Thou Shalt Not Pass: Solving the Psychedelic Specialist Therapist Bottleneck
At least 1.5m people in England are waiting for mental health treatment whilst 1 in 10 consultant psychiatrist posts are not filled. Mental health workforces are shrinking, at a time when demand for mental health services is increasing.
This is not a picture that is unique to England, or even the wider UK. We see shortages of mental health professionals globally, and this has only been exacerbated by the pandemic’s toll on people’s mental wellbeing.
Researchers are now developing novel treatments that use psychedelic drugs with the promise to address this mental health burden. Paradoxically, these therapies, assisted by psychedelics, may require a larger mental health workforce, and with new skills, due to the duration of medication sessions and these medications’ unusual effects on patients’ mental states.
So far, the initial excitement of developing new drugs has attracted significant commercial interest but the delivery aspects of these treatments are yet to receive the same attention. Currently, there are more than 150 psychedelic drug developers in the market, while more and more are joining. Patients’ demand for psychedelics is also increasing as psychedelics become mainstream.
There are not enough therapists to deliver these treatments. The shortage of psychedelic-specialist therapists is already a challenge for drug developers wanting to conduct clinical trials and this will lead to larger capacity and capability problems when psychedelic-assisted therapy is ready to be rolled out within the wider health system.
Without significant effort, a lack of trained therapists will be the main bottleneck that will limit the progress of not only clinical development but also the integration of these treatments into the health system.
There are multiple layers to this problem:
Not enough therapists
Not enough therapists interested in psychedelics
Not enough opportunities for interested therapists to gain and develop skills
Not enough practice opportunities for skilled therapists to keep and improve their skills until psychedelics get market approval
Not enough therapists
The under-capacity of mental healthcare is not an under-discussed issue. Although there have been attempts to improve mental health services through better funding, there has been a lack of staff to spend this money on. Relatively low salaries also don’t make this field the most attractive profession and this will continue until there is a systemic change.
Example digital health solution by Monsenso, a leading business in e-health space. (Source: monsenso.com)
Recent developments in e-health provide promising solutions by increasing the capacity to deliver mental health support. With e-health technologies, communication between patients and therapists does not have to happen in real-time allowing shorter but more frequent contact opportunities. Sessions can also be delivered online and remotely, addressing the geographical differences in the availability of the workforce.
As the practices around psychedelic-assisted therapy are being established in real-time, we have the opportunity to build them with technologies integrated from the start. Researchers are also investigating group therapy for psychedelics, which will help scale these therapies. Using a wider pool of the workforce to deliver therapy, such as re-skilling mental health nurses and social carers, can help address the shortage of therapists as well.
Not enough interest in psychedelics
Although psychedelics have started to be discussed in the mainstream media, the developments happening in the field are not widely known, especially outside circles with a special interest in psychedelics. In contrast, psychedelics still suffer from stigma and concerns around their potential risks, and therapists might not want to work with them.
Shifting the perception of psychedelics is challenging but essential. We can have all the necessary infrastructure, regulatory frameworks and efficacious drugs, but if we do not have therapists willing to deliver treatments, then psychedelics will stay inaccessible.
Continuously communicating the emerging evidence as well as including psychedelics in medical and other relevant degrees’ curriculum can mostly address this problem. We need to ensure that we speak the same language, as terms such as ‘mystical experience’ are unlikely to be relatable to the majority of mental health workers.
Until psychedelics are acknowledged by professional bodies and information about them is more widely available, we need to actively reach out to mental health professionals that are outside psychedelic bubbles. Accredition from a serious player such as British Association for Counselling and Psychotherapy (BACP) would be hugely beneficial.
Not enough training opportunities
Since we do not yet know what therapy or training model works best, there is no standardised training that is provided by an independent body. The majority of training courses are offered by drug developers. Every drug developer has its own certification for a specific therapeutic approach used in a specific clinical trial. However, this fragmented approach does not prepare the workforce to deliver therapy on a large scale as individuals will not be well equipped to work with different compounds and disorders.
“How strange would it be if your doctor was employed by AstraZeneca?”
Most training opportunities, especially the ones not offered by drug developers, are expensive and time consuming (some up to 300 hours over multiple years!), making training accessible only to people with spare time and money as opposed to those best suited to the role. This situation can potentially also create a situation whereby someone who pays £10k to join a training scheme expects to pass. If the training programme is pressured to do so, irrespective of the therapists’ capabilities, this is likely to lower the quality of therapists qualified to deliver therapy.
There is an urgent need to develop standards both for the therapy and also for its training model. We need this model to be transdiagnostic, delivered by independent organisations and accessible to more people both financially and professionally. It is still too early to standardise therapy as we do not know what works best, but we can make training freely available to a broader set of mental health professionals and focus on transdiagnostic therapy models with an existing evidence base.
We're highly likely to have a shortage of psychedelic-specialist therapists by the time these drugs reach the market due to the capacity and capability challenges faced.
Not enough practice opportunities
Practising psychedelic-assisted therapy for continuous professional development is very challenging. In an overwhelmingly large majority of jurisdictions, the only way to legally deliver psychedelic-assisted therapy is through clinical trials. However, clinical trials use different therapy models which require therapists to re-skill, and are not continuously available in different locations for therapists to keep their skills fresh. Even when trials are available, few patients participate them.
Adapting and using an evidence-based therapy model that is already widely practiced within the healthcare system can help address this problem. Training therapists to use a therapy model with psychedelics would be much quicker if they are already familiar with that model. It would also be easier for therapists to keep their skills fresh as they would have many opportunities to practice even if they have no access to psychedelics.
Message in a bottle(neck)
By the time psychedelic drugs reach the market, we need to have enough therapists able to deliver psychedelic-assisted therapy within the health system. Attracting and training therapists is key, but this needs to happen in an accessible and sustainable way while also considering the requirements of a health system that needs to deliver on a large scale. It is time that we start investing resources for the necessary infrastructure required to develop this vital workforce in parallel with drug development.
