Hard News by Russell Brown

Psychedelic therapy shows a lot of promise. Probably a large percentage could be done safely in community settings eg microdosing. But I wonder about rolling out facilities to cater for those who may need a residential setting eg people with major depression who may take some time to improve and whose risks may necessitate 24/7 supervision and when doses are large enough to generate risks by misadventure etc. And it’s well known that risk increases at the point when treatment for depression starts to take effect.

The government could set up a residential system in parallel to the curent acute mental health inpatient services but that would be expensive and to some extent duplicate resources and exacerbate an already dire shortage of mental health professionals.

Currently acute services wouldn’t be an ideal environment to have a psychedelic experience. The courts are sending very risky people to inpatient units when they should be going to the forensic services and because of under resourcing and increased illicit drug use staff and patient safety is placed at constant risk.

Ideally the govt would provide the resources to ensure that in patient settings would be appropriate for psychedelic treatment (many of those who would benefit are already being treated there) as well as just being safe for all which one would think would be a high priority anyway.

As well as complexities regarding treatment environment there are dilemmas already faced in acute mental health that haven’t been addressed at all in the recent review which will inevitably occur in any psychedelic treatment regime.

One example is if someone with a major depressive disorder receives psychedelic treatment but then goes on to complete suicide - will the treatment providers be held responsible?

If someone receiving psychedelic treatment wants to leave the treatment but remains at risk what duties of care would the clinicians have regarding preventing harm?

These are difficult and contentious issues which are hard to find solutions for and at present the government is not attempting to promote any public discussion in this area.