Health systems are investing in interventional psychiatry programs as demand for treatment-resistant depression therapies rises and payer policies evolve.
In 2021, an estimated 8.9 million U.S. adults were treated for major depressive disorder each year, and about 2.8 million — nearly 31% — had treatment-resistant depression. The total annual economic burden of medication-treated depression was $92.7 billion, with nearly half of that total — $43.8 billion — tied to treatment-resistant cases.
When first-line treatments fail, options such as transcranial magnetic stimulation, esketamine and electroconvulsive therapy can be a “lifesaver,” Dan Peterson, CEO of Sutter Center for Psychiatry and the behavioral health service line at Sacramento, Calif.-based Sutter Health, told Becker’s.
About 50% to 60% of people with depression who have not benefited from medications experience a clinically meaningful response with transcranial magnetic stimulation. About one-third of those individuals achieve full remission, but results are not permanent.
Despite growing adoption, access remains uneven due to costs, insurance variability and workforce shortages.
Scaling access
Expanding access to these therapies is critical to strengthening the continuum of behavioral healthcare, particularly as primary care providers and front-line workers encounter more patients with complex mental health needs, Mr. Peterson said.
Even when providers are aware of intervention options, navigating referrals and access can be challenging.
To address those barriers, Sutter Health is scaling interventional psychiatry services across Northern California. The program first launched at the Sutter Center for Psychiatry, where clinicians offer TMS and electroconvulsive therapy, with plans for broader expansion.
“There are some great clinics and great locations that are offering this in an academic setting or in a concierge, sort of private pay, limited-access setting,” Mr. Peterson said. “As a health system that’s serving 3.5 million patients, we have an opportunity to really do this at scale.”
Other systems have made similar investments.
New Haven, Conn.-based Yale New Haven Health launched interventional psychiatry services in 2013 and had early integrated services in place by 2019. The program offers electroconvulsive therapy, transcranial magnetic stimulation, intravenous ketamine therapy and esketamine nasal spray, as well as opportunities to participate in clinical trials. Practitioners are cross-trained in the different interventions to tailor treatment plans to individual patients, Robert Ostroff, MD, co-medical director of the Interventional Psychiatry Service at the hospital, said in a Dec. 1 article on Yale’s website.
Aurora, Colo.-based UCHealth committed $150 million in 2019 to expand behavioral health capacity across its continuum of care, Elicia Bunch, vice president of behavioral health, told Becker’s. As part of that effort, the system opened three behavioral health specialty clinics offering electroconvulsive therapy, esketamine and transcranial magnetic stimulation.
University of Alabama at Birmingham Medicine has also expanded access, opening a transcranial magnetic stimulation clinic within its Center for Psychiatric Medicine.
In the outpatient space, Stella Mental Health, based in Westmont, Ill., recently opened a clinic offering Spravato therapy, intravenous ketamine infusions, deep transcranial magnetic stimulation, accelerated transcranial magnetic stimulation and psychiatric medication management.
The Behavioral Health Center at Lancaster (Pa.) General Hospital also plans to build additional capacity for ketamine treatments following high demand in 2025.
Payers respond
As health systems scale capacity, payers are beginning to adjust coverage policies.
Evernorth Behavioral Health, a subsidiary of the Cigna Group, will eliminate prior authorization requirements for transcranial magnetic stimulation effective March 6 for contracted providers treating patients enrolled in Evernorth and Cigna Healthcare plans — a shift that could ease administrative burdens and expand access to care.
Premera Blue Cross also updated its coverage policy earlier in 2026 for transcranial magnetic stimulation, outlining new parameters for treatment types, session limits and clinical criteria.
The payer said transcranial magnetic stimulation may be covered for patients with unipolar depression, bipolar depression and obsessive-compulsive disorder if severity thresholds are met and the patient has not responded to medication.
