Purpose: To develop a grounded theory informed model explaining the decision-making process professionals in multi-disciplinary teams go through in deciding whether to administer Electroconvulsive therapy (ECT) or not.

Methods: A grounded theory informed methodology was used to analyse the data offered by ten participants who had all been involved in the process of deciding if someone has ECT or not.

Results: The core categories, described as ‘layers’ in this research, ‘personal and professional identity’; ‘subjective vs objective’; ‘Guidelines or Clinical Instinct?’; ‘Someone has to take Responsibility’ and ‘the decision in action’ were constructed from the data.

Conclusions: The study describes a useful insight into the layers of the decision-making process that could be further considered in clinical settings. The model highlights the decision to give ECT includes many different layers including professional identity, how a person understands the evidence base, past experiences, and the amount of power they have in the process. The consultant psychiatrist and the patient were seen as holding most power in the process depending on whether the Mental Capacity Act (2005) or Mental Health Act (2007) was being followed. Patients were seen to experience a very different decision-making process dependant on the personal views of the professionals in relation to ECT.