How MindSkiller® created an ecosystem of hi tech mental health interventions for a young adult mental health unit

An accessible, effective, affordable OCD inpatient treatment program

In collaboration with Professor Vlasios Brakoulias (world renowned psychiatrist academic and expert on OCD) and Dr Mikaela Tracy (research coordinator at Uspace at St Vincent's Private Hospital in Sydney), MindSkiller® and DP Immersive have developed an accessible, effective, affordable OCD treatment program at Uspace using an ecosystem of technologies designed to work together to workaround clinical care gaps, improve staff productivity and be cost effective to encourage more widespread use.  A/Prof Galambos, Dr Tracy and Prof Brakoulias presented a symposium about the Uspace OCD Program at the RANZCP Annual Congress in Canberra in June 2024. 

VR mindfulness intervention

MindSkiller® has been helping support the 20-bed inpatient unit - an early intervention mental health service for 16-25 year old young adults - by introducing there a powerful Virtual Reality mindfulness tool in May 2023.  This non-pharmacological solution for inpatients suffering distress gives inpatients experiencing high anxiety the option of using a scent-enabled VR headset developed by Vermont-USA based OVR Technologies to distract and relieve them from their physical distress to attain a state of calm. The headset comes with a range of natural world virtual scenarios for the user to immerse themselves into, accompanied by guided meditation. 

Patient-centred shared care outcome measures and clinical care pathways

To support the VR mindfulness intervention, MindSkiller® developed a tailored online outcome measurement tool to assist the inpatient team to monitor its effectiveness and compare it to other interventions such as as-required (so called ‘prn’) anti-anxiety medication, talking interventions and use of a sensory box.  This outcome measurement tool is one of a range of online psychometric tools it provides the team to enable clinical assessment of symptoms, levels of disability and distress, and forms that can be shared between clinicians and patients to collaborate on a clinical activity or goal.It also provides the multidisciplinary team with clinical care pathways for coordination of patient mental health care - interventional, diagnostic and a tailored pathway for the Uspace young adult service.MindSkiller® has been designed to support a patient-centred model of care - where inpatients can give permission for their usual external community clinicians to follow their progress to minimise any gaps in knowledge about what interventions they have received and the progress they have made during their episode of care.

Online specialist-grade eLearning

 This is on top of the platform’s specialist-grade eLearning program which includes biopsychosocial modules to help users understand anxiety and depression in general, how to cope with stressors, mood and anxiety disorders and their classification and a set of modules focusing specifically on particular mental disorders including Reactive Depression, Mixed Anxiety-Depression, Melancholic Depression, PTSD-Acute Stress Disorder, Panic Disorder and OCD. Patients have been given a complimentary subscription to this digital platform.

 

MRI-guided Transcranial Magnetic Stimulation (TMS) for OCD and treatment resistant depression

The OCD Program has been evolving at Uspace for the past year, with patients coming from Sydney, regional NSW, interstate cities (such as Perth, Melbourne and Adelaide) and even crossing the Tasman from New Zealand. MindSkiller® wanted to fill the gap of low availability of emerging translational interventions for OCD and assist Uspace to turn into a centre of excellence in the assessment, management, research and  development of translational interventions for OCD and related disorders. 

With the aid of funding from the St Vincent’s Curran Foundation , MindSkiller® launched a TMS treatment service for OCD in community radiology-based practices in January 2024. 

VisionTMS began accepting patients for TMS for treatment resistant depression back in December 2022, after MindSkiller® paved this unique partnership between radiologists and psychiatrists to provide MRI-guided TMS at radiology clinics. Many of these patients have co-existing OCD. 

TMS refers to brain stimulation with a specific pattern of magnetic pulses for either 3 or 19 minutes. MRI-guidance means that psychiatrists and radiographers can use brain MRI data and purpose-built neuronavigation software and hardware, including stereoscopic camera equipment, to determine the precise region in the brain to be targeted, map the scalp in 3D space and then determine exactly where on the scalp to position the TMS magnet on each occasion the patient is treated (the initial course is 4-5 weeks followed by a weaning course over a few months). 

Clinical care pathways and outcome measures for TMS courses  

MindSkiller® made possible for the Uspace multidisciplinary team and psychiatrists to coordinate patients having their TMS courses at decentralised radiology clinics by providing the Uspace team access to clinical care pathways for TMS being filled in by the VisionTMS team (with patient consent), in addition to use of outcome measurement digital tools to enable monitoring of symptoms and level of function.

Clinical care pathway for exposure therapy, 2D exposure therapy module and VR exposure therapy intervention for OCD 

Patients with OCD can use the platform to develop an online exposure plan for OCD (beta trial version available free via the  MindSkiller® shop ) to be used either in the ward, at home or during TMS courses. Whilst having a session of TMS for OCD (which takes 19 minutes), patients need to spend at least 5 minutes 'activating their OCD circuitry' by engaging in OCD behaviours (a type of exposure therapy called 'symptom provocation') in order for the treatment to be effective. 

MindSkiller®'s 2D exposure therapy digital tool allows patients to identify the subtypes of OCD relevant to them and mentally do symptom provocation using the software free on their own devices. 

This intervention has been designed to integrate with a VR exposure therapy (VRET) intervention for OCD prototype for individuals with contamination and cleaning subtype - the most common and disabling presentation. This intervention has been created by DP Immersive in conjunction with MindSkiller®, with a funding contribution by a family associated with the St Vincent's Curran Foundation . Patients can transfer the data they entered in the 2D intervention to the VR headset. 

The VR exposure therapy for OCD program has utilised the same scent-enabled VR headset developed by OVR Technologies  (that is being used for the mindfulness anti-distress intervention) because it enables very high-quality VR immersion, which A/Prof Gary Galambos (founder of MindSkiller® and medical director of Uspace) and Professor Brakoulias determined has been missing from previous attempts to introduce the practical delivery of VRET to patients with OCD.

The VR prototype being used in Uspace uses a VR environment called the “Unclean Bathroom”. It has four interactive activity stations, with each station targeting specific clusters of obsessions and compulsions. Patients interact with these stations to desensitise themselves to the anxiety-inducing scenarios.

A world first!

Last week, the VR exposure therapy prototype passed a milestone - the first patient suffering from the contamination subtype of OCD used the intervention. Uspace is now ready to offer the VRET intervention to more patients with the contamination subtype of OCD. The next step will be to test the usability of the VRET prototype in patients needing symptom provoacation during their TMS for OCD courses.

In summary, the VRET for OCD prototype: 

• allows the patient to experience realistic exposure tasks without the costs and inconveniences of real-world settings

• utilises olfactory stimulation for a more immersive experience

• is capable of functioning on any VR hardware including scent based (olfactory) hardware

• is adaptable for individual symptoms

• can be nuanced for cultural and indigenous sensitivities 

• can be engineered for in-person or remote guidance  

• is capable of seamlessly transferring data between 2D devices and VR devices

• can be utilised as standalone VRET or as an adjunct to TMS using the software’s symptom provocation function.  

This is how MindSkiller® has made use of combining technologies to make possible the highest quality methodology to give sufferers of OCD the optimal opportunity to achieve a good outcome from the interventions being employed as a package of care. The hope is to extend the ecosystem of technologies being developed to all mental disorders, one by one, after a template is created for treatment-resistent depression and OCD.