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Mental health care in Thailand was founded by King Chulalongkorn on November 1, 1889, from which time it has been managed by the Thai government.To briefly describe the origin and the developments of mental health care and electroconvulsive therapy (ECT) in Thailand.Thai mental health care has undergone extensive changes over the last 120 years in the quantity and the quality of techniques, the services, and the management provided. Thai mental health development can be divided into 7 periods based on specific characteristics. Regarding biological treatment, there is a long history of such development in Thailand starting with fever therapy and insulin coma therapy initiated in 1936 and Metrazol convulsive therapy in 1939. Electroconvulsive therapy was introduced in 1950. Modified ECT was subsequently commenced in 1974. A recent survey of ECT practice in Thailand indicated an ECT use rate of 11.2 patients treated per 100,000 with 93% of all ECTs being performed in psychiatric hospitals and 94% of all ECT treatments unmodified. At present, only 5 university hospitals routinely administer modified ECT.Through cooperation with all available public and private agencies and through the support given to encourage active participation in the community, mental health care in Thailand continues to improve and evolve. However, regarding ECT development, little has been done despite a high ECT use rate, and as such, some form of reform is needed to achieve and maintain optimal standards in its practice.