Objective: Electroconvulsive therapy (ECT) continues to be one of the most effective biological therapies for patients with mood disorders. Numerous studies address clinical response; however, few have examined psychosocial or occupational outcomes following ECT, especially in community settings. This study aimed to examine these outcomes in short- and long-term naturalistic follow-up of ECT conducted in a community hospital. Methods: A retrospective chart review was conducted of all patients who received ECT at Ridge Meadows Hospital in Maple Ridge, British Columbia, between January 1997 and December 2003. Charts were evaluated with the Clinical Global Impression (CGI), Global Assessment of Functioning, and Social and Occupational Functioning Assessment Scales prior to ECT and at 6 months, 1 year, and 2 years post-ECT. Results: A total of 90 patients with mood disorders underwent ECT; 86.5% were rated on the CGI as “markedly ill” to “among the most extremely ill” at baseline. All clinical ratings improved at every follow-up point, and by the end of 24 months, 56.6% of patients were rated as “much improved” or “very much improved” on the CGI. Similarly, the measures of psychosocial functioning also showed significant improvement throughout the follow-up period. Conclusions: These findings show that substantial and meaningful improvement occurred in clinical and psychosocial outcomes after ECT conducted in a community hospital. These changes were robust and stable over the 2-year follow-up period. Limitations of the study include the retrospective ratings, the open-label use of ECT, and the naturalistic treatment in follow-up.