Montana VA’s new mobile mental health service

Montana VA launched a new mobile medical unit in March to expand mental health treatment access to rural Veterans in Montana and parts of northern Wyoming.

The unit will provide transcranial magnetic stimulation (TMS) therapy, a procedure that uses magnetic pulses to stimulate parts of the brain in patients with treatment-resistant depression.

“The opportunity to take this to more patients, more Veterans of all ages, I think is going to change some lives for the better,” said one Army Veteran who received TMS therapy. “It has allowed me to be the person that I want to be and be the father that I wanted to be. I’m no longer held back by the oppressive weight of depression and suicide.”

Providing coverage for rural Veterans

Dr. Elizabeth Walter, Montana VA TMS program director, said the goal of the mobile TMS unit is to find better ways for Veterans to access more treatment options. “We want to provide the most coverage and most access to Veterans who are on the rural frontier,” Walter said.

Montana and Wyoming are among the most geographically rural states in the country, with the majority of their lands classified as rural or highly rural, according to the VA Office of Rural Health. Both states have also consistently had the highest national suicide rates for the last 20 years.

Mobile medical units are vans or trucks that move around VA healthcare systems to provide services for eligible Veterans who may not have access to local VA medical centers. While other units connect Veterans to a full range of services—including mental health, social workers, women’s health, audiology, laboratory and telehealth—this will be the first to provide TMS therapy.

TMS therapy is relatively new to VA. While it was first approved for use by the FDA in 2008, it wasn’t widely used in VA facilities until 2017. Today, approximately 60 VA facilities offer the treatment. Montana VA got its first TMS machine in 2021 and now has three stationary units at facilities in Kalispell, Helena and Billings.

“Given the volume of people we were seeing who struggled with treatment-resistant depression, it became very important for us to think about what else we could be doing for these Veterans,” Walter said.

Besides location, another barrier to receiving TMS therapy is the high number of sessions needed for treatment. A full course typically requires 30-36 sessions over 6-9 weeks.

“For many Veterans, coming to VA every day for 30 or more days in a row can be quite daunting, especially if they have to travel to a different city to receive treatment,” said Dr. Michelle Madore, neuropsychologist and director of VA’s clinical TMS program.

Rapid treatment protocol

However, during the COVID-19 pandemic, VA providers at Tampa VA developed an advanced rapid TMS treatment protocol delivering five sessions per day for five days.

“It was shown to be so effective we decided to adapt it for use in situations like the mobile medical unit where it would be logistically very challenging for the providers and patients. Now we’re able to offer this treatment to patients who otherwise would be unable to access it due to distance and time and we’re able to offer it closer to their home base and social supports,” Madore added.

Dr. Emily McMillan, adult psychiatrist with the VISN 19 Clinical Resource Hub, is one of the clinicians who provides TMS therapy to patients. She estimates she’s treated between 40-50 patients so far and said the results have been unlike anything she’s seen before. “I’ve seen some incredible transformations and incredible recovery stories. It’s been really rewarding.”

McMillan acknowledged that no one mental health treatment is going to work for everyone and not everyone who gets TMS therapy will see improvement.

“But as a psychiatrist, knowing I can send somebody for this other procedurally-based treatment they’ve never tried before and offer some additional hope when they have already failed with so many medications is amazing,” McMillan said.

If you or someone you know is having thoughts of suicide, contact the Veterans Crisis Line to receive free, confidential support and crisis intervention available 24 hours a day, 7 days a week, 365 days a year. Dial 988, then Press 1 or text 838255.