If it is decided to refer a patient to our specialized mental healthcare practice, the patient will undergo a comprehensive intake process. This involves our triage nurse, one of our psychiatrists as the coordinating therapist, and a treating clinician.

Lead Clinicians
Marguerite van den Bergh, Dianne Winkelmolen, Dan Knoester, Folkert Overbeek

Overall Management
Bram Wernsen, Owner and rTMS Supervisor

Specialized care practice

We are a specialized specialized mental healthcare (sGGZ) practice focusing on repetitive Transcranial Magnetic Stimulation (rTMS). Unlike regular care institutions, we do not take over long-term care trajectories. Our care is aimed at patients for whom rTMS may be an appropriate treatment. If rTMS does not produce the desired result, we refer back to the original referrer with advice on possible further treatment options.

What you can expect from us

• A clear and well-defined treatment trajectory, specifically focused on rTMS.
• Transparent communication about progress and results.
• No takeover of care, but specialized support within a collaborative approach.

Important advice regarding medication

We advise not to change your medication at the start of rTMS treatment. Medication changes can be neurologically stressful and make it difficult to accurately assess the treatment effect of rTMS. If your medication is prescribed by your GP, we can — based on indication — consider tapering or medication adjustments at a later stage of the treatment.

Communication and consultation for referrers

Do you have questions about a referral or would you like to discuss a treatment first? Please contact us at secretariaat@rtms-international.com. We will be happy to schedule a call to discuss your questions.

Referral and registration for adults (18+)

The patient can register themselves via the registration form, and the referral letter can be attached as a file with the registration.

The referral letter for an rTMS treatment is valid when it meets specific requirements set by the Dutch Healthcare Authority (NZa) and insurers. The referral letter must at least include:

• Referral to specialized mental healthcare (specialistische ggz) for an rTMS treatment trajectory
• Date of referral (must be no more than six months before the first treatment date)
• Name and position of the referrer
• AGB code of the referrer
• Practice stamp and/or signature of the referrer
• Patient details (name, address, date of birth)
• Indication of a psychiatric disorder or suspicion thereof, optionally specifying the disorder (supported by a validated mental health screening tool)
• The main diagnosis on the referral must be stated: treatment-resistant depression (in addition to OCD)
• Preconditions for rTMS treatment: at least two previous treatments attempted. Either one course of psychotherapy and one antidepressant, or two courses of psychotherapy, or two antidepressants

For specialized mental healthcare within our practices, the following codes are used, among others:

• CO0789 Quality statute Section II — Physician specialist, psychiatrist as coordinating therapist required according to LKS Diagnostics
• CO0781 Outpatient — Quality statute Section II — Other professions Diagnostics
• CO0326 Outpatient — Quality statute Section II — Other professions Treatment
• TC0014 Surcharge for repetitive Transcranial Magnetic Stimulation (rTMS)
• OV0126 Repetitive Transcranial Magnetic Stimulation (rTMS) performed by the rTMS Technician

Contraindications for referral to our care practice

• History of seizures
• Psychotic depression
• Brain damage due to illness or injury, such as brain tumor, stroke, or traumatic brain injury
• Metal or implanted medical devices in the body

Because of the magnetic field produced during rTMS, the treatment is not recommended for people with the following devices:

• Cochlear implants
• Electrodes for monitoring brain activity
• Implanted stimulators
• Implanted vagus nerve stimulators or deep brain stimulators
• Implanted electrical devices such as pacemakers or medication pumps
• Stents
• Aneurysm clips or coils

Duty of Care and Crisis Care: Clear Boundaries

Our duty of care means that we act carefully, professionally and responsibly within the scope of our role, capabilities and expertise. Our duty of care applies within the treatment we provide: rTMS. However, we are not a crisis care provider and do not offer 24/7 availability or on-site psychiatric care. This means that we cannot provide comprehensive crisis intervention or a formal crisis assessment in the way that a mental healthcare institution or GP can.

How do we respond to an actual or emerging crisis during treatment?

If signs of a crisis arise during an rTMS treatment programme, such as suicidality or severe psychological destabilisation, we follow a standard procedure:

• The treating clinician at the location identifies and discusses any concerns with the client.
• The clinician always consults with a colleague and, where necessary, involves the lead clinician (psychiatrist).
• Clinicians may assess suicidality, for example using the CASE approach, but do not conduct a formal crisis assessment in the capacity of a referring healthcare professional.
• In the event of immediate danger or acute safety concerns, 112 is always contacted. The police may also be involved where necessary.
• The role of the referring healthcare professional in a crisis

Throughout the treatment programme, the client remains primarily under your responsibility as the referring healthcare professional. In the event of an actual or emerging crisis, our clinician will ask you, as the clinician responsible for the client’s overall treatment, to contact the crisis service. We do not contact the crisis service independently because:

• we are not the referring healthcare provider;
• crisis services generally require an assessment by
• an authorised referring healthcare professional;
  our psychiatrists are not able to conduct an immediate in-person assessment of the client.

In practice, this approach helps prevent delays and ensures that the client receives the most appropriate and responsible care. Outside office hours, clients are advised to contact the out-of-hours GP service or, in the event of immediate danger, to call 112.

Transparency and collaboration

We believe it is important to establish these boundaries clearly in advance, both for clients and referring healthcare professionals. We therefore explicitly communicate that:

rTMS International does not provide crisis care;
we do not have on-site psychiatric coverage;
in the event of a crisis, the referring healthcare professional remains responsible for acute care and appropriate escalation.

This clear division of responsibilities helps prevent uncertainty, unrealistic expectations and delays at times when rapid action is essential.