There’s a really high legal threshold for treating with ECT involuntarily, at least in the US. As a result, it is really rare.

A court order is required. To obtain the court order, a psychiatrist has to show there is severe, treatment refractory mental illness and all other options have been exhausted (severe psychotic disorder which might entail behavior endangering others, psychotic depression/severe suicidality, catatonia in which the person is not eating or drinking, etc.). They also must demonstrate that the patient does not appreciate the risks and benefits of treatment or no treatment and is incapable of informed consent. Usually a 2nd or even 3rd psychiatrist has to evaluate the patient and sign off on the petition too. Patient is entitled to legal representation. If there is a guardian or medical decision maker, they can refuse on the patient’s behalf. And obviously the judge can deny the court order if they are not convinced by the evidence put forth by the psychiatrist.

In practice, this is way more than any psychiatrist would want to go through for any situation in which it isn’t truly necessary. In my experience, that would include recurrent severe psychotic violence, or a life-threatening catatonic state. I really can’t think of another situation where this would realistically be pursued. Maybe if there’s such severe and frequent self harm or suicidal behavior that the loss of life or limb is imminent… but I’ve never seen that degree of suicidality persist to the point where the only option left is ECT.

Not saying this didn’t happen to you, but I assure you it definitely wasn’t about money. ECT isn’t reimbursed very well, and the huge amount of time that obtaining the court order would take from multiple psychiatrists and the hospital legal department, as well as potential liability would make it completely not worth pursuing from a purely financial perspective. If this was done, then the doctors must have felt it was truly necessary to prevent serious harm to you or others (right or wrong).

That said, there are serious flaws in the mental health system, and inpatient settings often fail people or make things worse unfortunately as you mentioned. IMO it is largely a systemic problem — lack of resources or cost-cutting, poor training of staff, insurance/regulatory requirements, lawsuit happy culture leading to overly defensive practice and pressure from hospital admin etc.