Psychedelics: A Solution to a Global Mental Health Crisis? Not likely.

Author: Iain Burgess is the lead researcher at Blossom. He studied Global Health (MSc) and Physiology (BSc) and has researched the various scientific, societal, cultural and political dynamics that have shaped our understanding of psychedelics throughout history.

Psychedelics are poised to be a paradigm shift in mental health care. The renewed interest in the therapeutic potential of these psychoactive substances has researchers, the media and even celebrities singing the praises of psychedelic medicine.

While such praises do ring true given the clinical evidence that is emerging on what is now a daily basis, we may be over-optimistic regarding the potential reach of psychedelic-assisted therapy (PAT).

We have become all too familiar with the mental health crisis that continues to tighten its grip across the globe. The profusion of companies and actors in the psychedelic space like to remind us of this crisis in the hope that their proprietary formulation of a given psychedelic will be the answer we’ve been looking for.

Many are being led to believe that psychedelics are a silver bullet aimed at global mental health. Many company websites tend to quote figures on mental health from The World Health Organization followed by promises that they will “revolutionize psychiatry and address a growing mental illness market” or their molecules “have potential to change the lives of millions.” While in the media psychedelics are often referred to as the “next big thing” in mental healthcare. In reality, like many innovative technologies in the medical world, PAT is likely to be a luxury for people in high-income countries.

If the current rate of COVID vaccine inequity between the Global North and Global South is anything to go by, PAT is far cry from a silver bullet. With time, it is plausible that PAT becomes a viable therapy option for people in the South. However, will the fact that issues surrounding mental health are often taboo in lower-middle-income countries (LMICs) impact the implementation of PAT?

Furthermore, will people in countries that rely on medical frameworks outside the scope of western medicine be receptive to PAT? Or do LMICs have the infrastructure to support PAT? If psychedelics are really going to impact global mental health, then surely their potential must extend to some six billion people living across the Global South.

Barriers in the South

Making technology work, in this case, PAT, across different contexts requires substantive effort as each context possess a unique set of boundaries that must be overcome. While we in the North are well aware of the importance of maintaining a healthy mind, mental health disorders tend to be overlooked in countries where the threat of communicable diseases like malaria, cholera, and AIDS is far more imminent. The implications of this notion are reflected in the scarcity of research and the allocation of resources dedicated to mental health in many LMICs.

Across Africa, for example, the region has an average of 1.4 mental health workers per 100,000 people, compared with a global average of 9.0 per 100,000 [1]. Additionally, as a result of poorly resourced mental health facilities, the proportion of Africans who receive treatment for mental health problems is extremely low.

A similar story is unfolding in India. The latest edition of the Global Burden of Disease study estimated that 14% of India’s population suffered from mental health disorders, including 45.7 million suffering from depressive disorders and 49 million from anxiety disorders [2].

Across countries in the South, a lack of education and awareness combined with traditional views of health has resulted in mental health being highly stigmatized in these countries [3]. Subsequently, seeking treatment for mental health is made all the more difficult. When people do seek treatment, western medicine can often be overlooked in favour of traditional healing practices.

The Importance of Context

Given that traditional healers are the original vanguards of psychedelic plant medicine, it could be possible that people who seek more traditional healing methods are more receptive to psychedelic-assisted therapies. However, if psychedelics are confined within the biomedical framework, it is likely that the scope of the therapeutic potential of these substances will be limited. For PAT to reach people in the South, it will be essential to engage with these traditional healers as well as the communities in need of mental health treatments.

The importance of context is well-known by those in the world of psychedelics and is emphasized at the individual level through the concept of set and setting. However, in countries where mental health may not be the highest priority, community engagement is essential to gain an understanding of context and the perceived barriers to treatment people face before PAT can be implemented on a wide scale.

Even still, the current scheduling of psychedelics as Schedule I substances and the resulting high costs of working with these substances makes the idea of PAT as a viable treatment option in LMICs somewhat unfathomable. Thus, the policy surrounding psychedelics must be reformed if these substances are going to have a truly global impact.

If the policy is changed and communities in the South warm to the notion of PAT, many countries may not have the infrastructure to support such treatment models. Many people rely on primary healthcare centres for their medical needs. These healthcare centres often have a wide catchment area, particularly in rural areas, but are often understaffed and lack basic infrastructures such as a consistent supply of water and electricity.

Moreover, the need for therapists and medical professionals that are adequately trained in psychedelic medicine could further jeopardize the chances of PAT becoming available within urban areas in LMICs, never mind rural healthcare centres.

Education is perhaps the most important step to seeing the successful transfer of PAT to LMICs. While education surrounding psychedelics is undoubtedly important, education surrounding mental health, in general, should be the first point of call. Educating communities on the importance of mental health should be the first step as it helps to destigmatize and let people know it is ok to seek help.

Structural Change

Despite significant progress over the past number of years, psychedelic science remains in its infancy. As many countries in the North await the latest mental health treatment, those in the South largely await mental treatments in general. Even in high-income countries, it is going to take a significant amount of time before PAT becomes widely accessible. The idea that psychedelics are a solution to the global mental health crisis is false. The solution relies on something much more than another drug-based paradigm in mental healthcare. Structural change is needed to ensure equity for all.

Actors in the field of psychedelics need to dismiss the rhetoric of psychedelics being the solution. Psychedelics are only going to be a solution for some and only time will tell if their reach can extend beyond high-income countries. If these actors truly want to impact global mental health perhaps, they should start focusing on structural changes and creating infrastructure for these therapies as opposed to another proprietary formulation.

References

1. Sankoh, O., Sevalie, S., & Weston, M. (2018). Mental health in Africa. The Lancet, E954-E955.

2. Global Burden of Disease. (2019). The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990–2017. Lancet Psychiatry, 148-161. https://doi.org/10.1016/S2215-0366(19)30475-4

3. Pendse, S., Karusala, N., Siddarth, D., Gonsalves, P., Mehrotra, S., Naslund, J., . . . Sharma, A. (2019). Mental Health in the Global South: Challenges and Opportunities in HIC for Development. Microsoft Research. https://www.microsoft.com/en-us/research/uploads/prod/2019/07/pendse-compass2019-mental-health-global-south.pdf