Geographic Disparities and Socioeconomic Barriers to Electroconvulsive Therapy in the United States: A Nationwide GIS Analysis and Manual Audit.

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.