Putting patients at the centre • The New Statesman
Tom McDonald, the CEO of Clerkenwell Health, a British mental health start-up, explains how psychedelic-assisted therapy might hold the key to putting clients at the centre of treatment.
Psychedelic medicines are at a turning point. Used in combination with structured talking therapies, these compounds are being trialled in the treatment of a range of mental health conditions. Last year, for instance, UK regulators gave the green light for the first clinical trial of the use of the psychedelic drug dimethyltriptamine (DMT) to treat depression.
Interest in the sector is also at a peak, as the rate of investment is increasing. A growing number of researchers and companies are developing new drugs and treatments for serious mental health conditions.
To understand the trials and tribulations of this fledgling sector, we need to look at how the pharmaceutical industry has evolved over the last few decades and how the patient has faded from focus.
According to polling, Big Pharma is little trusted by the general public and can be found near the bottom of consumer trust indexes. Even the sector’s successes in fighting Covid-19 have not altered public perceptions. This reputation is likely due to a number of scandals, from the opioid crisis in the US to price gouging of essential medicines for HIV and diabetes.
Most people working in pharmaceuticals truly care about the patients, however. They want their treatments to make people better.
Many employees are clinicians, leading scientists and operators who have put the care of others first throughout their careers. The good faith of these individuals is undermined by the system that has developed around them.
Over the past decade, the term “patient centricity” came into circulation, partly in an effort to counter the poor reputation of the system. It was, and still is, a popular buzzword. But what does it actually mean?
Put most simply, patient-centricity means putting the patient’s needs and desires at the centre of everything you do.
Interest in psychedelic treatments is growing.
The pharmaceutical sector has been a net force for good over the past 150 plus years, but it was not built with patient- centricity as a foundational component. Pharmaceutical firms were built for profit, which drives competition and innovation. Any ideas, no matter how beneficial to the patient, are not widely adopted unless they improve the bottom line.
However, a glimmer of hope is on the horizon in the form of psychedelics. These chemicals gained significant traction among mental health researchers in the 1960s, but until the 2010’s restrictive regulations slowed any major advancements. Now these drugs are attracting mainstream attention again as they move through phase 2 and 3 trials.
Based on these early-stage trial results, in the US the FDA has classified some psychedelic drugs as having “breakthrough status”, while mental health issues are at an all-time high.
Now is the right time to build a new model for mental healthcare, one that puts patients at its centre. One that will help provide deep, lasting relief to people.
Psychedelic drugs are administered to patients in the hope that they may be able to view issues from a different perspective, and to use their experience to change patterns of thought or habit.
Talking therapy itself is the most important part of the treatment; psychedelic compounds are useful tools to enable this. How talking therapy
is delivered, by whom, and when it is delivered should be carefully planned, with the patient’s journey starting long before they walk through the door of the clinic or hospital.
The patient experience for psychedelic treatments starts with the first time they come into contact with the clinic until the final treatment they receive. The use of innovative technologies such as remote therapist consultations and patient-facing apps can help ensure the entire care pathway is tailored to the individual.
This is the time for a new model for healthcare.
As with drug therapy in general, genetic testing could be used to identify genetic traits that allow a greater response to psychedelic treatments, as well as flagging those with a higher risk profile for adverse reactions.
It is well known that “set and setting” are vital to encourage positive interactions with psychedelic medicines. Setting covers everything from the design of the room to the soundtrack a patient listens to, while set covers the patient’s own mindset toward the therapy, their expectations, hopes and fears.
When supporting patients in a fragile mind state it is vital to have the appropriate safeguards for those in positions of power. Therapists require clinical expertise, significant levels of compassion, and a great bedside manner. Confidence in the system as a whole could be derailed by just a few bad apples in the early stages of this industry.
Just as “set and setting” are important in the use psychedelic medicines in mental health treatment, so is an awareness of the cultural and ethnographic history of these medicines. These important elements can be forgotten as a drug moves
from the fringes to the mainstream. With psychedelics, one should pay heed to those like the Mazatec and pre-Columbian Mesoamerican cultures who built the anecdotal, cultural, and sociological base of research that inspired much of today’s university and commercial research.
The world is evolving, and ethical, patient-centric healthcare is more important than ever. Psychedelics can play an important role in putting the patient back into the heart of mental health care.