Young adults’ experiences and recovery in Uspace’s transdiagnostic and OCD-specific inpatient programs: a mixed-methods study of outcomes for young people with complex mental health conditions.

The study evaluates a package of non-drug interventions integrated into routine inpatient care at Uspace for young adults with complex mental health conditions, focusing on feasibility, safety, acceptability, and clinical outcomes over a typical admission episode. Patients are admitted to Uspace under a transdiagnostic, routine-care General Program, and an OCD diagnosis may sometimes be identified or confirmed only during their inpatient stay, after comprehensive assessment and multidisciplinary review. This means a patient may enter the service as part of the “general” cohort and subsequently move into, or concurrently receive, OCD-specific interventions during the same admission. Arm 1: Standard Group Therapy Brief name: Standard transdiagnostic and OCD-specific group therapy. Materials: Structured psychoeducational handouts, worksheets (for example, DBT skills sheets), and group guidelines are provided in printed and digital formats to support learning and peer discussion. Procedures: Daily transdiagnostic groups focus on psychoeducation, emotional regulation, distress tolerance, interpersonal effectiveness, and peer support; for the OCD Program, additional psychoeducational and feedback groups for patients and families address OCD mechanisms, coping strategies, and service improvement. Participation is voluntary, with clear ground rules to support emotional safety and confidentiality. Who delivers: Qualified mental health clinicians (clinical psychologists, psychiatrists, mental health nurses, and allied health staff) with experience in group therapy for young adults. Mode of delivery: In-person, face-to-face group sessions on the inpatient unit, with some family sessions optionally including telehealth participation where clinically appropriate. Number and timing: General Program: Typically 1–2 group sessions per weekday, 45–60 minutes each, across the duration of the inpatient stay (approximately 2–6 weeks, depending on clinical need). OCD Program: In addition to standard groups, OCD-specific psychoeducation and family sessions occur approximately once per fortnight during the admission, 60–90 minutes each. Location/setting: Uspace 20-bed young adult inpatient mental health unit at St Vincent’s Private Hospital Sydney (specialist early-intervention service for young adults). Adherence/fidelity: Attendance is recorded for each group; a standardised group program schedule and facilitator guides are used, and senior clinicians periodically review content and delivery to maintain fidelity to the therapeutic model. Arm 2: MRI-Guided Transcranial Magnetic Stimulation (TMS) Brief name: MRI-guided TMS for depression and OCD. Materials: MRI scanner and neuronavigation system to identify cortical targets, TGA-approved TMS device with magnetic coil, treatment chair, safety questionnaires, and adverse-event monitoring templates. Procedures: A baseline neurological and psychiatric assessment is completed, including standard safety screening. An MRI brain scan is used to localise target regions (for example, dorsolateral prefrontal cortex for treatment-resistant depression and OCD-relevant targets as available), followed by courses of repetitive TMS according to standard clinical protocols, with real-time observation and recording of side effects. Courses may be delivered either by radiographers with advanced training or by psychiatrists/nurses, always under consultant psychiatrist supervision, with the operator recorded prospectively for each session. Who delivers: Consultant psychiatrists prescribe and supervise courses; TMS is administered by trained radiographers (linked radiology/TMS services) or Uspace psychiatrists/nurses with specific TMS training. Mode of delivery: In-person, one-to-one sessions at partnered radiology/TMS clinics; MRI is delivered in standard radiology suites. Number and timing: A typical course consists of approximately 20–30 sessions delivered 5 times per week over 4–6 weeks, with each TMS treatment session lasting about 20–40 minutes, consistent with routine clinical protocols. Location/setting: Uspace inpatient unit (for assessment, referral, and follow-up) and partnered MRI/TMS facilities (for example, external radiology/TMS providers). Adherence/fidelity: Treatment logs record session attendance, stimulation parameters, side effects, and operator; feasibility and fidelity are assessed by completeness of prescribed courses, adherence to protocol, documentation audits, and supervision with structured training resources to support operator competence. Arm 3: Virtual Reality Exposure Therapy (VRET) and 2D Exposure Module (2DET) Brief name: Virtual reality and digital exposure therapy for OCD. Materials: VRET: VR headset, computer and software providing graded OCD-relevant exposure scenarios with adjustable intensity, and emergency stop controls. 2DET: A digital two-dimensional exposure module delivered via the secure MindSkiller platform or similar, using structured exposure tasks and psychoeducational content. Procedures: A structured exposure hierarchy is developed collaboratively with the clinician. VRET sessions expose participants to virtual OCD-relevant triggers in a graded fashion with response-prevention coaching and monitoring of subjective distress; emergency stop and intensity controls support safety. 2DET sessions guide participants through non-immersive, screen-based exposure exercises completed in-session or as supported tasks between sessions, integrated with routine OCD therapy. Who delivers: Clinical psychologists, psychiatrists, and other trained mental health clinicians with CBT/OCD expertise deliver and supervise VRET and 2DET sessions. Mode of delivery: VRET: Face-to-face, one-to-one sessions using VR hardware in therapy rooms on the ward. 2DET: Individual, digitally mediated exposure tasks accessed on ward computers or personal devices under clinician guidance. Number and timing: VRET: Typically 4–8 sessions per admission, 30–60 minutes per session, 1–2 times weekly depending on length of stay and clinical tolerance, commencing after assessment and consent. 2DET: Shorter, more frequent modules (for example, 2–3 times per week, 15–30 minutes each) embedded in the inpatient schedule, with optional follow-up use post-discharge. Location/setting: Uspace inpatient unit (therapy rooms or quiet spaces) using secure hardware and networked access to the software platform. Adherence/fidelity: Session logs capture attendance, scenario type, duration, distress ratings, and early termination; standardised exposure protocols and session checklists are used, and MindSkiller-linked tools allow monitoring of utilisation and symptom change over time. Arm 4: Virtual Reality Positive Memory Enhancement (VRPME) Brief name: VR-based AI-assisted positive memory enhancement for depression and anxiety. Materials: VR headset and software delivering immersive positive or soothing environments combined with AI-assisted therapeutic scripts guiding positive memory recall and cognitive re-scripting. Procedures: Participants engage in structured sessions in which they are prompted to recall and elaborate positive or mastery-oriented memories while immersed in tailored VR scenarios (for example, calming nature environments), with a clinician supporting emotion regulation and cognitive restructuring. Who delivers: Clinical psychologists, psychiatrists, or other trained mental health clinicians with experience in trauma-informed and cognitive therapies for young adults. Mode of delivery: Individual, face-to-face sessions using VR equipment in designated therapy spaces on the ward. Number and timing: Approximately 3–6 sessions per admission, 30–45 minutes each, usually 1–2 times per week depending on symptom severity, engagement, and length of stay. Location/setting: Uspace inpatient unit, in VR-capable therapy rooms or quiet spaces. Adherence/fidelity: Standard VRPME protocols and scripting templates are used; session notes document content, emotional responses, and any adverse events, and adverse event registers track side effects such as dizziness or nausea. Arm 5: Mental Health Literacy eLearning Platform (MindSkiller) Brief name: MindSkiller digital mental health literacy and research platform. Materials: MindSkiller online platform providing interactive psychoeducational modules, multimedia content, knowledge checks, and scenario-based learning for depression, anxiety, OCD, and transdiagnostic topics, as well as secure case report and outcome-measure modules for research data capture. Procedures: Participants complete tailored learning pathways on MindSkiller during admission (for example, diagnosis-specific modules, coping skills, treatment options), while clinicians review progress and link content to individual care plans; the platform concurrently collects symptom and functioning outcomes via standardised questionnaires. Who delivers: Content and oversight are provided by consultant psychiatrists and clinical psychologists with digital mental health expertise; ward clinicians encourage and support patient use. Mode of delivery: Digital, self-paced eLearning accessed individually on personal devices or ward computers, supported by brief face-to-face check-ins with clinicians as needed. Number and timing: Participants are encouraged to complete several core modules during their inpatient stay (for example, 3–6 modules, 20–40 minutes each) plus optional additional content, typically a few sessions per week aligned with individual capacity and length of stay. Location/setting: Uspace inpatient unit and, where feasible, post-discharge at home via secure login to the MindSkiller platform. Adherence/fidelity: Platform analytics track log-ins, duration of use, modules completed, and quiz performance; clinicians review engagement reports and prompt completion where appropriate, and standardised modules with version control ensure protocol consistency during the study period. Personalisation and Fidelity Across Arms Personalisation: All interventions are embedded in a person-centred inpatient model in which treatment plans are tailored to diagnosis, symptom severity, comorbidities, and patient preferences, with the intensity and combination of group therapy, TMS, VR/2DET, VRPME, and MindSkiller adjusted collaboratively in multidisciplinary meetings. Fidelity: Structured protocols, manuals, and digital pathways are used for each intervention, with routine documentation of attendance, dose, adverse events, and operator type (for example, radiographer versus psychiatrist/nurse for TMS), plus periodic supervision and audit by senior clinicians to support fidelity assessment.