by Jake Mitchell
Written while I was a student at Centennial College – Addiction and Mental Health Worker Program (Special Populations Course).
Most healthcare and mental health workers are likely to experience a form of post-traumatic stress or compassion fatigue during their career. According to the Mental Health Commission of Canada more than 40% of doctors and nurses experience advanced stages of burn out from their jobs; further stating that, “healthcare workers are 1.5 times more likely to be off work due to illness or disability” (Mental Health Commission of Canada [MHCC], 2016, para.11). These helping professions including first responders who have increasing rates of suicide related to Post-Traumatic Stress Disorder (PTSD) carry a high burden and stigma around being open with mental health struggles. Just like a carpenter relies on their hands to work properly to craft their projects, healthcare and mental health workers must maintain a stable psyche to manage their clients and patients who rely on them.
With the research supporting psychedelic-assisted therapy for this population coming to light, we must take advantage of the high efficacy and safety profile to make this new optional treatment path available. This is important to me because my co-workers and I have struggled with compassion fatigue and trauma-related stress at times as a paramedic; also, I have done years of research on the neuroscience of these disorders and the mechanisms that make psychedelic-assisted therapy safe and effective in the correct set and setting. Many professionals lean more towards conventional treatments like anti-depressants, Cognitive Behavioural Therapy, or psychotherapy due to fear bred by the stigma and propaganda constructed around these substances. According to Al Jazeera America (AJA) recent trials with psychedelics showed 83% of participants no longer fit the PTSD criteria (Multi-disciplinary Association of Psychedelic Studies [MAPS], 2019, para.21). Some of my knowledge has been primarily anecdotal or first-hand until the recent surge of clinical trials using psilocybin and methylenedioxymethamphetamine (MDMA) to alleviate treatment-resistant symptoms of depression and PTSD.
Despite the desperate need for a treatment option like psychedelic-assisted therapies there is still stigma and resistance slowing down the progress of regulating them for a few more years. With more of honest dialogue and increasing evidence-based knowledge of the safety and efficacy of psilocybin and MDMA-assisted interventions, the stigma can be overcome so more professionals are open to trying these options in a regulated setting with a trained therapist and decrease the rates of stress-related mental health disorders. Could these psychedelic treatments be integrated into the healing of healthcare and mental health workers who experience PTSD or compassion fatigue? Could they soon become an alternative option to SSRIs or CBT?
The question that must be answered in this appraisal is important to the well-being of addictions and mental health workers. Are psychedelic-assisted therapies a safe and effective alternative to conventional CBT, psychotherapy, or anti-depressants for healthcare and mental health workers for the symptoms of compassion fatigue and PTSD? The phrasing and Boolean operators that assisted this search will be elaborated on in the “Methods” section below. Knowing this may assist my professional practice is two distinct areas. The first would be that my goal is to work with clients who are experiencing symptoms of PTSD or compassion fatigue, which makes it crucial that I make safe and informed recommendations to give them the best chance at improving quality of life, while being mindful of the value and ethics of evidence-based practice.
The second area is in my own self-care decisions going forward in my career. I have already learned how to safely and effectively integrate cannabis into my health and wellness due to the newly available research and information on terpene profiles. If psychedelic-assisted therapies continue to prove to be as safe and effective as the current clinical trials are showing, they may be a more favourable option over conventional therapy if I ever re-experience any of those symptoms. Furthermore, if asking this question can shed light on the truth around the neurophysiology and efficacy of these novel treatments then more professionals and patients may become more open to their benefits. If integrating psychedelics into our healing can increase meaning and compassion surrounding our careers and well-being as helpers, then they may be a protective factor in preventing work-related mental health problems.
To collect the evidence, I went with a strategy that I practiced while appraising research for paramedic practice in Nova Scotia. I decided to use the PubMed database for its variety of medical literature and consistency in accessible articles. This is one I have used a lot in the past. I am familiar with the PICO style question when reviewing literature and find it effective for comparing interventions. I initially searched for the keywords (psilocybin OR MDMA OR methylenedioxymethamphetamine OR psychedelic) AND (“compassion fatigue” OR “burnout” OR “post-traumatic stress disorder” OR PTSD), which yielded 114 results that were unrelated to my question or did not fit my criteria required.
I then decided to focus more on finding trials that proved safety and efficacy for relieving symptoms to keep the topic relevant and specific to the aim of my question. Due to the current success of MAPS in legalizing and regulating MDMA for the treatment of PTSD, with FDA approval set for the year 2021, I decided to focus the search on the safety and effectiveness of psilocybin on the symptoms of compassion fatigue and depression amongst the healthcare and mental health work population. That way I can be as certain about psilocybin for compassion fatigue and depression as we can now be about MDMA for PTSD. I searched the keywords (“quality of life” Or “depression” Or “symptom relief”) AND (psilocybin).
To select the best studies from those results to include in my appraisal I decided to use some controlled quantitative studies that showed the direct physiological effects of psilocybin on physically healthy participants. I mostly used controlled qualitative studies that explored the subjective effects and symptoms relief that psilocybin gave subjects who experienced moderate to severe symptoms of depression. Combining the quantitative certainty of highlighting exactly how psilocybin allows the brain to heal with the subjective experiences of the subjects will reinforce an understanding of how effective of an alternative psychedelic-assisted therapies can be.
I made sure they were not funded by any companies that would have an interest in keeping psychedelics illegal such as alcohol, tobacco, pharmaceutical, and others that would have conflict of interest. I included studies done with a controlled dose, set, setting, and intention; which would exclude systemic reviews of emergency room visits or other recreational situations that would affect the ability to control those variables. The core reason that subjective experiences are important to focus on is that everyone experiences symptoms of trauma, stress, compassion fatigue, and depression differently. Therefore, finding evidence that this treatment option allows the healing of those subjective symptoms would mean that it would increase efficacy by allowing healing through a client-centered lens. This would be most the effective and revealing root causes of trauma, accounting for the high success rates of the recent psychedelic-assisted therapy trials.
Using the search strategies including the PICO method, keywords and PubMed database I was able to yield 93 results. Most results were not included for not matching the criteria of measuring the quantitative or qualitative effects that were mentioned in the above “Methods” section. Out of the 93 results 53 were excluded by their abstracts because they were not measuring symptom relief of the specified mental health problems, 30 were excluded by their abstracts because they did not control for health status of participants or not on healthy volunteers, 3 were excluded by their titles because they were done on rats, 2 were excluded because I could not access the full article. In the end I included 5 studies that matched the values, ethics, and criteria of this specific research question.
These studies were either quantitative controlled neuro-imaging studies that showed the correlations of the physiological effects with the symptom relief or qualitative studies that controlled for the purity of psilocybin, quality of therapy, set and setting. This is enough to assess the safety and effectiveness of psychedelics as an alternative option to conventional treatments for symptoms of mental health problems in healthcare and mental health workers. The relevant information and findings from the studies are summarized in the tables below.
|Citation||Erritzoe, D., et al. “Effects of Psilocybin Therapy on Personality Structure.” Acta Psychiatrica Scandinavica, vol. 138, no. 5, 2018, pp. 368–378., doi:10.1111/acps.12904.|
|Purpose and study rationale||To see if psilocybin-assisted therapy could alter personality traits of those with treatment resistant depressions (increasing extraversion and openness)|
|Fit and specific rationale||The qualitative method is appropriate because they are assessing subjective personality changes of participants|
|Design||It was appropriate because it measured depression and personality scores before and after psilocybin therapy, with 3-month follow up. Done in controlled setting.|
|Participants||Picked based on having severe treatment-resistant depression|
|Researcher (or researchers)||Random volunteers with no relationship to researchers.|
|Ethics||Physically healthy volunteers with treatment-resistant depression who have tried everything else, done in a supportive setting, with trained professionals. Follow up was done 3 months after.|
|Context||Controlled lab/treatment room that was decorated in a supportive and calming atmosphere for the experience.|
|Data||Depression and personality scores taken before and after, then at 3-month follow-up. Altered State of Consciousness scale done with session.|
|Analysis||It was done with three thorough scoring tools in a controlled environment and controlled dosage.|
|Findings and results||They found absolute increases in extraversion, openness, and conscientiousness that they can attribute to the mechanism of anti-depressant effects|
|Conclusions||Psilocybin-assisted therapy may be effective for treatment-resistant depression due to its positive affects on personality change|
|Implications and application||Very valuable to the future goals of treatment and aims of further neuroscience research to explore where these effects are taking place neurologically|
|Citation||Carhart-Harris, R. L., Bolstridge, M., Day, C. M., Rucker, J., Watts, R., Erritzoe, D. E., . . . Nutt, D. J. (2017). Psilocybin with psychological support for treatment-resistant depression: An open-label feasibility study. Lancet Psychiatry, 3(7), pp.619-27. doi: 10.1007/s00213-017-4771-x|
|Purpose and study rationale||The aim is clearly to assess the safety, efficacy, and feasibility of using psilocybin as a treatment for treatment-resistant depression|
|Fit and specific rationale||Qualitative is fitting as it is assessing feasibility for symptom relief for patients who may have subjective expereinces|
|Design||Designed appropriately to assess the subjective effects of psilocybin when given to physically healthy volunteers in a controlled, supportive setting|
|Participants||It was appropriate with selecting participants because it only selected participants with unipolar treatment-resistant depression|
|Researcher (or researchers)||There was no prior relationship before the study. A supportive relationship was formed during the trials to build trust and rapport and add to the safety of a supportive environment.|
|Ethics||Participants were screened for contraindications and goal is to alleviate symptoms where participants have tried all other options|
|Context||In a controlled lab that was made to be comfortable and supportive of a psychedelic experience.|
|Data||Participants screened and depression scores assessed prior to trial. Monitoring of physical condition during the trial and at subsequent follow ups. Depression scores taken again at follow-up to compare with baseline, prior to treatment.|
|Analysis||Data for 16-item depression scores and physical assessments collected at 1 week and 3 month follow-ups (both in clinic and remote)|
|Findings and results||There was a clear finding that psilocybin now has preliminary results that support its feasibility, safety, and efficacy. Dose was detectible at predictable time frames and the experience was tolerated by all participants in the supportive setting.|
|Conclusions||Psilocybin appears to have positive affects and alleviate symptoms of depression in most participants. Further research and more rigorous studies are recommended to have a better idea of the mechanisms of effect.|
|Implications and application||This is valuable in moving psychedelic research forward and allowing this treatment to be made passable by the FDA for use in Canada as an adjunct to therapy.|
|Citation||Carhart-Harris, R. L., Bolstridge, M., Day, C. M., Rucker, J., Watts, R., Erritzoe, D. E., . . . Nutt, D. J. (2017). Psilocybin with psychological support for treatment-resistant depression: Six-month follow-up. Psychopharmacology, 235(2), 399-408. doi:10.1007/s00213-017-4771-x|
|Purpose and study rationale||After reports of marked increase in symptom relief from psilocybin, this is assessing the safety, efficacy, and feasibility for up to 6-months after the trial.|
|Fit and specific rationale||The symptoms and effects being measured for feasibility are subjective to each participant and must be qualitative to assess the impacts of these effects on each of their quality of life.|
|Design||The design was appropriate in its aim to follow-up with clients using the same depression scoring tool and assessment as were used in the trial, 1-week, and 3-week follow-ups for consistency.|
|Participants||They selected twenty patients (mostly male, six female), who had ben administered psilocybin in a controlled and supportive clinical setting 6 months prior.|
|Researcher (or researchers)||There is no conflict in the relationship of the researchers.|
|Ethics||Volunteers were screened for any contraindications, were physically healthy. The intention of the trial was to alleviate depressive symptoms using a substance with a high safety profile, at tolerable dose.|
|Context||In a controlled, supportive lab environment with two sessions seven days apart and 6-month follow-up.|
|Data||Dose of 10 mg given, then 25 mg seven days later while monitoring 16 item quick depression inventory tool for subjective effects.|
|Analysis||The qualitative method and self-evaluation tools were appropriate for assessing safety and effectiveness after 6-months.|
|Findings and results||Psilocybin is safe and has a large effect on alleviating symptoms of unipolar depression, quickly after just two sessions|
|Conclusions||Psilocybin is showing to be a promising treatment in severe depression and should move on to controlled double-blind placebo trials next.|
|Implications and application||This is valuable in showing the safety and rapid effectiveness of psilocybin on this population and can be a useful tool in treating unresponsive symptoms of depression.|
|Citation||Roseman, L., Demetriou, L., Wall, M. B., Nutt, D. J., & Carhart-Harris, R. L. (2018). Increased amygdala responses to emotional faces after psilocybin for treatment-resistant depression. Neuropharmacology, 142, 263-269. doi:10.1016/j.neuropharm.2017.12.041|
|Purpose and study rationale||To gauge whether or not psilocybin will change patients’ amygdala reaction to faces expressing various emotions.|
|Fit and specific rationale||This study takes a quantitative measurement of fMRI results surrounding amygdala activity in relation to fearful faces, under a dose of psilocybin.|
|Design||The design was appropriate to build trust and rapport with participants and multiple tools used to measure brain activity in amygdala before and after trials.|
|Participants||They screened for any history of psychotic disorders or any other risk factors. Volunteers were physically healthy.|
|Researcher (or researchers)||No prior relationship before trial but a trust and rapport was built between therapists and participants in order to allow them to let go and reach the “mystical-type” experience.|
|Ethics||Received favourable opinion from National Research Ethics Service of London, supported by Imperial College London.|
|Context||Controlled and supportive therapy environment.|
|Data||Screening was done, then participants abstained from SSRIs prior, had assessments and scans done using the appropriate tools, had two sessions of increasing dosage, then repeated assessments and scans.|
|Analysis||They measured brain activity through four different complimentary imaging packages for fMRI.|
|Findings and results||They found that psilocybin caused the amygdala to react more to emotional faces and work through the associated fear response, effectively reprocessing it. This is the opposite of SSRIs which quiet down the amygdala response.|
|Conclusions||Psilocybin increases the response of amygdala activity when presented with angry or fearful faces, but in a sense of re-processing the response. Therefore, psilocybin causes the patient to work through an emotion instead of repressing it. This would indicate why psilocybin may be more affective at intervening at the root of a client’s depression for a more long-term healing.|
|Implications and application||This is valuable to healthcare and mental health workers who experience symptoms of depression from compassion fatigue or PTSD. It may allow a re-processing of the accumulated traumatic experiences, allowing the subject to return to their baseline before experiencing the symptoms. More trials must be done on frontline workers and professionals in the field of mental health.|
|Citation||Lyons, T., & Carhart-Harris, R. L. (2018). More Realistic Forecasting of Future Life Events After Psilocybin for Treatment-Resistant Depression. Frontiers in Psychology, 9. doi:10.3389/fpsyg.2018.01721|
|Purpose and study rationale||To see if psilocybin with psychological support would improve pessimism bias in participants with Major Depressive Disorder (MDD)|
|Fit and specific rationale||This is mostly quantitative as it measures testing scores before and after sessions. Placebo group included but study was open-label.|
|Design||The design was appropriate to address if there is any impact on pessimism bias for future life events, although a more diverse sample population would be more favourable.|
|Participants||The study recruited participants with Major Depressive Disorder who were screened for any risk factors. The sample size was only twenty, but this is enough to gauge any obvious changes in activity and compare between subjects. The diversity should be improved in future studies as it was all white males, mostly of post-secondary education at least. More data on different socioeconomics, genders, and classes would be important.|
|Researcher (or researchers)||No bias or conflict with relationships.|
|Ethics||Psychological support was provided to clients during sessions, as well as preparatory non-psilocybin and low dose sessions. Received favourable opinion from NRES London-West London. Participants provided informed consent. Site and protocols approved in accordance with Good Clinical Practice Guidelines. Supported by Imperial College London.|
|Context||Controlled and supportive therapy environment, with comfortable atmosphere.|
|Data||Participants matched with placebo control who also had Major Depressive Disorder (MDD) and given Prediction Of Future Life Events (POFLE) tool. Psilocybin given 10mg and 25mg one week apart with psychological support. POFLE was repeated and assessed to compare psilocybin group with placebo group.|
|Analysis||All participants scored with lots of pessimism bias on initial scoring of POFLE which correlated with symptom severity. Group who was given psilocybin scored significantly more optimistic on the POFLE assessment after psilocybin sessions, which correlated with decrease in symptom severity. The psilocybin group was measured as being more accurate with the life events over the next thirty days after the sessions which was not seen in the placebo group. The placebo group showed no changes from baseline on POFLE.|
|Findings and results||Psilocybin decreases pessimism bias, allowing participants to have more optimistic outlooks and more accurate prediction of future life events.|
|Conclusions||Major Depressive Disorder is correlated with high pessimism bias, which seems to be alleviated by psilocybin when administered with psychological support, even increasing accuracy of predicting life events.|
|Implications and application||This is valuable to mental health workers and healthcare workers when working with clients. When workers experience compassion fatigue or “burn out” the increase in pessimism bias can be detrimental to the care of patients or clients, even increasing morbidity and mortality in the acute care setting. Treating frontline workers with psilocybin-assisted therapy when experiencing compassion fatigue may be able to alleviate pessimism bias and allow the worker to maintain quality of care and practice in their field.|
The results of this literature review have many implications for the future of treating work-related mental health problems amongst healthcare and mental health professionals. The qualitative studies have revealed the subjective symptom relief that leads to improvements in quality of life for most subjects, without any concerning adverse reactions. This is important as it considers how everyone has various factors that contribute to the differing subjective symptomology of these stress and trauma-related disorders. These treatments do not force the mind into a specific way of functioning but allow it to reintegrate emotional memory of passed life and reprocess psychological responses to future experiences. This can be observed in the study on psilocybin’s effects on personality structure that found enhancing traits of Extraversion and Openness correlated with the improved depression scores and quality of life of the subjects who were given psilocybin, which is an effect that psychedelic therapies have over anti-depressants (Erritzoe, D., et al., 2018, p. 368-378). Furthermore, psychedelics provided a level of insightfulness that facilitated more effective long-term changes (Erritzoe, D., et al., 2018, p. 368-378). Opening new neural pathways and connections for the client to guide their own journey of healing is likely why the effects of psychedelics are profound and long-lasting for those who experience them in the correct set and setting.
The qualitative findings can be enforced by the quantitative findings that followed functional Magnetic Resonance Imaging (fMRI) of subjects’ responses to human faces. Each subject was exposed to human faces exhibiting various strong emotions, which revealed that clients had an increase in emotional responses to these activations of the amygdala after the psilocybin session; allowing them to effectively reintegrate how they respond compassionately and empathetically to the stimuli (Roseman, L., Demetriou, L., Wall, M. B., Nutt, D. J., & Carhart-Harris, R. L, 2018, p. 263-269). These findings support the efficacy in how these treatments can be used to not only manage symptoms of compassion fatigue or PTSD in workers, but even produce improvements in performance and client/patient care as they become more empathetic and compassionate with future client interactions. If future trials continue to support these findings it would make psychedelics an effective tool to increase the ability to provide quality of care if workers are given the option to use them for self-care or emotional recovery.
The quantitative study that looked at subjects with MDD and assessing POFLE scores before and after psilocybin-assisted therapy compared to a control group was useful in seeing the objective improvements from psychedelic interventions. The findings showed that subjects who were given psilocybin had profound improvements from their baseline pessimism bias (Lyons, T., & Carhart-Harris, R. L, 2018, p. 1). Subjects given psilocybin even had a noticeable increase in their accuracy of predicting future life events over the control group, which was a finding that surprised researchers (Lyons, T., & Carhart-Harris, R. L, 2018, p. 1). This is useful for healthcare and mental health workers with compassion fatigue or PTSD, who also experience pessimistic biases as a result. Correcting pessimism bias can help the client re-process their view of their environments and enhance practices of motivational interviewing and empathy in future client/patient interactions. This can decrease workplace hazards associated with employee burn-out and low morale. The increase in accuracy of predicting future events may lead to improvements with patient/client care goals and success of interventions, from the increase in ability to be less biased to pessimism and be more realistic in planning or expectations in recovery goals.
These findings correlate with the qualitative study that was done through Imperial College London, seeking the subjective effects of psilocybin on subjective experiences and the depression inventory scores of subjects with TRD. This study had quantitative aspects in the scoring of the depression inventory but was focused more on qualitative experiences. The six-month follow-up to this study is also part of this review because it adds to the understanding of safety and efficacy around the lasting effects of the experience. The subjects experienced large effects on their moods that onset rapidly and sustained for up to six months without the need for anti-depressants or subsequent treatments (Carhart-Harris, R. L., Bolstridge, M., Day, C. M., Rucker, J., Watts, R., Erritzoe, D. E., . . . Nutt, D. J, 2017, p. 399-408).
Comparing the quantitative results of the POFLE scores with the qualitative results of the clinical trial measuring effects on depression and six-month follow-up shows that psilocybin is both safe and effective as an alternative to conventional treatments due to its lack of adverse effects and ongoing improvements in quality of life that subjects experience; peaking at five weeks (Carhart-Harris, R. L, et al., 2017, p. 399-408. Dr. Robin-Carhart Harris has been working with Dr. David Nutt at Imperial College London to research the bio-psycho-social effects of psychedelics, through a neuroscience lens, with multidisciplinary teams working to expand that lens to understand the implications of psychedelics in modern healthcare.
There is a major gap in research amongst the Indigenous and First Nations communities, where most of these psychedelic medicines began their healing implications. Western researchers and healthcare workers there must recognize and integrate the knowledges of these peoples who have learned to harness these medicines for healing over thousands of years. The rituals surrounding set and setting, preparation, and integration of a psychedelic experiences should be developed in collaboration with Indigenous healers and shamans around the world. That is how to not only harness the highest potentials of these medicines but to pay respect to the cultures that have formed deep relationships with them to avoid unintended consequences or cultural appropriation of ancient healing wisdom. Future political conversations and research surrounding psychedelic healing should strive to be inclusive and respectful.
Overall, this literature review shows that when psilocybin is administered in a controlled set and setting it is a safe and effective alternative to antidepressants and conventional therapeutic approaches. While conventional therapies promote avoidance and suppression of difficult emotions psychedelics seem to operate on a different mechanism. Psychedelics such as psilocybin allow the individual to confront and reintegrate powerful emotional experiences, allowing for more lasting and profound effects with symptom relief (Roseman, L., et al., 2018, p. 263-26). Although the sample sizes are smaller in these trials, we can consider the yearly Global Drug Survey (GDS), ongoing research, and tacit knowledge to confidently state that psilocybin-assisted therapy should be a legal option for healthcare and mental health workers who wish to use it for healing of mental health problems, or as a self-care strategy. The findings from the most recent GDS of 2018 show psilocybin or “magic mushrooms” to have a higher safety profile than alcohol, over-the-counter medications, even cannabis. All of which are recreationally available to Canadians for use without legal repercussions, despite their relative risk profiles. If we can allow legal access to substances as destructive as nicotine and alcohol, then it is feasible to allow psilocybin to be available to those who require it therapeutically as soon as possible. The need for new treatment options continue to grow as conventional treatments for mental health problems struggle to provide effective relief for many healthcare and mental health workers.
The data does not show any safety concerns or hemodynamic vulnerability in physically healthy volunteers that use set doses in controlled environments. Future trials should require sample sizes to be larger with more gender and cultural diversity to account for more variables. There is also a need to have double-blind placebo trials with psilocybin compared to CBT and anti-depressants, as is currently being done for MDMA-assisted psychotherapy. More studies should be conducted with the healthcare and mental health worker population to find how to make psychedelic interventions more effective at treating work-related mental health struggles, such as compassion fatigue and Post-Traumatic Stress Disorder. As was done with cannabis across Canada, psychedelics should be legalized with regulations that allow for the safe and effective use of these alternative methods of healing psychological suffering.
The prevalence of work-related mental health problems amongst healthcare and mental health workers is undeniable. Many are forced to use conventional treatments that focus on repressing negative reactions to life events or long-term therapies that leave a feeling of hopelessness and impatience. Every year we lose first responders to suicide, and social workers are stigmatized for their symptoms of compassion fatigue. It is important to find effective and feasible interventions for those who work in these helping professions. Rather than relying on a rotating door of new employees in the field, we must seek to heal and support those who have experienced and learned the true suffering that exists in the clients or patients that seek these services. As one moves through their career, they take on the pain and anguish that has been witnessed over the years of helping others. Therefore, must be able to heal and use it as a strength.
Through this research review I have been able to use specific search strategies to ask the question of whether psychedelics, like psilocybin, are a safe and effective alternative for treating work-related mental health problems in healthcare and mental health workers. There should be further studies focused on first responders, nurses, and social workers with compassion fatigue to have more specific population data around those professions. Preliminary results show psilocybin-assisted therapy to be a safe and effective alternative at treating symptoms of work-related mental health problems amongst healthcare and social workers. I find that the suppression of research around these substances has prevented us from realizing their potentials earlier. From reading these findings, I believe that these treatment models show promise because they allow us to learn how to process emotional responses effectively; while the blunting effects of conventional treatments prevent the healing from happening at the deepest core of our beings. I feel that trauma manifests deep enough that it becomes painful to work through, which is why these psychedelic experiences should be had in the presence of a trained guide or professional that can safely support the efficacy. I also feel that this research shows that the criminalization and fear of understanding these medicines has been harmful to various cultures in Canada. Some cultures have Indigenous approaches to psychedelic medicines that have lost their autonomy due to our current laws.
The research shows promise for being able to refer future clients, or myself, to these treatments for work-related mental health problems, when they become available in Canada. Healthcare and mental health professionals should be given the right to try a psilocybin treatment in a controlled setting, with a therapist, if they desire this option as an alternative to conventional treatments. The Global Drug Survey (GDS) is updated every year to inform emergency care and drug policy in many countries. This year the GDS shows that psilocybin is the safest drug worldwide with the least likely-hood of emergency room visits (Global Drug Survey [GDS], 2018, para. 3). This indicates that psilocybin should be decriminalized so these experiences can be made safe enough to develop guidelines for personal use at home, with the support of a colleague who is comfortable with holding space. I feel that we should also allow Elders of First Peoples’ communities who have identified that they do not respond to western psychiatry, the freedom to access these altered states to help heal their communities. It would be a priority to include Indigenous Elders, Healers, and Shamans who first learned to harness the power of these psychedelic experiences by set, setting, respectful intention, and ritual for generations before western society began to criminalize them. This is not only in Canada but in other parts of the world that have lost their rights to use plants like psilocybin, ibogaine, San Pedro, Ayahuasca, bufotenine, and others that western culture has demonized. Denver, Colorado has decriminalized psilocybin in May 2019 and Oakland, California decriminalized all entheogenic plants in June 2019. What will be the next logical step in making psychedelics more available for healing compassion fatigue or post-traumatic stress in first responders and healthcare workers?
Al Jazeera America. (n.d.). How Underground Therapists Are Using Psychedelics to Heal Trauma. Retrieved from https://maps.org/resources/responding-to-difficult-psychedelic-experiences/6018-al-jazeera-america-how-underground-therapists-are-using-psychedelics-to-heal-trauma
Carhart-Harris, R. L., Bolstridge, M., Day, C. M., Rucker, J., Watts, R., Erritzoe, D. E., . . . Nutt, D. J. (2017). Psilocybin with psychological support for treatment-resistant depression: An open-label feasibility study. Lancet Psychiatry, 3(7), pp.619-27.doi: 10.1007/s00213-017-4771-x
Carhart-Harris, R. L., Bolstridge, M., Day, C. M., Rucker, J., Watts, R., Erritzoe, D. E., . . . Nutt, D. J. (2017). Psilocybin with psychological support for treatment-resistant depression: Six-month follow-up. Psychopharmacology, 235(2), 399-408. doi:10.1007/s00213-017-4771-x
Erritzoe, D., et al. (2018). Effects of Psilocybin Therapy on Personality Structure. Acta Psychiatrica Scandinavica, 138 (5), pp. 368–378. doi:10.1111/acps.12904
Global Drug Survey. (2018). Retrieved from https://www.globaldrugsurvey.com/gds-2018/
Lyons, T., & Carhart-Harris, R. L. (2018). More Realistic Forecasting of Future Life Events After Psilocybin for Treatment-Resistant Depression. Frontiers in Psychology, 9. doi:10.3389/fpsyg.2018.01721
Mental Health Commission of Canada. (2016). Workplace Mental Health. Retrieved from https://www.mentalhealthcommission.ca/sites/default/files/2017-01/Issue_Brief_workplace_mental_health_eng.pdf
Roseman, L., Demetriou, L., Wall, M. B., Nutt, D. J., & Carhart-Harris, R. L. (2018). Increased amygdala responses to emotional faces after psilocybin for treatment-resistant depression. Neuropharmacology, 142, 263-269. doi:10.1016/j.neuropharm.2017.12.041