The potential therapeutic application of psilocybin in the treatment of mental health illnesses, and alleviating pressures on the NHS

Sarah Hopkinson

BA (Hons) Education Studies

Abstract

This piece argues that there is potential for psilocybin to be used in the treatment of mental health illnesses in the UK. It is argued that, owing to its apparently rapid efficacy, psilocybin may help alleviate pressures on the National Health Service (NHS). The article begins by contextually defining depression in relation to wellbeing. It then focusses upon the introduction of psilocybin into Western medicinal treatment settings, and resultant Governmental responses. Recent prominence in the study of psilocybin’s potential therapeutic applications is critically evaluated, exploring the need to redress historical Eurocentric biases, but possibly at the cost of academic rigour in peer and regulatory review systems. Finally, the article explores how the general public and health professionals could be educated about the use of psychedelics, including psilocybin, thereby reducing the stigma surrounding alternative medicinal drugs as potentially effective forms of mainstream treatments for mental illnesses.

What is Wellbeing?

‘Wellbeing’ is to have optimal physical health, positive mental health, and material prosperity. It is a term that is often used to characterise a person’s attitude toward their daily successes and failures, together with their view on life in general (Department of Health and Social Care, 2022). The National Institute for Health and Care Excellence (NICE) (2012) categorises social and emotional wellbeing into three categories:

• Emotional wellness
• Psychological wellness
• Social wellness

A person’s socioeconomic status, and cultural environment may have a substantial influence on mental health. Poverty, unemployment, loneliness, and discrimination may all have a harmful influence on an individual’s mental wellbeing (Department of Health and Social Care, 2022; NICE, 2012). Conversely, supportive social connections, access to quality healthcare and education, and a sense of purpose and meaning in life can all contribute to better mental wellbeing. As such, promoting mental wellbeing in society can involve addressing a wide range of social and environmental factors that can impact mental health. This may include efforts to reduce poverty and inequality, promote social inclusion and support, and improve access to mental healthcare and other services (Department of Health, 2011, p. 5). It may also involve efforts to create more supportive and positive social environments, such as through the promotion of healthy lifestyles and the development of supportive communities. Additionally, it is recognised that schools are in ideal positions to improve students’ health and wellbeing (Aggleton et al., 2010, p. 2), and research evaluating health and wellbeing practices in schools suggests they have a positive impact on students (Barry et al., 2013, p. 17; Clarke et al., 2014, p. 591; Weare & Nind, 2011, p. 163).

The Effects of Depression on Wellbeing

Depression is a mental illness that may have catastrophic impacts on an individual’s quality of life. The National Health Service (NHS) (2021) characterise depression by a lack of interest or pleasure in normally enjoyable activities and by persistent feelings of hopelessness and helplessness. The physical manifestations of depression can include changes to appetite and sleeping patterns, lethargy, and struggling to concentrate (NHS, 2021; NICE, 2022). These symptoms may greatly impair a person’s ability to function in everyday life and have a detrimental effect on their overall mental health. Depressive episodes occurring in adulthood can often be rooted back to a person’s formative years (Felitti et al., 1998, p. 251). Early childhood establishes the framework for almost every aspect of human development, including physical, intellectual, and emotional development (Marmot, 2010, p. 22). What occurs during these early years has lasting effects on many elements of health and wellbeing, such as obesity, heart disease, mental health, educational accomplishment, and economic position (Felitti et al., 1998, p. 251; Waldfogel, 2004).

Treatment for depression, such as talking therapies and medication, can help alleviate symptoms and increase a person’s sense of wellbeing. Some individuals may find that addressing their depression leads to an improvement in their overall wellbeing, while others may find that other factors, such as social support or lifestyle changes, have a greater impact on their wellbeing (NHS, 2021). There are several therapies and strategies that can be effective in treating depression. The specific treatment approach depends on the severity of the depression and individual preferences and needs. NICE (2022) and the NHS (2021) outline some common treatments for depression including:

Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants.

Psychotherapy with a therapist or counsellor. There are several types of therapy that can be used to treat depression, including cognitive behavioural therapy (CBT) and interpersonal therapy (IPT).

Simple self-care strategies, such as exercising regularly, getting enough sleep, and eating a healthy diet. Additionally, some may find alternative treatments useful, such as acupuncture, herbal supplements, meditation, or psychedelics.

A Brief Psychedelic History and the War on Drugs

Indigenous civilisations and communities have utilised psychedelics within rituals and other contexts for centuries (Johnson & Griffiths, 2017, p. 734). The Aztec Indians of South America consumed mushrooms in particular in religious and medicinal practices, referring to them as teonanácatl or ‘god’s flesh’ (Nichols, 2020, p. 679). Some of the mushroom-forming variety of fungi contain psilocybin, a psychoactive substance and a tryptamine alkaloid, which when ingested is known to induce hallucinations (Geiger et al., 2018, p. 2438). Albert Hoffman synthesised and commercialised psilocybin for use in psychopharmacological and therapeutic clinical research in 1959, introducing it into western civilization (Geiger et al., 2018, p. 2438; Nichols, 2020, p. 680). In the 1950s and 1960s, psychologists and psychiatrists regularly employed psychedelic substances in study and therapeutic treatment (Andersen et al., 2020, p. 102), and by 1961, there were more than a thousand articles produced on the medical applications of lysergic acid diethylamide (LSD), psilocybin, N, N-dimethyltryptamine (DMT), and mescaline (Grinspoon et al., 1979, p. 343). However, studies into the therapeutic use of psychedelics were quashed in part due to the fear of psychedelic drug abuse in the developing counter-culture (Johnson & Griffiths, 2017, p. 734).

In 1971, the President of the United States, Richard Nixon, formally declared the war on drugs and concurrently the UK introduced the Misuse of Drugs Act 1971 (Buchanan & Young, 2000, p. 3; Lassiter, 2015, p. 134). In 1972, psilocybin and similar substances were classified under Schedule 1 of the United Nations (UN) Convention on Psychotropic Substances (United Nations Economic and Social Council, 1972, p. 392). Inclusion of psilocybin in the Convention decelerated research into its potential therapeutic uses for decades to come, as it became difficult to obtain, and its quantities produced per annum became limited (Geiger et al., 2018, p. 2440; Nutt, 2015). In response to this Nutt (2015) suggests that individual governments redefine individual UN Schedule 1 drugs as Schedule 2, allowing continued compliance with the UN conventions, but permitting simpler access to psychedelic substances for research purposes (p. 5). The London School of Economic and Political Science (LSE) (2014) report ‘Ending the drug wars: Report of the LSE expert group on the economics of drug policy’ takes this further, arguing that the UN strategy to create a ‘drug free world’ causes devastating harm from ‘overly militarised and enforcement-led drug policies’, and consequently the war on drugs should be ended completely (p. 6).

Furthermore, Csete et al. (2016), demonstrate that all too frequently, masses of drug consumers become the focus of the war on drugs, which disproportionately affects the impoverished, ethnic minorities, and women. This is similar to findings by Buchanan and Young (2000) who conclude that thousands of otherwise ‘law abiding’ persons are criminalised for recreationally using ‘soft’ drugs, while problem drug users, who tend to be dependent on ‘hard’ substances like cocaine and heroin, are stigmatised and secluded inside drug subcultures. The current populist drug policy in the UK, which focuses largely on prevention, prohibition, and punishment, strengthens this viewpoint and creates a more hostile setting (Buchanan & Young 2000, p. 18). Both the LSE (2014) and Buchanan & Young (2000) suggest that resources should be diverted toward successful evidence-based policies that are supported by thorough economic analysis (p. 3), and the creation of initiatives that combat inequity, disadvantage and prejudice, to facilitate the social reintegration of substance abusers who have been socially isolated (p. 19).

The Therapeutic Potential of Psilocybin

The Default Mode Network (DMN) is a set of brain regions that has been linked to depression, and psilocybin may be effective as it interferes with the regular functioning of the DMN by increasing the activity of the serotonergic system, which is involved in mood regulation (Broyd et al., 2009, p. 279; Carhart-Harris et al., 2014, p. 10; Daws et al., 2022, p. 846; Carhart-Harris & Nutt, 2017, p. 1106). Serotonin has been linked to a variety of mental health issues, including depression, mood disorder, and schizophrenia (Geyer & Vollenweider, 2008, p. 445; Lin et al., 2014, p. 196). The significance of the serotonergic system in the treatment of mental diseases is shown by the establishment of SSRIs (Lin et al., 2014, p. 196). Psilocybin has a molecular structure comparable to serotonin. This suggests that serotonin is essential to comprehending the effects of psilocybin on the brain (De Veen et al., 2016, p. 209).

An increasing number of studies suggest that psilocybin and other psychedelics, may have potential as treatments for depression, obsessive compulsive disorder (OCD), and other psychiatric disorders (Carhart-Harris et al., 2017a; Carhart-Harris et al., 2017b; Johnson & Griffiths, 2017; Moreno et al., 2006; Nutt et al., 2020; Wilcox, 2014). Despite tight regulation due to its status as a controlled substance, researchers have been able to analyse psilocybin for its therapeutic applications. Early findings indicate that it has a positive impact on patients suffering with depression, and psilocybin’s antidepressant effects may be seen after as little as two doses and may last for months or even years in some patients (Carhart-Harris et al., 2017a, p. 2; Carhart-Harris et al., 2017b, p. 403; Nutt et al., 2020, p. 1). Additionally, unlike other psychedelics, psilocybin has notably been found to have protective qualities against psychological suffering and suicidality (Hendricks et al., 2015, p. 1042) suggesting it has a favourable safety profile over other psychedelics (Gable, 2004, p. 690).

Criticisms and Limitations

Despite the encouraging results, Hall and Humphreys (2022) provide a major critique of a number of research studies, arguing that the studies’ rise in popularity is due to the lowering of standards by several prominent medical journals and scientists’ overstatement of their findings in the media. Their editorial cautions against using inadequate evidence to prescribe psychedelic medicines and rejects the claim that psychedelic substances deserve preferential treatment in the peer and regulatory review procedures due to historical bias. A limitation of studies involving psychedelic drugs is noted by Bender and Hellerstein (2022), who make the significant argument that it is difficult for trials with psychedelic drugs (such as psilocybin) to be double-blind due to their inherent hallucinogenic nature, as trial participants are acutely aware they have taken a drug with hallucinogenic properties (p. 1928). The knowledge of treatment assignment may result in compromising the blinding of the trial, which is a critical aspect of study designs that help reduce bias and increase the accuracy of results. Moreover, Carhart-Harris et al. (2021) conclude that there is little difference in the anti-depressive effects of psilocybin and escitalopram (an industry approved SSRI class of antidepressant), suggesting that there may not be sufficient evidence to justify utilising psychedelics for the treatment of depression and that more substantial studies are required for robust findings.

Furthermore, Rucker and Young (2021) warn of retreat websites referring to early phase clinical experiments using psilocybin that are used to bolster advertisement claims, targeting prospective clients. Some facilities publicise the findings of their own studies, without acknowledging limitations and bias (Rucker & Young, 2021, p. 3). This poses a potential risk to those seeking such treatments. Psilocybin is not currently an approved treatment for depression and is therefore unregulated. Psilocybin can cause potential negative side effects (Bienemann et al., 2020, p. 6), including psychological distress and the risk of developing psychosis in people who have a history of or are prone to psychotic disorders (Carbonaro et al., 2016, p. 9). However, clinical studies mitigate this risk by carefully screening participants for a history of, or pre-disposition to psychosis (Carhart-Harris et al., 2021, p. 1403; Daws et al., 2022, p. 852).

Alternative therapies could alleviate pressure on the NHS

One in six individuals in the UK encounter a common psychological disorder such as anxiety or depression in any single week (Mental Health Foundation, n.d., McManus et al., 2016, p. 8). In addition, Pierce et al. (2020) found that the COVID-19 pandemic has had a major negative impact on mental health, with significantly more people expressing symptoms of anxiety and depression (p. 890). According to the Institute for Fiscal Studies (IFS) report ‘Pressures on the NHS’ by Warner and Zaranko (2021), the NHS, is under significant pressure to provide mental health services to meet growing demand due to a combination of factors: a lack of funding and resources, a shortage of mental health professionals, and a growing population. Similar to Pierce et al. (2020), Warner and Zaranko (2021) suggest that the COVID-19 pandemic has further strained mental health services, as increased stress and isolation have led to a rise in mental health issues.

Alternative psychedelic therapies may have the potential to alleviate some of the pressures faced by the NHS in the UK by providing new treatment options for patients that may be more effective than traditional approaches. Most drugs used to treat psychiatric disorders are used on a daily basis and for extended periods of time, often taking weeks to achieve the therapeutic benefits (dos Santos et al., 2021, p. 903). Studies of the therapeutic effects of psilocybin suggest it may have rapid and sustained anti-depressant effects (Carhart-Harris et al., 2017a, p. 2; Carhart-Harris et al., 2017b, p. 403), therefore potentially reducing the need for patients to take industry approved anti-depressants over an extended period of time, leading to reduced costs for both patient and the NHS, and potentially improved health outcomes for those seeking treatment. The rapid anti-depressant effect of psilocybin could also lead to a reduction in patients reaching a critical mental health mass, therefore resulting in less hospitalisations, and freeing up resources for other patients.

Drug stigma and public education

Discrimination and social stigma experiences of illicit drug users are complex, and they are typically linked to worsening physical and mental health (Ahern et al., 2007, p. 195). However, this does not necessarily suggest that stigma and discrimination are barriers to seeking treatment for addiction (Hammarlund et al., 2018, p. 133). The stigma associated with drug addiction and usage amongst the general public is potent, and often reinforced by government rhetoric and policies that contribute to its widespread acceptance (Earnshaw et al., 2012, p. 1; Yang et al., 2017, p. 6). This suggests stigmatisation may create uncertainty in the public when potentially introducing psychedelics as a form of legitimate therapeutic treatment. Therefore, along with drug policy reviews, a level of public education would be required. Public health campaigns could be a useful tool in educating the public to reduce stigma surrounding psychedelics and demonstrate the potential therapeutic use of alternative treatments for mental health disorders. The Health Campaign Effectiveness Coalition (HCE) is a cross-campaign coalition that promotes learning and system transformation, it brings together nation leaders, donors, multilateral organisations, Non-Governmental Organisations (NGOs), and health systems, ethics, and economics experts from numerous large-scale health campaigns (2022). The HCE promotes research that tests and replicates evidence-based campaign techniques. It also creates recommendations to help campaigns work with national health systems (2022). The HCE could potentially provide guidance and strategies to government agencies to create effective campaigns to help break down drug stigma and strengthen the notion that schedule 1 drugs should be reclassified and employed for therapeutic uses. Additionally, Public Health England (PHE) have the resources to create campaigns at both a national and local level. PHE have previously demonstrated their ability to run successful campaigns, for example, the Stoptober campaign continues to ‘effectively drive smokers to make a quit attempt’ (Public Health England, 2021). The strategies and tools used by HCE, PHE and other agencies could be transferred to create public campaigns that provide accurate and evidence-based information on the safety and efficacy of psychedelic substances in treating mental health disorders.

An additional approach is to educate healthcare workers in scientific research and clinical trials. By conducting robust and controlled studies, researchers can gather and provide strong evidence on the therapeutic use of psychedelic substances that can be presented in healthcare curriculums. Nurses are specialists in clinical and routine development, research, and strategic planning, and they are transforming care in many settings. England’s Chief Nursing Officer (CNO) wants nurses to inform professional, contemporary, and socially helpful policy (NHS England, n.d.). By ensuring that nurses and midwives can interact with policy based on empirically sound research and data, it is possible to maximise their contribution to change and development at the national, regional, municipal, and systemic levels in both the health and care sectors (NHS England, n.d.). By incorporating psychedelics education into the nursing curriculum, nursing professionals would be better informed about the potential benefits of psychedelic therapy in the treatment of psychological disorders, therefore placing them in a leading position to disseminate information to patients. Lastly, having open dialogue and creating safe spaces for people to share their experiences with psychedelics can also help to educate the public and break down the stigma surrounding the use of these substances for mental health treatment.

Conclusion

In conclusion, psilocybin has the therapeutic potential for treating mental health issues such as depression, and could be employed as an alternative to mainstream anti-depressants. This alternative mode of treatment could alleviate the pressures on the NHS, due to psilocybin’s apparent fast acting nature. However, it is clear that more research is needed to fully understand the potential and risks of psilocybin in the treatment of depression due to the limited scale of existing research and historical bias employed by major journals when publishing psychedelic related research. Furthermore, there is a need for both public and policymaker education to remove the stigma pertaining to the potential use of psychedelics as a form of treatment. It is perhaps time for progressive and regulating policies pertaining to psychedelics to allow for larger scale studies to take place on their effects, and to consequently end the failed war on drugs, allowing alternative therapies a greater standing alongside current industry approved treatments of mental illnesses.

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