Psychedelic-assisted therapy (PAT) can transform the lives of people who might otherwise face lifelong mental health challenges.

Understanding how it works best, who it is likely to help and in what contexts, however, is not a simple task.

“It is a complex therapy to implement,” explains Dr Sarah Catchlove, who is the co-lead author with Dr Katrin Oliver of a paper about PAT published this month in Addiction.

It involves administering psychedelics such as MDMA or psilocybin to patients alongside psychological interventions in specific environments and contexts that interact to treat mental illness.

“The therapy isn’t just about the psychedelic in isolation,” Dr Catchlove says. “It’s about the interplay between the psychedelic itself, the therapist's skill, client readiness and the environment.”

To better understand how PAT works and for whom, the research team from Monash University explored the perspectives of clinicians and service leaders on psilocybin-assisted therapy for people experiencing alcohol use disorder co-occurring with depression.

“We wanted to understand their perspectives because clinicians and service leaders are the ones responsible for executing the intervention within policy and resource constraints,” says Dr Catchlove.

“Their attitudes don’t just shape understanding, they shape the models of care that follow,” she adds. “As models of care continue to be refined and developed, these stakeholders will play a pivotal role in determining how PAT is understood, delivered and integrated within existing systems.”

The findings of the study will have implications for the implementation and scaling of the therapies both in Australia and internationally.

For example, service leaders highlighted operational and ethical tensions within regulatory requirements.

Clinicians emphasised the need for careful integration, robust support for clinicians, and aftercare for patients. They also voiced concerns about equity and access to the treatment.

The study’s findings also revealed three distinct attitudes about how best to apply the therapy and who it best serves.

1. A treatment as a last resort

Service leaders tended to understand PAT as a treatment of last resort, once people had used various other treatments without ‘success’.

“This way of describing PAT is consistent with the current regulatory approaches, but some experts have voiced concern that it positions it as a medical intervention for a specific pathologised population,” says Dr Oliver.

In other words, those who have ‘failed’ to respond to other treatments.

“Experts have voiced concerns that this also restricts its use to people who can document multiple failed attempts while excluding people who face barriers to care, and positions it at the end of a treatment pathway hierarchy,” Dr Oliver explains.

Other ways of conceiving the therapy have revealed broader potential applications.

2. A tool to unlock ‘stuckness’

In contrast with the more outcome-oriented views expressed by service leaders, clinicians often described PAT as a tool to unlock ‘stuckness’ – a point in therapy when progress stalls despite ongoing engagement.

“Rather than interpreting ‘stuckness’ as an individual’s problem, many clinicians describe it as a predictable and ordinary stage in the therapeutic process,” Dr Oliver says. “This perspective opens the door to using PAT more flexibly, not just as a last resort.”

In other words, PAT could become one option among many that could help people regain momentum.

“In this context, the treatment could be integrated into existing services, rather than reserved for a small group of people at the end of a long treatment journey,” Dr Oliver says.

3. A catalyst for rapid progress at any stage

In contrast to the first two themes, some clinicians’ openness to broader applications went even further, stating that PAT could be a helpful catalyst at any stage of treatment.

This view sees potential for PAT to fast-track progress, irrespective of the stage, regardless of how many previous attempts at treatment they had and whether early in the treatment trajectory, stuck or not.

Where to next?

“Our findings from this Australian pre-implementation study reveal that psilocybin-assisted therapy does not exist as a single intervention with universal meaning but is actively shaped by the people responsible for implementation processes,” Dr Catchlove says.

While current regulations emphasise caution by limiting PAT to ‘treatment‑resistant’ conditions, clinicians’ perspectives challenge this idea.

Their perspectives suggest that PAT could become a tool within a broader therapeutic toolkit rather than a pharmaceutical last resort.

“Expanding access also raises important practical and ethical questions about resource allocation and who is best placed to receive it, as well as ensuring it does not become available only to those who can afford private treatment,” Dr Catchlove says.

Clearly, the boundaries, appropriate use and target populations for PAT are not yet settled. But one thing is clear.

Instead of accepting fixed boundaries determined elsewhere, Australia’s clinicians and service leaders are at the forefront of generating new knowledge about how PAT should be implemented and who it is for.

Read the paper, which includes practical implications and advice for service leaders and clinicians: Unlocking ‘stuckness’ and catalysing change: A qualitative study of clinician and service leader perspectives on psychedelic-assisted therapy for substance use and mental health problems

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