Neurostimulation Service referrals
The Fremantle Hospital Neurostimulation Service provides structured and equitable access to electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) for eligible consumers through clearly defined referral pathways.
Our multidisciplinary team oversees all aspects of consumer assessment, treatment delivery, monitoring and follow-up. All team members possess specialised training in their respective modalities, ensuring consistent application of protocols, adherence to clinical governance requirements and the delivery of high-quality clinical outcomes.
Entry to the service is based on:
- clinical assessment
- treatment indication
- safety considerations
- service capacity.
Referrals follow a clear and coordinated process to ensure timely access and appropriate triage for all consumers. All new referrals are triaged by the clinical nurse specialist or relevant coordinator, in collaboration with the lead consultant psychiatrist
All consumers enter the service under the oversight of a consultant psychiatrist, with governance processes ensuring lawful, ethical and consumer‑centred care.
Referral catchment
We accept referrals for all active Fiona Stanley Fremantle Hospitals Group consumers and those across the south metropolitan region. See the FSFHG and broader SMHS catchment (PDF 164KB).
External referrals may be considered for consumers residing outside the local catchment area where this treatment may be unavailable, supporting equitable access to both ECT and rTMS where clinically appropriate.
Inclusion criteria
Consumers may be considered for either neurostimulation pathway when the following criteria are met:
- A primary mental health diagnosis is established.
- Neurostimulation is identified as an appropriate intervention within the individual’s treatment plan.
- Clinical risk is assessed as manageable within an outpatient or day procedure setting, where applicable.
ECT may be recommended in accordance with Office of the Chief Psychiatrist ECT standards and guidelines and at the discretion of the consultant psychiatrist.
Common clinical indications include:
- severe major depressive episodes, including those with psychotic features or significant suicidality
- catatonia
- treatment resistant mania or psychosis
- treatment resistant schizophrenias
- situations involving acute or urgent clinical deterioration where a rapid therapeutic response is required.
Exclusion criteria
Our service does not accept referrals for patients without a mental health diagnosis, or where a medical condition is the primary concern. Patients must be:
- under the age of 18 years, unless approved by the Mental Health Tribunal.
- deemed medically unfit following anaesthetic review.
ECT referral process
All ECT referrals must be made under the care of a consultant psychiatrist.
- Voluntary, involuntary and emergency ECT referrals are triaged through the FSFH internal e-referral system.
- External referrals and/or general enquires are to be emailed to the ECT group.
- External referrals must commence their first ECT treatments as an inpatient and must be waitlisted for a Fiona Stanley Fremantle Hospitals Group mental health bed through Enterprise Bed Management and in liaison with relevant bed managers.
- Involuntary ECT will need to be approved by the Mental Health Tribunal prior to commencing treatment, unless indicated that patient requires emergency ECT.
- Consumers receiving ECT under involuntary status may be required to attend a Mental Health Tribunal hearing to review or authorise their treatment order. Hearings may be conducted in person or via videoconference, depending on clinical needs and tribunal requirements, and are conducted in the Tribunal Room, V Block Level 5 of Fremantle Hospital. Hearings comprise:
- a legal member
- a psychiatrist or medical member
- a community member
- the consumer, along with their chosen support person(s), which may include a family member, carer, friend, or legal representative.
Inclusion criteria
Consumers may be considered for either neurostimulation pathway when the following criteria are met:
- A primary mental health diagnosis is established.
- Neurostimulation is identified as an appropriate intervention within the individual’s treatment plan.
- Clinical risk is assessed as manageable within an outpatient or day procedure setting, where applicable.
This treatment may be offered in line with RANZCP guidance and at the discretion of the treating consultant psychiatrist.
Common clinical indications include:
- a confirmed diagnosis of treatment resistant major depressive disorder (MDD)
- evidence of adequate prior treatment trials (pharmacological and/or psychological)
- completion of comprehensive safety screening to ensure patient safety and suitability.
Exclusion criteria
Our service does not accept referrals for patients without a mental health diagnosis, or where a medical condition is the primary concern. Patients must be:
- under the age of 18 years
- deemed medically unfit for treatment.
- deemed unsuitable following assessment /screening with the transcranial magnetic stimulation (TMS) screening tool – for example, patients who have:
- metallic or electronic implants in or near the head including Cochlear implants
- aneurysm clips or coils
- deep brain stimulators.
rTMS referral process
Internal referrals are submitted and triaged through the eReferral system, ensuring streamlined communication and continuity of care for current patients within the service.
Please note external referrals from GPs are not being accepted until September 2026 when the Mental Health Crisis Centre opens. Based at Fremantle Hospital, the centre will become the single point of access for Fremantle Hospital Mental Health service. External referrals must include a completed risk screening form (transcranial magnetic stimulation screening tool) to ensure appropriate clinical assessment and safe treatment planning.
Acceptance and commencement of treatment
Once a referral has been triaged and approved, the relevant modality coordinator will schedule the next available treatment session to commence therapy.
Where possible, treatment is expected to commence within one to two weeks of acceptance, however, commencement timeframes are dependent on clinical need, current caseload and service capacity.
The modality coordinator will liaise with both the referring team and the consumer to confirm acceptance of the referral and to ensure timely communication of appointment details.
Consumers referred for rTMS will be scheduled for an initial appointment with the lead rTMS psychiatrist. This appointment will include completion of course documentation, including informed consent and prescription, as well as treatment mapping, prior to commencement of therapy.
Contact us
Phone the Fremantle Hospital Switchboard on 9431 3333.
Location
Neurostimulation Suite, V Block
Fremantle Hospital, Alma Street, Fremantle WA 6160 – see the Fremantle Hospital map (external PDF 284KB)