As demand for behavioral health services continues to climb, so too does the adoption of interventional psychiatry like Transcranial Magnetic Stimulation (TMS) and psychedelic therapies like ketamine treatments.

Sherry Rais, the CEO and co-founder of Enthea, which provides insurance plans for interventional psychiatry methods like psychedelic-assisted therapy and TMS, said she has seen a 6,000% increase in employer interest in TMS over the last year.

“There is a huge amount of interest,” Rais said at Behavioral Health Business’ INVEST Conference in Nashville. “There is more education and awareness, not just about how effective these treatments are, but how ineffective the traditional approach is.”

Both TMS and ketamine therapies have been proven to be effective therapy methods for persistent mental health conditions like treatment-resistant depression, among other things.

A 2022 study found that 63% of treatment-resistant depression patients responded to TMS therapy and 42% reached full remission. A separate study in 2019 found that esketamine nasal spray 59.3% achieved stable remission and ketamine in any form has been proven to rapidly reduce depression symptoms.

However, what needs to change before these modalities truly take off and become mainstream therapies for patients and investors is an update to CPT codes for proper reimbursement and standardization of federal and state regulatory requirements, providers said.

“In order to change our mental health system, I think there needs to be patients demanding more from psychiatry,” Dr. Eugene Lipov, the co-founder and chief medical officer at Stella Mental Health, said during INVEST. “What does it mean you can provide fast, effective, improved care to patients? It’s not complicated… I think a big push where insurance companies can lean on psychiatry and APA saying these modalities are working, will move the needle on some level there. I think that will work.”

Stella Mental Health is a Westmont, Illinois-based interventional psychiatry practice with locations across the U.S. that provides ketamine infusion therapy, TMS and other novel mental health interventions.

A big headache, particularly on the psychedelic therapy side, is state-to-state laws and regulations. Oregon and Colorado are currently the only two states that have decriminalized some psychedelic drugs. But individuals who work in the space agree that even if or when other states move to do the same, variables in these laws could make things even more complicated for providers, lacking guidance at a federal level.

“I think the federal government, the state, the DEA, CMS, FDA, all of these entities, the complexity in their alignment affects our ability to do this legitimately, with regulation, with oversight,” Lydia Rudy the chief development officer at ERC Pathlight, said during INVEST. “That forces, in many ways, patients to choose less safe options because there’s no pathway for them to get their preferred treatment.”

ERC Pathlight is a Denver-based provider of inpatient, residential, intensive outpatient, partial hospitalization programs and virtual care for eating disorders and a range of mental health conditions. ERC Pathlight offers TMS and ketamine therapies. 

“Federal providers are regulated by federal entities. Insurances respond to federal entities,” Rudy said. “So, although we have some legalities, we have an intersection of state laws that are not aligned, which really impacts these modalities.”

However, if the barriers presented by the current regulatory landscape ease, widespread adoption of these emerging modalities could move the needle further on value-based care, which in turn could make the case for more payers and insurers to support these treatments.

“I think all of these modalities and innovative treatment options are great use cases for value-based care because we can directly track each patient’s outcomes,” Rais said. “With interventional psychiatry, it is easier to say that this will be tied to an X% decrease in your PTSD symptoms and your anxiety or depression symptoms or a remission rate in addiction treatment. I think that’s what payers want to hear. That’s what people want to hear. That’s better quality care. I’m really excited about that being the future.”

The future of TMS, psychedelic therapy and other emerging modalities could also bring about more targeted, personalized treatments and anticipate continued innovation in the space, they explained.

“I think interventional psychiatry will do better and better,” Lipov said. “Tms, will get better and better… There are some new treatments you use in ultrasound, which are amazing. So will physical measures and then AI get better with before-and-after support. I think these treatment advancements will be growing and raising one another. I think natural substances such as LSD, and psilocybin will become accepted, or there’s going to be so much access to the people that they will be using it.”

Treatment times with modalities like TMS and psychedelics may also decrease as innovation continues. Innovations in the TMS space, such as in-home neuromodulation devices, may reduce in-clinic treatment times. Meanwhile, advancements in research around psychedelics may allow for shorter trips without an altered state and more accessibility for patients, Rais explained.

“What I think we might start seeing happening is drugs being developed that provide a shorter trip experience or a shorter altered state experience using the neuroplasticity you get from all of these psychedelics, without the altered state,” Rais said. “I think we’re going to start seeing that emerging more often, which is a lot more accessible.”