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This article describes a quality management project undertaken for the purpose of ensuring that the most appropriate patients were being selected for electroconvulsive therapy (ECT) at an 80-bed, state-operated, civil psychiatric facility for the seriously mentally ill.Thirty mentally ill patients, including patients with comorbid substance abuse diagnoses, were treated with ECT. Pre-ECT and post-ECT scores on the 24-item Brief Psychiatric Rating Scale (BPRS-24) were compared with admission and discharge BPRS-24 scores of a control group treated with psychotropic medication.ECT-treated patients demonstrated greater improvement in BPRS scores during a shorter period than did non-ECT-treated patients. Furthermore, the greatest improvement was seen in the areas of depression and expressed suicidal intent. An unanticipated result was that patients with comorbid substance abuse diagnoses treated with ECT showed the most improvement in these areas.ECT was shown to be particularly useful in the treatment of suicidally inclined depressed patients, suggesting that ECT should be an early consideration for suicidal patients.