Bringing It Home: Steps to Full Implementation of Mobile TMS Treatment for Montana’s Veterans

Background: Montana's Veterans face disproportionately high rates of suicide and limited access to specialized mental health services, including transcranial magnetic stimulation (TMS) for treatment-resistant major depressive disorder (trMDD).This project aimed to develop and evaluate a scalable care delivery model to improve access to TMS for rural Veterans using a Mobile Medical Unit (MMU) and assess the efficacy of the accelerated TMS protocol administered in the MMU.Methods: Montana VA TMS implemented the MMU program, the development of this program meant utilization of a vast network of providers, an accelerated TMS treatment, and telehealth to reduce provider burden and allow deployment of the MMU.Preliminary analysis of data on 27 Veterans who received TMS in the MMU in Montana, USA was conducted.We analyzed change in PTSD, MDD, suicidal ideation, and Quality of Life scores.Results: Depressive symptoms significantly improved post-treatment.55.6% of participants met criteria for clinical response and 37% met criteria for remission.Suicidal ideation on the BSSI and Item 9 of the PHQ9 also significantly improved after TMS.For PTSD, 95.2% met criteria for response and 71.4% met criteria for remission.Finally, wellbeing, social functioning, and pain on the SF-36 also significantly improved after TMS treatment. Conclusions:This mobile TMS care model demonstrated strong clinical outcomes and high patient satisfaction for Veterans in rural and highly rural areas.These findings support the feasibility and effectiveness of accelerated TMS for MDD.This mobile unit may serve as a blueprint for expanding equitable neuromodulation access across underserved populations.