Psychedelic Promise, Prohibitive Price: the Accessibility Crisis in Novel Mental Health Treatments
by Robyn Kane
In 2019, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) found that mental health disorders remained in the top ten leading causes of burden worldwide (GBD 2019 Mental Disorders Collaborators, 2022). In Australia, the 2023 Burden of Disease Study found that mental and substance-use disorders have increased by 27% since 2003 and are now estimated to be responsible for 15% of the total burden of disease, second only to cancer (Australian Institute of Health and Welfare, n.d.). Additionally, the recent COVID19 pandemic created conditions in which factors contributing to poor mental health outcomes were exacerbated, highlighting globally the inadequacies of many mental health systems (Santomauro et al., 2021). These figures are startling and will likely worsen. Studies show that increased social-media use is associated with aggravated mental health conditions (Karim et al., 2020), that geopolitical instability is increasing (World Economic Forum, 2025) and that climate concerns are coming to a head (Hansen et al., 2025); all indicators that the existing healthcare model cannot cope with current demands, let alone anticipated ones.
In the 1950s and 1960s in America, psychedelic drug lysergic acid diethylamide (LSD) was at the centre of a promising field of research, with psychiatrists finding it (and other psychedelic compounds) helpful in a variety of psychiatric settings. However, government backlash against the recreational use of LSD brought psychedelic research to a halt in the 1970s with psychedelic compounds being categorised by the Controlled Substances Act as Schedule 1: considered to have a high potential for abuse and no accepted medical use (Drug Enforcement Administration, n.d.). With this backlash came a campaign of propaganda aimed at demonising psychedelic drugs. However, the 1950s and ’60s was not the first time that psychedelic compounds had been identified as useful medicinal substances. Psychedelic plant medicines - such as peyote, used by Native North Americans as an entheogen and curative medicine for millennia (Bouayad, 2019), ayahuasca, used by Indigenous peoples around the Amazon basin (Tupper, 2008), and psilocybin, used by the Mazatec peoples in Mexico – have served as spiritual and therapeutic medicines for thousands of years (Changā Institute, n.d.). Additionally, with ‘recreational’ use still prevalent, and the formation of a fierce underground movement of passionate advocates of psychedelic medicines, prohibition did not completely curtail their use in the general populous.
Thanks to the efforts of many dedicated proponents of psychedelics, the world has entered a period some call the ‘psychedelic renaissance’, research into their possible medicinal properties having been reignited. In the United States, trials using 3,4-methylenedioxymethamphetamine (MDMA) alongside therapy to treat PTSD in war veterans produced results that led to the drug being recognised, in 2017, as a breakthrough therapy; in 2020 Australia ran its first clinical trial into MDMA for PTSD, with rescheduling by the Therapeutic Goods Administration (TGA) soon to follow (Alcohol and Drug Foundation, 2023). Faced with studies showing that soldiers are nine times more likely to die by their own hand than they are in combat (Barlow, 2024) and that, in 2024, 14% of male and 24% of female veterans were diagnosed with PTSD and associated comorbid conditions (U.S. Department of Veterans Affairs, n.d.), governing bodies found the results of the trials hard to ignore, and there occurred a gradual shift in their perception, and that of the medical industry and the general population: something previously associated with rave culture, chaos and even neurotoxicity was now potentially therapeutic (O’Brien & Nutt, 2025; McCann et al., 1998).
Currently, psychedelics have been found to demonstrate therapeutic potential in treating neuropsychiatric disorders. Studies have demonstrated their ability to promote sustained cognitive flexibility, often impaired in depression and Post-Traumatic Stress Disorder (PTSD) (Brouns, Ekins, & Ahmed, 2025). Trials - largely focusing on depression, anxiety and PTSD - abound, and the results look promising, with psychedelics being shown to be more effective in many subjects than current mental health treatments (Lowe et al., 2022). Multiple scientific trials have been followed by numerous mainstream publications, documentaries and pop-culture references; excitement is building, in psychiatric and scientific fields as well as in the broader community, around a potential “light at the end of the tunnel” for the treatment of mental health disorders. However, with the hype and the hope comes many conditions, concerns, constraints, and unanswered questions. While the research into psychedelic medicines shows much promise, and public perceptions gradually shift, attempts to fit them into the tightly controlled western scientific/medical model have the potential to negatively impact the accessibility and equitable distribution of these medicines to those most in need. Ironically, the opportunity to fully utilise psychedelics - which appear to be effective, in part, by promoting cognitive flexibility - may well be frustrated by present scientific inflexibility.
Assessing the safety and efficacy of these medicines, using the rigorous scientific methods that we hold in high esteem poses problems. The use of the gold standard double-blind randomized-control trial (RCT) – aimed to measure how effectively, and how safely, a certain drug can treat a certain condition – is flawed in psychedelic trials, with approximately 78% of studies showing poor blinding success and expectancy bias (Barstowe & Kajonius, 2024). Reducing psychedelics to a pill that can be taken for a defined condition and comparing the results with a placebo can neither fairly assess its efficacy, nor capture the profound, complex nature of a psychedelic experience. From an ethical perspective, the possibility of gaining truly informed consent is questionable, given the dynamic, potentially transformative, and ineffable nature of a psychedelic experience (Villiger, 2024). While assessing safety and efficacy is important, psychedelics seem over-scrutinised in this area. Paracetamol overdose causes the death of 50 Australians every year (Therapeutic Goods Administration, 2022), yet it is not only TGA approved but also readily available in supermarkets; alcohol use was linked with 1742 deaths in Australia in 2022 - and these are only deaths related to cirrhosis and alcohol poisoning (Alcohol and Drug Foundation, 2023) - yet we need no informed consent forms signed before a trip to the local bottle-shop. In contrast, a study by the National Drug and Alcohol Research Centre (NDARC) attributes just 43 Australian deaths related to LSD or psilocybin use in the last 23 years (National Drug and Alcohol Research Centre, 2024). Furthermore, although admittedly less scientific, over-intellectualising and over-scrutinising a treatment that is ineffable in nature, can induce mystical experiences, and seemingly has the reduction of ruminative thoughts as part of its mode of action (Ramarushton et al., 2024), seems ironic. The process of fitting psychedelics into our current scientific and medical model seems akin to fitting a square peg into a round hole, and while we grapple with how to make the peg fit, people are either suffering or resorting to breaking the law to access psychedelics via alternative means.
Photo by Joshua Hoehne on Unsplash
The medicalisation model of psychedelic-assisted therapy (PAT) that is proposed does not, it would seem, solve the unmet needs. At time of writing, Australians are looking at out-of-pocket expenses of $25,000 - $35,000 to receive PAT, making it beyond reach of the majority (Harris, 2023). Additionally, eligibility for PAT currently requires patients to taper off their regular medications, which has the potential to cause relapse (Black Dog Institute, 2023). In order to access PAT, patients must have a formal diagnosis of PTSD or treatment-resistant depression, meaning that people judged ‘well’ cannot access them, despite the increasing body of research showing that psychedelics can also yield a variety of benefits in healthy people, and lead to the betterment of well people (Gandy, 2019). Moreover, this research does not capture the anecdotal evidence of psychonauts engaging in non-problematic (although illegal) drug-use for psychological self-enhancement (Móró et al., 2011). Researchers have started to capture the perspectives of seasoned psychonauts via surveys like the Global Psychedelic Survey out of the University of Michigan. After all, if you want to learn how to surf, you employ a surfer, not a scientist who studies the ocean.
The decades-long demonisation of psychedelic drugs means that these drugs still carry much stigma. While shifts in public perception, the recent embrace by mainstream media and an explosion of scientific interest have certainly started to de-stigmatise these mysterious compounds, perhaps the greatest challenge of all will be acceptance of the need for a complete paradigm shift in the way that we incorporate these medicines into our western medical model. The future may necessitate a collaborative model of care that blends western health models with Indigenous ones (Sebben et al., 2024). Medicalisation as a concept – being entwined with power structures, social control, paternalistic, and profit driven motives (van Dijk et al., 2020) – has been criticised by sociologists. Colonial legacies have also left a lasting imprint on modern western medical systems (Clark et al., 2023); thus, since psychedelic medicines have a long history of Indigenous spiritual practice, it is not surprising to find them in the ‘out group’ when it comes to modern medicine. The tumultuous history of their criminalisation may not only be political, but also religious.
As well as a potential tool in the future of mental health care, psychedelic drugs potentially increase a sense of connectedness to oneself, others, and the world (Patterson, van Mulukom, & van Elk, 2023). Could they have the potential also to decrease the divide between opposing worldviews – views on health and well-being – enhancing efforts at reparations and, in turn, healing people through connectivity? It is worth asking the question of why mental health disorders are so prevalent and on the rise. Humility and open-mindedness (both qualities needed in the undertaking of a psychedelic experience), coupled with the acceptance that no health model is infallible, may be necessary elements for overcoming present disparities in mental health care, if medicalisation - rather than decriminalisation - is to be the way forward.
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