
Mental health is a state of well-being in which the individual realizes his or her own abilities, can cope
with the normal stresses of life, can work productively and fruitfully, and is able to contribute to his or
her community.1 The primary indicators used to evaluate an individual’s mental health are:2
Emotional well-being- Perceived life satisfaction, happiness, cheerfulness, peacefulness;
Psychological well-being- Self-acceptance, personal growth including openness to new
experiences, optimism, hopefulness, purpose in life, control of one’s environment, spirituality,
self-direction, and positive relationships; and
Social well-being- Social acceptance, beliefs in the potential of people and society as a whole,
personal self-worth and usefulness to society, sense of community.
Mental illness is collectively all diagnosable mental disorders or mental health conditions that are
characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated
with distress or impaired functioning.3 Thus, mental health refers to an individual’s mental state of well-
being whereas mental illness signifies an alteration of that well-being. Mental illness affects millions of
people in the United States each year. Nearly one in five adults lives with a mental illness. 4 During their
childhood and adolescence, almost half of children will experience a mental disorder, though the
proportion experiencing severe impairment during childhood and adolescence is much lower, at about
22%.5
Mental Health Treatments
There are more than 200 types of mental health disorders.6 Some of the most common types include:7
Anxiety disorders, including panic disorder, obsessive-compulsive disorder, and phobias;
Depression, bipolar disorder, and other mood disorders;
Eating disorders;
Personality disorders;
Post-traumatic stress disorder; and
Psychotic disorders,8 including schizophrenia.
1 World Health Organization, Mental Health: Strengthening Our Response, https://www.who.int/news -room/fact-sheets/detail/mental-
health-strengthening-our-response (last visited January 21, 2024).
2
Centers for Disease Control and Prevention, Mental Health Basics, http://medbox.iiab.me/modules/en-
cdc/www.cdc.gov/mentalhealth/basics.htm (last visited January 21, 2024).
3 Id.
4 National Institute of Mental Health (NIH), Mental Illness, https://www.nimh.nih.gov/health/statistics/mental-illness (last visited January
21, 2024).
5 Id.
6 Cleveland Clinic, Mental Health Disorders, available at https://my.clevelandclinic.org/health/diseases/22295-mental-health-disorders,
(last visited January 29, 2024).
7 National Library of Medicine, Mental Disorders, available at https://medlineplus.gov/mentaldisorders.html, (last visited January 29,
2024).
8 Psychotic disorders, also called psychoses, are severe mental disorders that cause abnormal thinking and perceptions. People with
psychoses lose touch with reality. Two of the main symptoms are delusions and hallucinations. See National Library of Medicine,
Psychotic Disorders, available at https://medlineplus.gov/psychoticdisorders.html, (last visited January 29, 2024).
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Treatment for mental illness depends on the type of mental disorder the individuals has and the
severity. Treatment may include, medication, psychotherapy, hospital and residential treatment
programs, brain stimulation treatments and neurosurgical treatments for mental disorders. 9
Medication is popular treatment method for mental disorders. While they do not cure mental
illness, they often help to significantly improve symptoms. Medications may also make other
treatment plans, such as such as psychotherapy, more effective.10 Common psychiatric
medications include antidepressants, anti-anxiety medications, mood-stabilizers, and
antipsychotics.11
Psychotherapy, also referred to as talk therapy, is the most common treatment of mental
disorders.12 Psychotherapy involves the individual talking about his or her condition with a
mental health professional. During psychotherapy the person learns about their condition,
moods, feelings, thoughts, and behavior and acquire coping and stress management skills. 13
Psychotherapy is typically done one-on-one, but can be done in group settings.14
Hospital and residential treatment programs are generally recommended when the mental
illness becomes severe and the person is unable to properly care for him- or herself or when the
individual is in immediate danger of harming him- or herself. Hospital and residential treatment
options include 24-hour inpatient care, intensive outpatient treatment, partial or day
hospitalization, or residential treatment, which offers a temporary supportive housing. 15
Brain stimulation treatments are generally reserved for situations in which medications and
psychotherapy have not worked. This treatment is used to treat severe symptoms of mental
disorders, including depression. Brain stimulation treatments include electroconvulsive therapy,
repetitive transcranial magnetic stimulation,16 deep brain stimulation17 and vagus nerve
stimulation.18
Neurosurgical treatment for mental disorders, also known as psychosurgery, is a surgical
procedure performed on the brain by a neurosurgeon. This procedure is used to treat patients
with severe and incapacitating mental disorders who have not responded to other treatments.
9 Mayo Clinic, Mental Illness: Diagnosis, available at https://www.mayoclinic.org/diseases-conditions/mental-illness/diagnosis-
treatment/drc-20374974, and Victoria Department of Health, Neurosurgery for Mental Illness, available at https://www.health.vic.
gov.au/mental-health-and-wellbeing-act-handbook/neurosurgery-for-mental-illness (last visited January 29, 2024).
10 Mayo Clinic, Mental Illness: Diagnosis, available at https://www.mayoclinic.org/diseases-conditions/mental-illness/diagnosis-
treatment/drc-20374974, and Family Doctor.Org, Different Types of Mental Health Treatment, at https://familydoctor.org/different-types-
mental-health-treatment/, (last visited January 29, 2024).
11 Mayo Clinic, Mental Illness: Diagnosis, available at https://www.mayoclinic.org/diseases-conditions/mental-illness/diagnosis-
treatment/drc-20374974, (last visited January 29, 2024).
12
Family Doctor.Org, Different Types of Mental Health Treatment, at https://familydoctor.org/different-types-mental-health-treatment/,
(last visited January 29, 2024).
13 Supra, note 11.
14 Supra, note 12.
15 Supra, note 11.
16
Transcranial magnetic stimulation is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve
symptoms of major depression. See. Mayo Clinic, Transcranial Magnetic Stimulation, available at https://www.mayoclinic.org/tests-
procedures/transcranial-magnetic-stimulation/about/pac-20384625, (last visited January 29, 2024).
17 Deep brain stimulation is a procedure that involves implanting electrodes within areas of the brain. The electrodes produce e lectrical
impulses that affect brain activity to treat certain medical conditions. Deep brain stimulation is commonly used to treat con ditions such
as Parkinson’s, epilepsy, tourette syndrome, and obsessive-compulsive disorder. See Mayo Clinic, Deep Brain Stimulation, available at
https://www.mayoclinic.org/tests -procedures/deep-brain-stimulation/about/pac-20384562, (last visited January 29, 2024).
18 Vagus nerve stimulation is a procedure that involves using a device to stimulate the vagus nerve to send electrical impulses to the
brainstem. The impulses change brain functions and alter brain activity to treat various medical conditions, such as treatmen t-resistant
depression, epilepsy, or to help with rehabilitation when recovering from a stroke. Also see Mayo Clinic, Vagus Nerve Stimulation,
available at https://www.mayoclinic.org/tests-procedures/vagus-nerve-stimulation/about/pac-20384565, National Alliance on Mental
Illness, ECT, TMS and Other Brain Stimulation Therapies, available at https://www.nami.org/About-Mental-Illness/Treatments/ECT-
TMS-and-Other-Brain-Stimulation-Therapies, and Supra, note 9. (last visited January 29, 2024).
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Neurosurgery is mostly used to treat severe depression, obsessive-compulsive disorder, and
anxiety disorders.19 In some cases neurosurgery may also be used to treat schizophrenia.20
Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is a medical procedure most commonly used for patients who suffer
with major depression or bi-polar, serve persistent suicidal ideation, mania, or schizophrenia and who
have not responded to other treatments or medications. 21 During the procedure, electrodes are placed
on the patients head and a small electric current is passed through the electrodes into the brain to
intentionally trigger a brief seizure.22 This dramatically increases the patient’s brain activity which
creates changes in the brain chemistry that can quickly improve certain mental health conditions. 23 ECT
is performed under general anesthesia and is typically administered by a medically trained team of
anesthesiologists, psychiatrists, nurses, or physician assistants.24
ECT treatments generally involve a series of six to 12 treatments given two or three times a week for
three or four weeks. The number of treatments depends of the severity of the patient’s symptoms and
how quickly the patient responds to treatment.25 Prior to having an ECT treatment, a patient may be
required to undergo a full evaluation, which may include, medical history, a complete physical exam,
psychiatric evaluation, basic blood test, and an electrocardiogram (ECG) to check heart health. 26
Risks of ECT Treatment
While most consider ECT to be generally safe, there are several risks and side effects associated with
the procedure. The risks and side effects may include:27
Confusion. A patient may immediately experience confusion after treatment, which generally
last from a few minutes to several hours. However, in rare cases confusion may last several
days or longer. Confusion is typically more noticeable in older adults.
Memory loss. A patient may experience temporary memory loss or have temporary difficulty
learning. Some patients may have difficultly remembering events that occurred in the days,
weeks, or even months prior to treatment. Memory problems usually improve within a couple of
months after treatment. However, some patients may experience memory loss for longer
periods, including permanent gaps in memory. 28
Physical side effects. The most common physical side effects that patients experience include
nausea, headache, fatigue, jaw pain and muscle aches. These side effects can generally be
treated with medication and resolve quickly.
19 Victoria Department of Health, Neurosurgery for Mental Illness, available at https://www.health.vic.gov.au/mental-health-and-
wellbeing-act-handbook/neurosurgery-for-mental-illness and Very Well Mind, What is Psychosurgery?, available at
https://www.verywellmind.com/what-is-psychosurgery-5114483, (last visited January 30, 2024).
20 Hellovaia.com, Psychosurgery, available at https://www.hellovaia.com/explanations/psychology/psychological -
treatment/psychosurgery/, (last visited January 30, 2024).
21 Central Florida Behavioral Hospital, Electroconvulsive Therapy (ECT), available at https://centralfloridabehavioral.com/programs-
services/electroconvulsive-therapy/, and American Psychiatric As sociation, What is Electroconvulsive Therapy ECT, available at
https://www.psychiatry.org/patients -families/ect, (last visited January 29, 2024).
22 WebMd, ECT and Other Procedures for Schizophrenia, available at https://www.webmd.com/schizophrenia/electroconvulsive-
therapy, and Mayo Clinic, Electroconvulsive Therapy, available at https://www.mayoclinic.org/tests-procedures/electroconvulsive-
therapy/about/pac-20393894, (last visited January 29, 2024).
23 Mayo Clinic, Electroconvulsive Therapy, available at https://www.mayoclinic.org/tests-procedures/electroconvulsive-
therapy/about/pac-20393894, (last visited January 29, 2024).
24 American Psychiatric Association, What is Electroconvulsive Therapy ECT, available at https://www.psychiatry.org/patients -
families/ect, (last visited January 29, 2024).
25 Supra, note 21.
26 Id.
27 Id.
28 Supra, note 22.
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Medical complications. Medical complications may include complications related to the
general risks of anesthesia. Other medical complications include the risk of heart problems.
During ECT, the patient’s heart rate and blood pressure are elevated, which could lead to
serious heart problems.
Psychosurgery
Psychosurgery is a brain surgery performed to treat certain psychiatric disorders involving the selective
surgical removal or destruction of nerve pathways for purposes of influencing behavior. 29 The basic
concept behind psychosurgery is that if certain parts of the brain are responsible for certain symptoms,
then destroying the brain tissue connecting those parts of the brain will essentially help to eliminate
those symptoms.30
The most well-known example of psychosurgery is the lobotomy.31 This procedure involved drilling two
small holes in a patient’s skull and cutting the nerve fibers that connected the front of the brain, which
controls personality, decision-making and reasoning, with the other regions of the brain.32 This
procedure often produced serious and irreversible side effects, with many patients left severely brain
damaged or dead. Lobotomies were very popular during the 1930s and 1940s. However, upon the
introduction of antipsychotic drugs in the 1950s, the use of psychosurgery vastly declined until
eventually ending in the mid-1970s.33 During the late 1990s, psychosurgery began reemerging as a
treatment option for psychiatric or mental disorders. However, the procedure still remains banned in
some countries.34
Modern Psychosurgery
While psychosurgery procedures such as lobotomies are no longer used, modern psychosurgical
procedures are used to treat extreme cases of mental disorders when medications and behavioral
therapy have failed. However, the surgical techniques used now to perform psychosurgeries are vastly
different. The procedures are also much safer and more effective.35 Modern psychosurgery procedures
have fewer detrimental side effects and the risk of permanent damage to the brain is substantially
lower.36 Modern psychosurgery involves destroying tiny bits of brain tissue using heat. 37 The specific