By A/Prof Gary Galambos  
The treatment room of the future is already beginning to look different in my practice. Developing it has been a gradual process, shaped by years of clinical work, hospital leadership, teaching, advocacy and collaboration. I began as a generalist psychiatrist caring for adults across many populations and settings. Over time, my clinical focus shifted towards complex young adults, earlier intervention and interventional psychiatry. Alongside that, my work as a service developer evolved from hospital buildings and consulting rooms towards virtual infrastructure and integrated, multimodal treatment environments. Each development has brought another question into view. How can care remain connected between appointments and across services? How can biological and psychological interventions work together more meaningfully? How can research help us improve care as we deliver it? And how can technology enrich the therapeutic relationship?

These questions have become the foundations of the treatment room I am developing.

Link to video: My Journey Towards Developing the Treatment Room of the Future

What I learned from developing hospital services

My early work exposed me to a broad range of psychiatric care: general adult psychiatry, perinatal mental health, psychosis and clozapine treatment, alcohol and other drug problems, complex personality difficulties, and ECT.

That breadth continues to shape my practice. Even as my work has become more specialised, I retain a generalist perspective. A person’s difficulties need to be understood through their history, physical health, relationships, circumstances and experience of themselves.

Hospital leadership taught me to consider the setting around that clinical encounter. Good care depends on how people, knowledge, resources and responsibilities are brought together.

At St John of God Hospital Burwood, my Medical Director responsibilities included education, continuing professional development and service improvement. With my mentor and colleague, Dr Nicholas Di Ciaccio, I helped revitalise the ECT program. We attended CPD at Northside Hospital with colleagues, learning from a service we regarded as a centre of excellence. When Burwood was rebuilt, our work included developing a new ECT suite.

Later, I organised the practical aspects of a small ECT program for selected Uspace patients at St Vincent’s Private Hospital. The late A/Prof Peter McGeorge facilitated the public–private collaboration that made it possible.

These experiences showed me that developing a service requires sustained attention to the whole clinical pathway: the room, the equipment, staff capability, patient preparation, institutional relationships and follow-up.

Training was integral to that work. For ten years, I convened a monthly CPD program at St John of God without missing a session. I helped establish medical student teaching and registrar training, building on supervision that began during my time at Rozelle Hospital.Teaching, mentorship and service development have always been closely connected in my career. Helping others learn also requires me to examine and refine my own practice.
 

Young adult care changed the questions I was asking

My involvement in establishing Uspace at St Vincent’s Private Hospital Sydney, and subsequently becoming its Medical Director, brought an increasing focus on complex young adults.

I saw how difficult it could be for a young person to move between hospital care, outpatient psychiatry, psychological treatment and everyday life. Several interventions might be appropriate, but the person still needed a coherent course through them.

For many years, my Adelaide Street practice provided follow-up for Uspace patients who did not have their own psychiatrist. That experience strengthened my interest in continuity and earlier intervention.

I became increasingly curious about the architecture of care: how assessment, treatment, review and follow-up could remain connected around an individual’s needs and goals.

My advocacy has grown from the same clinical experience. OCD became a particular recent focus because of the substantial gaps in recognition and access to comprehensive treatment. Working with Professor Vlasios Brakoulias and our colleagues to develop the Uspace OCD program brought together service development, specialist expertise and that advocacy interest.

The question was becoming broader: how could I help develop a course of care that accommodated complexity over time?

From hospital buildings of bricks and mortar to virtual hospital infrastructure

MindSkiller began with education.

I wanted to make psychiatric-grade knowledge more accessible to patients, families and clinicians. Education can help people understand their experiences, consider treatment options and participate more confidently in care. It can also provide a shared language across a multidisciplinary team.

As MindSkiller developed, I began applying what I had learned in hospitals to the digital environment.

A hospital connects expertise, information, pathways and responsibilities. I could see opportunities to support some of those connections virtually, extending them across physical locations and between appointments.

Education became a foundation for a larger ambition: virtual hospital architecture.

MindSkiller has evolved to support outcome measures, care pathways and multidisciplinary collaboration within a team and between teams. I sometimes describe it as the operating system for the developing ecosystem because it helps organise information and connect the people contributing to care.This architecture remains a work in progress. Some functions are already being used; others require further development and evaluation. But it has changed how I think about the treatment room. Preparation, education, coordination and follow-up can extend well beyond its walls.
 

My interventional practice evolved

My interest in neurostimulation grew through years of ECT practice and later through adopting TMS at Uspace and undertaking further training.

When Medicare enabled outpatient TMS treatment, I saw an opportunity to develop a service combining psychiatric and radiology expertise. Working with A/Prof Barnabas Bako and the Vision XRAY Group, I helped establish VisionTMS, incorporating MRI-guided neuronavigation into the treatment pathway.

This collaboration brought another discipline’s knowledge and skills into psychiatric service development. Imaging and neuronavigation help identify intended stimulation locations and guide coil positioning. Anatomical targeting continues to evolve, and there is much still to learn about personalising treatment.

Alongside this work, I became increasingly interested in the psychological experience occurring during stimulation.

What was the patient attending to? What emotions, memories or avoided experiences could we work with? How might the session become part of a purposeful psychological intervention?

These questions led towards developing psychological state-based targeting.

Developing the experience within the treatment room

Through Immersive Therapeutics, Dr Stéphane Verhaeghe and I have been developing personalised psychological and multisensory interventions.

Stéphane brings experience as a neurologist, researcher and innovator. We share an interest in integration: combining our knowledge and clinical experience while retaining a broad understanding of the person receiving care.

Our work has explored reflective interventions, behavioural and emotional activation, exposure and response prevention, and mindfulness-based approaches.

These approaches serve different purposes. Reflective work can help someone examine their narrative and experience. Behavioural and emotional activation can engage meaningful activities and memories. Exposure work can support approaching feared situations while resisting compulsions. Mindfulness can support distress tolerance and connection with the body, other people and the surrounding environment.

AI has expanded our capacity to produce personalised therapeutic media. Conversations, photographs, autobiographical material, interests and goals can inform content that we review and develop with the patient.

Our tools have also changed. We began exploring VR environments and have moved towards AI-generated videos viewed through AR glasses, alongside other multimedia approaches.

Digital olfaction adds another possibility. The AromaShooter2 delivers selected, timed scent bursts through directed airflow towards the nostrils, coordinated with therapeutic content. There is no visible smoke, steam or mist.

The clinical question is what a particular sensory experience means for this person and whether it serves the agreed therapeutic task.The added contribution of these interventions during TMS remains a research question. Their development has nevertheless opened up new clinical conversations and possibilities for personalising the treatment experience.
 

Why I developed TMS Plus

As these capabilities expanded, I recognised another service-development need: coordination.

I had helped bring together multiple teams, technologies, clinical settings and software systems. The patient needed a coherent pathway through them.

I established TMS Plus to help organise that pathway.

MindSkiller supports digital infrastructure and education. VisionTMS brings together psychiatry and radiology. Uspace provides hospital care and multidisciplinary programs. Immersive Therapeutics develops personalised psychological experiences. Adelaide Street is evolving from a consulting-room practice into an interventional psychiatry clinic.

This coordination has helped me develop longitudinal packages of care. Someone travelling to Sydney may undertake a concentrated course over two or three weeks. A local patient’s course may extend over several months. Preparation, treatment, psychological work, measurement and review can be connected across that period.The developing ecosystem depends on the people delivering it. Clinical, nursing, radiology, administrative, media and research teams all contribute. Helping those contributions work together has become a substantial part of my role.
 

Building research into the care pathways

Research and development now form a significant layer of this work.

Earlier experiences of research collaboration taught me that evaluation can place considerable demands on clinical services. I wanted to develop an approach where rather than being onerous for a service, research could contribute useful information to care while allowing the service to be examined systematically.

U-INSPIRE and its outpatient extension, O-INSPIRE, are part of that effort. Stéphane has been instrumental in developing this work and extending evaluation across the inpatient and outpatient ecosystem.

Alongside clinical evaluation, we are developing and testing the infrastructure that supports it.

There are two closely connected R&D streams. One examines MindSkiller’s digital architecture: how information is collected, separated, de-identified and shared appropriately; how systems work across sites; and how external devices can be integrated reliably.

The other evaluates multimodal interventional care, including feasibility, safety, tolerability, engagement, symptoms, functioning and longer-term outcomes.

These streams inform each other. Clinical experience exposes technical limitations. Technical development creates new possibilities that need clinical evaluation.

Our CRC-P submission with Brain Vector and the University of Technology Sydney proposes a further program of clinician-support tools, research and training. It remains a funding proposal, with the intended capabilities and benefits requiring development and validation.Much of this work happens behind the scenes: software development, device integration, protocols, consent processes, media production and reliable data handling. Together, they represent a sustained effort to develop both the treatment model and the infrastructure needed to deliver and evaluate it.
 

Learning from each course of care

Measurement has become increasingly important to my service-development approach.

Standardised outcome measures, patient feedback and clinical assessment help us examine what is changing. Stéphane has introduced biosensor measurement, and we are exploring whether physiological information can add useful understanding.

We are also investigating how AI might help synthesise information from different sources. Its usefulness requires testing and clinical interpretation.

My goal is a developing feedback process in which the patient and team agree goals, deliver care, review experience and measurements, and refine the plan together.

This extends to what happens after an intensive course. Personalised therapeutic media may offer ongoing support informed by what we have learned during treatment. Its value after TMS remains to be evaluated.

Stéphane and I are also preparing an ethics application to investigate ketamine priming around the beginning of a multimodal TMS course for selected patients. We want to examine feasibility and whether there is a signal of added benefit. The proposed study requires approval and concerns a limited initial role, rather than a maintenance-ketamine pathway.

My broader interest is in learning how an initial course can support a subsequent management plan that is as minimally invasive as appropriate.Training continues alongside this development. Students have been observing the ecosystem, and I am working with Professor Kay Wilhelm at the University of Notre Dame Australia to discuss broader placements. The treatment room is also becoming a place where future clinicians can see the relationships between clinical judgement, psychological work, technology and research.
 

How this has changed my therapeutic relationship

The evolution of the service has changed the way I practise.

I now accompany some patients through assessment, imaging, treatment planning, personalised media development and repeated reflection on their experience.

A photograph, a memory or a scene that does not quite feel right can open an important conversation. In my experience, this work can give me a deeper understanding of the patient and help us develop a shared sense of purpose.

The therapeutic frame has become more dynamic. That requires attention to the individual. Some people value the involvement of several team members; others need a smaller, more consistent setting.

As a service developer, I am also concerned with accessibility. How can comprehensive care be delivered efficiently and affordably? How can technology reduce unnecessary duplication while protecting privacy and preserving clinical judgement?

These questions remain part of the design.

The treatment room of the future is taking shape through this continuing journey: from generalist psychiatry and hospital leadership to connected infrastructure, interventional care and personalised therapeutic experiences.What gives that development meaning is the person receiving care. My aim is to keep learning how the different contributions can work together around them—and how I can accompany them more effectively through treatment and recovery.

If you would like to learn more about how this work is taking shape—or explore treatment, referral or opportunities for collaboration—please visit the TMS Plus website 

This artwork was created by Jordan Lovegrove of the Ngarrindjeri people of the lower Murray River, the Eastern Fleurieu Peninsula and the Coorong Lands. It was developed for the RANZCP Reconciliation Action Plan in the colours of the RANZCP branding and depicts neurons communicating, healthy brain function, wellbeing, and positive thought. It is reproduced for the RANZCP with the artist’s permission.