Increasing the Availability of Transcranial Magnetic Stimulation in the Veterans Health Administration: Implementation, Growth, and Lessons Learned

Transcranial magnetic stimulation (TMS) is one of the most important developments in psychiatric treatments in the past few decades. There is now considerable evidence for the effectiveness of TMS for treatment-resistant depression. This population is particularly important for the Veterans Healthcare Administration (VHA). Having recognized the unique opportunity to improve the mental health of our nation's Veterans with this new treatment, the VHA has embarked on an ambitious, nationwide program for TMS. This program's aim is to provide training to VA clinicians by experts in TMS in order for them to deliver evidence-based TMS to as many Veterans as possible. By fostering the establishment of new clinics in VHA medical centers across the nation, growing from six programs to almost 70, this program leverages the unique scale of the VHA and establishes a platform from which to advance clinical implementation. The program provides standardized training for administering TMS and generates harmonized data for well-powered measurement-based evaluation of the clinical utility of TMS in a complex population. Providers who have completed the training program have reported high levels of satisfaction. The VA Palo Alto Health Care System was tasked with leading these efforts. We outline our experiences to date, inclusive of the context for the program as well as its structure and function. The paper focuses on how the program was implemented by describing training provided to VA clinicians as well as limitations and considerations for future programmatic efforts.