By Bart Magee, Ph.D.
News of the strike of mental health providers at Kaiser Permanente was the latest in a stream of stories of a mental healthcare system stretched far beyond its limits by a growing post-pandemic demand for care and a shortage of psychotherapists, psychiatrists and other providers. This crisis of care started well before the pandemic and will take many years to resolve. In the middle of it all, we are seeing the fruits of the research in psychedelic medicine lead to an explosion of interest in their potential, which begs a critical question: will the recent advances in psychedelic medicine and coming FDA approval of treatments help us expand treatment options and effectiveness help to mitigate the mental healthcare crisis?
There are multiple fronts in the current crisis of care, the first being the vastly increased need among youth, a need that was exacerbated by pandemic-related school closures and isolation. Suicide attempts are up dramatically among youth with ER crisis visits increasing 51% in the past two years. But increased needs aren’t just showing up among young people. According to the World Health Organization, rates of anxiety and depression are up 25% since the start of the pandemic. The recent social climate of high anxiety, misinformation, social isolation, disruption to routines, and ongoing loss has impacted our collective mental health in complex ways that will take time and real efforts to recover from.
Just when people are needing more support, the shortage of mental healthcare providers is projected to go from bad to worse. In 2018 a study out of UCSF projected that by 2028 there would be half as many psychologists, psychiatrists and licensed clinical social workers as there were in 2016. This is largely due to the high number of retirements among the baby boom generation and an education and training system that has not responded and failed to grow. This was before the pandemic pushed even more late-career professionals to reduce or close their practices.
The impact of this shortage is experienced most acutely among low-income individuals and families, those who lack the kind of insurance coverage that gives access to larger panels of providers. This is just the issue that families covered by Kaiser Permanente are facing. When there aren’t enough therapists or psychiatrists on a panel, patients have to wait for weeks, event months for a first visit. This is a big reason we see the spike in crisis ER visits. In addition, as the demand rises, therapists are less and less likely to accept the kinds of insurance, like Medicare and MediCal, that lower-income folks have.
Today, a therapist can easily fill her practice with people who have the disposable income to pay up front and wait for insurance reimbursement or not need it at all.
The obvious solution to this gap is to increase the education and training of providers, also obviously a complex process can’t be achieved overnight. Educational programs need time to hire more instructors and training programs like Access Institute also need the time and funding to hire more staff and build capacity. While this is all happening, there has been an explosion of interest, research and clinical practice in psychedelic medicine. Can this emerging practice and model of care help us address the gap?
Highly psychoactive substances have been around and used in medicine for a long time. Plant based psychedelics like the psilocybin in certain species of mushrooms, for example, have been used for healing purposes for millennia. Substances derived from chemical processes like LSD and MDMA were discovered early in the 20th century and were originally studied for their potential benefit to patients suffering from mental illness and substance abuse. These studies thrived in the 1950s and 1960s, but were shut down when the war on drugs, which began in the ‘70s, led to all these substances being classified as Schedule 1 by the FDA, meaning they were deemed to have a high-addictive potential and no known therapeutic benefit. This tight regulation made it almost impossible to conduct research. Thanks to the efforts of a few intrepid scientists and advocates, research began to revive in the late 1980s and 1990s. Pressure on federal agencies had an impact and with the drug war losing its political momentum research projects gained approval. Which brings us to today.
Over the past 30 plus years, researchers have amassed a wealth of data on the efficacy of psychedelic medicines for a wide range of mental health problems including, anxiety and depression in cancer patients, post-traumatic stress disorder (PTSD) in veterans, eating disorders and various forms of substance dependence. Recently, the Biden Administration announced that the FDA approval for psychedelic medicines will occur within two years. Approval will vastly expand and bring these treatments into the mainstream. In the meantime, states are pursuing their own efforts. Oregon voters approved a ballot measure that will make psilocybin legally available for treatment next year. Other states are following. And ketamine is already being prescribed “off-label” as a treatment for depression.
With these new treatments coming up, we are truly entering a watershed moment in mental healthcare. We have not seen the introduction of so many potentially beneficial treatments in decades, if ever. For many patients who suffer from severe PTSD, treatment resistant depression, the debilitating effects of obsessive compulsive disorder (OCD), or serious substance dependence, traditional therapies and medications do help and can be lifesaving, but often take a long time to have an impact and, for many, only offer mild to moderate reductions in symptoms. A severely depressed patient may no longer be actively suicidal, for example, but remains limited in their daily activities. Some of the research findings from the studies of psychedelic medicines have demonstrated their potential to greatly accelerate the therapeutic healing process and many cases have resulted in the complete remission of symptoms.
While there is great promise for these emerging therapies, so many questions must be explored. How do these medicines work in the brain and in the mind? Which ones work better for which conditions? How are they used in therapy and how do we weigh the risks and benefits? What about the potential for abuse, how do we ensure that these drugs are used for therapeutic benefit and not for personal gain and profit? And how do we make sure that these medicines reach the people who need them most, rather than becoming accessible only to the wealthy and privileged?
At Access Institute, we are keenly interested in all these questions. We recognize our good fortunate in the Bay Area to be at the center of so much of the research. In addition, a number of the graduates of Access Institute’s training programs have gotten involved in research programs and initiatives. We are pleased to be bringing a number of them together for a public event the evening of Friday, September 16th in San Francisco. I will facilitate as the panel addresses questions and engages in a deep discussion of the issues with the goal of providing a roadmap for how we can maximize the potential of these new therapies to address the crisis of care and provide a new avenues of healing for those suffering the most.