Transcranial Magnetic Stimulation

Adjourned debate on motion of Hon. T.A. Franks:

That this council—

1. Notes that—

(a) transcranial magnetic stimulation (TMS) is an effective treatment option for some people with major depression;

(b) in 2018, the Royal Australian and New Zealand College of Psychiatrists recommended that 'TMS should be accessible in private and public mental health services and made available in addition to the current spectrum of treatment options';

(c) in 2022, the Prescribed Psychiatric Treatment Panel, a part of the Office of the Chief Psychiatrist of SA Health, recommended that TMS be introduced into public mental health services as a first-line treatment ahead of the significantly more disruptive electroconvulsive therapy;

(d) the inclusion of TMS in the range of options available under the public health system would ensure that people have access to suitable treatments that allow them to continue living their lives; and

2. Calls on the health minister to ensure that TMS is made available to South Australians by including it in our public health system.

(Continued from 9 March 2023.)

The Hon. R.B. MARTIN (16:59): I rise on behalf of the government to speak in support of the motion brought by the Hon. Tammy Franks MLC. Transcranial magnetic stimulation is a procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of major depression. It is called a non-invasive procedure because it is done without using surgery or even cutting the skin. TMS usually is used only when other depression treatments have not been effective.

The Prescribed Psychiatric Treatment Panel position statement states that transcranial magnetic stimulation is an effective, evidence-based treatment for major depression involving the delivery of repetitive magnetic pulses to the brain. The use of TMS in the treatment of major depression is endorsed by the Royal Australian and New Zealand College of Psychiatrists as a well-tolerated, safe medical procedure with a good evidence base.

I am advised that as of September 2022, there are eight psychiatrists practising in South Australia who have expertise in TMS research and treatment delivery. However, TMS is not currently offered in the South Australian public mental health system.

As of November 2021, new items for TMS therapy services have been added to the Medicare Benefits Schedule for eligible patients with diagnosed medication-resistant major depressive disorder. Medicare will provide funding for an initial course of treatment and a course of retreatment, but not for longer term maintenance treatment.

Patients have been required to self-fund TMS therapy with the assistance of private health insurance where available. This means that access to the therapy is often limited to those with financial means. Expansion of this emerging therapy will be explored and further advice is being developed about the steps required to implement this treatment in the public sector. I thank the honourable member for raising this important motion and reiterate that we will be supporting it.

The Hon. N.J. CENTOFANTI (Leader of the Opposition) (17:01): As the speaker for the opposition, I rise in support of the motion put forward by the Hon. Tammy Franks. Transcranial magnetic stimulation (TMS) is a proven and effective treatment option for some people with major depression, particularly for those whose illness is resistant to other treatment options.

It is a recognised alternative treatment to the significantly more disruptive electroconvulsive therapy, also known as electro-shock therapy. Indeed, it has also been the preferred treatment over electro-shock therapy by the Royal Australian and New Zealand College of Psychiatrists since 2018. The college recommends that, and I quote from their literature:

TMS should be accessible in private and public mental health services and made available in addition to the current spectrum of treatment options.

TMS has been approved and regulated by the federal Therapeutic Goods Administration since the early 2000s and is approved to treat not just severe depression but also anxiety, chronic pain, obsessive compulsive disorder and several other conditions.

Despite its recommendation from the peak body and having been on TGA's approved therapies list for two decades, it is not covered by public health insurance in Australia. Patients may need to pay out of pocket or through some private health insurance policies.

However, repetitive transcranial magnetic stimulation therapy was added to the Medicare Benefits Scheme for eligible patients diagnosed specifically with medication-resistant major depressive disorder in 2021. To clarify, there is no guarantee of insurance coverage but it is covered by Medicare as a treatment for one particular diagnosed condition. This leads us to the issue of accessibility.

Just this week, I have spoken publicly about the huge pressure that veterinarians and veterinary staff face and the poor mental health outcomes for some of those workers. We need to support and look after those of us in our community who are struggling. We, the opposition, support this motion put forward by the honourable member, as this is the kind of pragmatic and practical solution we need. We need to do just that: look after those who need it. We need to allow people access to resources and therapies that can help them regain control over these debilitating conditions and can allow them to continue with their everyday lives, around their illness.

This outcome is possible as, unlike some other treatments, TMS requires no or minimal downtime. There is no heavy sedation from medications. There are no physical ailments like those obtained through electroconvulsive therapy.

Regarding the issue of accessibility at present, only one site in South Australia offers TMS, namely, a private mental health facility in Gilberton, called the Adelaide Clinic. My understanding is that it is highly sought after. When inquiries were last made by my office several months ago, there was a substantial waitlist for treatment.

By allowing people with these conditions to have access to TMS through the public health system, we will see a reduced number of mental health patients in hospital beds, less time off work for chronic mental health conditions and their side effects, and more people re-engaging in community. This is something that the Liberal Party of South Australia absolutely supports. Healthy individuals equals healthy communities. I thank the member for bringing this practical motion to this chamber. She has the opposition's support.

The Hon. T.A. FRANKS (17:06): I wish to thank all those who have made a contribution today, namely, the Hon. Reggie Martin and the Hon. Nicola Centofanti. I express my gratitude for their indication of both the Labor government's and the Liberal opposition's support of this motion. I note also the previous support in a contribution by the Hon. Sarah Game, and the attendance of SA-Best MPs, which seemed very supportive, at the briefing that we held on this issue. I think we have an outbreak of consensus to finish our day.

Since I last spoke on this matter, there has been some correspondence from the Flinders Student Psychiatry Society as well, which I would like to add to the public debate. That letter, dated 25 May and co-signed by Sam Diprose (the President), Lauren Hammond (the Vice President), and Sara Ataie Ashtiani (the Director of Education), says:

…(TMS) is used to treat Major Depressive Disorder when medications have failed. This fact alone is enough to articulate that by supporting access to TMS for public patients, you will be voting to directly improve, and save, life.

The Flinders Student Psychiatry Society aims to promote psychiatry and mental health as a career among Flinders University's Medical School. We are a student body who represent the next generation of doctors who will dedicate their careers to the preservation of life.

We ask that you provide these doctors with the tools they need to achieve this.

I note that the future generation, soon to be practising in South Australia, certainly looks forward to this parliament supporting public access to TMS in the near future. I hope that we can hear updates from the government in coming months on their progress towards that.

TMS will save lives and it will change lives. TMS is a proven option here that I am so glad all members on all sides of politics have shown an interest in supporting. I also want to thank the Premier's Advocate for Suicide Prevention—Nadia Clancy, the member for Elder in the other place—for her support of a forum that she and I co-hosted.

It is a lovely way to end the day to have support for this motion, but I certainly hope that the words today are turned into deeds tomorrow—or, if not then, in the coming weeks and months but certainly by the end of the year. With that, I commend the motion.

Motion carried.