Neurologist partners with PCPs to elevate care for patients with mental illness

We are in a crisis when it comes to mental health in Alabama. According to the National Alliance on Mental Health, one in five adults in the state lives with mental illness.

In addition, current estimates indicate that Alabama only has one-fourth of the mental health providers needed to effectively address these needs. As such, we must get creative with new business models.

At Novus Neurology and TMS in Tuscaloosa, we piloted a new model more than 2 years ago in which we partner with primary care practices to address patients’ mental health needs. The model has been so successful that we currently have four locations with plans for expansion across the state in 2023 and 2024.

Given the shortage of mental health providers, this model works because primary care physicians are currently the front line for mental health care. If a patient comes in with symptoms of depression, the doctor can refer the patient to a psychologist or counselor; however, those are in short supply, along with psychiatrists. The doctor can also prescribe an antidepressant, yet medications do not work for 20% to 60% of patients with psychiatric disorders (Howes, et al.)

Leveraging primary care physicians

By partnering with primary care practices, we can be the treatment arm for patients who need mental health care. In our model, eligible patients are referred to Novus via their physician. A Novus mental health provider joins the care team, working collaboratively with the PCP to identify the best treatment options for the patient.

This model can make a difference in whether a patient decides to receive treatment for a mental health issue. As one of our partnering PCPs, William E. Alldredge, MD, FACP, of Internal Medicine Associates of Tuscaloosa, said, “The strength of a primary care doctor’s relationship with their patient can be the deciding factor about whether a patient tries a new therapy.”

Through this model, patients can receive a diagnosis and treatment — and still receive care within the comfort of their primary care setting.

Offering nontraditional treatment options

Once a Novus provider joins the team, we can provide medication management for treatment-resistant patients who do not respond to the first or second medication prescribed by the PCP. We also provide deep transcranial magnetic stimulation (Deep TMS, Brainsway) treatment for patients with depression, anxious depression, obsessive-compulsive disorder and smoking addiction.

For many patients, having access to a technology such as this at their primary care office can be life-changing, as it provides a noninvasive, nondrug treatment.

One of our partners, Jeffery C. Laubenthal, MD, of West Alabama Family Practice & Sports Medicine, offers the treatment to his patients. “Deep TMS has been vital in our practice, giving us a successful and reliable treatment for difficult mental health disorders that traditionally would have required specialty referral,” he said.

According to Brainsway, Deep TMS is a neurostimulation technology that uses a magnetic coil to activate neural networks in targeted areas of the brain. It is FDA-approved to treat major depressive disorder, obsessive-compulsive disorder, smoking cessation and anxious depression.

A Novus-trained technician who is supervised by the clinic’s physicians administers the 20-minute treatment while the patient sits in a chair, wearing a cushioned helmet containing the magnetic coil. Patients receive daily treatments over the course of several weeks. There are no systemic side effects, and treatment does not require anesthesia.

TMS vs. Deep TMS

TMS, or repetitive TMS, is a noninvasive treatment that uses magnetic fields to regulate the activity of brain structures found to be related to different mental health conditions. Traditional TMS was the first type of TMS on the market, and it relies on repeated pulses of magnetic fields to reach certain areas of the brain. The difference between traditional TMS and Deep TMS is the breadth and depth at which the electromagnetic waves can penetrate the brain.

Clinical data of more than 1,300 patients with depression in real-world settings have shown compelling results with Deep TMS (Tendler A, et al, Psychiatry Res). Among patients who completed at least 30 sessions, approximately four in five achieved response, and approximately two in three achieved remission. Additional clinical studies with similar positive outcomes for OCD and smoking addiction also exist.

Using TMS to treat depression, other mental illnesses

TMS has many advantages over traditional treatments for depression. Deep TMS has been clinically proven to benefit many patients who do not respond to antidepressants or talk therapy (Tendler, et al, APA), and TMS does not come with the systemic side effects associated with antidepressants. That said, many patients benefit from both medication and TMS.

Deep TMS treatment for depression is covered by most major health care insurance companies and all Medicare providers, and it is increasingly covered for treatment of OCD.

Providing mental health care options like deep TMS in primary care practices — and making sure patients know their options — is critical. With this unique model, we aim to set the standard for improving mental health in Alabama and serve as a model for other states across the country that are facing similar struggles.

References:

• Brainsway: How does it work? https://www.brainsway.com/how-does-it-work/.
• Brainsway: Is deep TMS covered by insurance? https://www.brainsway.com/patients-faqs/is-deep-tms-covered-by-insurance/.
• Howes OD, et al. Mol Psychiatry. 2021;doi:10.1038/s41380-021-01200-3.
• Mental health in Alabama. https://www.nami.org/NAMI/media/NAMI-Media/StateFactSheets/AlabamaStateFactSheet.pdf.
• Tendler A, et al. Improvement in reported quality of life following deep TMS for treatment-resistant MDD. Presented at: American Psychiatric Association Annual Meeting; May 20-24, 2023; San Francisco.
• Tendler A, et al. Psychiatry Res. 2023;doi:10.1016/j.psychres.2023.115179.

For more information:

Timothy Prestley, MD, is the founder and director of Novus Neurology and TMS, a comprehensive brain treatment center in Tuscaloosa, Alabama.