Is Systemic Racism Impeding Access to Psychedelic Therapy?

Breaking down cultural barriers to improve mental health care for all

Posted April 29, 2021 | Reviewed by Hara Estroff Marano

This post was written by Jessica Maples-Keller, Ph.D.

Every single person deserves access to evidence-based, high-quality mental health care. But right now, America’s mental health system is stacked against Black communities. These are the people especially likely to experience mental health problems due to systemic oppression, yet they are less likely than others to have access to the high-quality care they may need.

As a young research assistant who worked on a psychological study of Hurricane Katrina evacuees, I was inspired by the potential of research to improve help for people with mental health difficulties. But I was also struck by the challenges of access to high-quality mental health care in marginalized and underprivileged communities. Today my own research focuses on understanding and improving psychotherapy , including behavioral and pharmacological augmentation strategies, and individual differences and other factors that increase risk of mental health difficulties or affect treatment response.

People of color in the United States experience systemic racism and oppression, resulting in increased rates of trauma and poor mental and physical health outcomes. Sadly, distrust of the medical community due to historical injustices and inequalities in mental health care can stand in the way of getting treatments to the patients who need them.

Currently I am an investigator with Grady Trauma Project (GTP), an interdisciplinary clinical research group based at Atlanta’s Grady Memorial Hospital, which serves a low income, primarily African American community with high rates of psychiatric illness. At GTP we are researching the impact of stress and trauma-related risk factors for post- traumatic stress disorder ( PTSD ) and related mental and physical health conditions in Black Americans.

The GTP employs a variety of techniques (neuroimaging, psychophysiology, focus groups, intervention research) to understand health outcomes related to trauma and PTSD. Over the last 15 years, we have conducted trauma interviews with over 12,000 people through Grady Memorial Hospital. Our research suggests this community experiences high rates of trauma, with over 90% reporting at least one traumatic experience, almost half showing a lifetime prevalence of PTSD, and 36% having lifetime major depressive disorder (Gillespie et al, 2009).

There is strong evidence from many studies around the world indicating the potential of psychedelic therapy for treating a range of mental health conditions. But people of color have been underrepresented in psychedelic studies to date; most participants enrolled in psychedelic clinical trials are non-Hispanic whites. We in the healthcare world have a special obligation to ensure that if such therapies are approved and available for patients, cultural differences don’t stand in the way of people accessing and receiving optimal benefit from them.

Earlier this year, Dr. Sierra Carter of Georgia State University, a fellow GTP investigator, and I began looking at mental health care needs and attitudes towards psychedelic therapy in Black Americans. Dr. Carter leads the Health Equity, Agency, Racism, and Trauma (HEART) Lab and has a program of research investigating racial health disparities and racial discrimination as an acute and chronic stressor and developing culturally relevant interventions in underserved populations.

In our study, we want to understand perceptions of psychedelic therapy, potential barriers to engaging in these investigational treatments, and views of language and cultural context of these therapies in Black American communities. We believe that historical consciousness is an important aspect of this work; we need to understand how systemic racism against Black Americans, historical injustices perpetrated by the research community (e.g., the Tuskegee Syphilis study), and racial disparities in psychiatric treatment and the U.S. criminal justice system may affect perceptions of psychedelic therapy. We need to know how to best provide this intervention in a culturally competent way. The goal is to improve access by addressing barriers, conducting outreach, and developing psychedelic therapy to meet the needs of all communities.

We are using a mixed-methods approach, including conducting an online survey to compare perceptions of psychedelic therapy and views of barriers and potential advantages among Black and white Americans, as well as conducting focus groups with members of the GTP community. We also plan to conduct focus groups with therapists who primarily work with communities of color, and with Black Americans outside of the GTP community.

We recently completed the online survey and have begun some analyses. Results indicate that Black participants report significantly more positive views of psychedelic therapy compared to white Americans, and they find it appealing that psychedelic therapy is new and different from standard approaches. Religious and spiritual beliefs appear to be a potential barrier for some Black Americans, and Black Americans are more likely to state a preference for psychedelic therapy with a therapist of their same race/ ethnicity .

Data collection is ongoing, but the importance of trust at the individual and community level has definitely emerged as a theme, as well as strong dissatisfaction with current psychiatric treatment options and access. There is interest in psychedelic therapy as a novel and different option, particularly one not requiring ongoing medication use or therapy sessions. We are excited about completing this research and believe it has significant potential for informing cultural competence within psychedelic therapy and culturally informed psychedelic therapy for Black Americans.

Identifying evidence-based practices that contribute to the development of culturally tailored or culturally informed treatments is vital to breaking down racial health care inequities. We must ensure that all people, whatever their background and wherever they live, feel comfortable seeking help and support for their mental health.

Trust is always important in any mental health intervention, and especially with psychedelic therapy, in which the potential for alterations in consciousness highlights the need for a safe, effective, and trusting therapeutic process. If we understand how to get this right, we can develop and deliver better interventions with this treatment approach and make an impact on mental health care across all communities.

Jessica Maples-Keller, Ph.D., is a licensed clinical psychologist and practicing clinician. She is an investigator at Grady Trauma Project and assistant professor in the department of psychiatry and behavioral sciences at Emory University School of Medicine, Atlanta, Georgia. In 2020 COMPASS Pathways provided an unrestricted educational grant to Grady Trauma Project with the goal of developing culturally informed psilocybin therapy for depression and other mental health conditions.

Grady Trauma Project http://gradytraumaproject.com/

Gillespie, C F, Bradley, B, Mercer, K, Smith, A K, Conneely, K, Gapen, M, ... & Ressler, K J (2009). Trauma exposure and stress-related disorders in inner city primary care patients. General hospital psychiatry, 31(6), 505-514

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