We need an urgent taskforce to tackle the mental health pandemic sparked by Covid-19
Mental health charity Mind Medicine Australia (MMA) calls for and strongly supports all recommendations to form a Mental Health Innovation Taskforce to be immediately established. This must be established now to guide the government in planning the next steps to manage the increasing mental health pandemic triggered by Covid-19 and the recent bushfires tragedy.
We live in one of the wealthiest countries and we have one of the best medical systems in the World. Yet despite the high calibre of our medical practitioners, and the enormous associated system costs, we also have one of the highest rates of mental illness in the World. These rates are increasing exponentially now.
Experts warn that a long-term mental health pandemic is looming in Australia that will potentially surpass the physical health impacts of the coronavirus. Frontline charities are suggesting that the effects of the current pandemic on mental illness could be “seven times” worse than the spike in mental illness caused by the recent bushfires.
It’s estimated that I in 5 Australians currently has a chronic mental health condition and I in 2 of us will experience such a condition in our lifetimes. 1 in 8 Australians (and 1 in 4 older people) are on anti-depressants. The rate of anti-depressant use amongst adolescents is also growing markedly. Worryingly, suicide rates, particularly amongst young people and veterans, are also increasing.
Only an estimated 20% of depressed individuals in the general population experience remission from current pharmacotherapies or psychotherapies. The majority of sufferers experience ongoing symptoms and between 50% to 80% relapse after treatments stop. In addition, psychotherapy is costly and can lead to dependence. Pharmacotherapies are also usually associated with considerable adverse side-effects.
PTSD is even harder to treat and is often co-morbid with other disorders and illnesses such as anxiety, depression, obesity, hypertension, addiction and immune dysfunction.
Simply doing more of the same or making only incremental changes to the current system is not going to solve this problem and relieve the immense suffering. To create positive change, we have to be innovative to broaden the tools available to our medical practitioners and qualified therapists working in this area.
The focus of the Taskforce will need to be on innovation in treatments and pragmatic implementation to reach the millions who are suffering from a mental illness.
Effectiveness and Safety of Psilocybin and MDMA Assisted Therapies
Medicine-Assisted Psychotherapies are highly innovative and should be made available in Australia to treat critical mental illnesses caused or exacerbated by the current Coronavirus crisis. Therefore, the Taskforce must include a senior psychiatrist familiar with both these treatments and the global developments taking place right now. MMA stands ready to help the federal government identify the most appropriate candidate to assist with the Taskforce.
The treatments involved in Medicine-Assisted Psychotherapies use psilocybin for depression and MDMA for post-traumatic stress disorder (PTSD) as part of psychotherapy in medically-controlled environments. Medicine-Assisted Psychotherapies have already been granted “breakthrough therapy designation” in the United States by the Food and Drug Administration to fast track the approval process. They are also available to doctors and their patients on a limited basis through expanded access schemes in the United States, Switzerland, and Israel.
There has been a massive increase in the research of psilocybin and MDMA assisted therapies for Depression and PTSD respectively over the last 15 years at major clinical centres in the United States and Europe. These medicines are now also being trialled for treatment of dementia, eating disorders, addiction, obsessive compulsive disorder and end-of-life anxiety.
Large multi-site Phase 2b (psilocybin) and Phase 3 (MDMA) trials have already commenced overseas. Results from the preceding Phase 2 clinical trials have been so compelling that the Food and Drug Administration (“FDA”) in the United States has recently designated these therapies as “Breakthrough Therapies”. This designation highlights the FDA’s anticipation that these therapies may offer substantial advantages over current treatments. In addition, MDMA-assisted psychotherapy has recently been approved for advanced access (referred to as Compassionate Use) in Israel for patients who have not improved with available approaches, and a similar program (Expanded Access) is pending approval in the United States.
Most effective treatments for mental illness show effect sizes (using Cohen’s d values) in the order of d = 0.5 (where 0.2 is small, 0.5 is medium and 0.8 represents a large treatment benefit). Anti-depressants for Depression have effect sizes of around d = 0.3. By comparison in the Phase 2 trials MDMA assisted psychotherapy for PTSD had significantly higher effect sizes of d=1.17 -1.24 and psilocybin-assisted psychotherapy for Depression had even higher effect sizes of d = 2.0–3.1. Both therapies have very strong safety records when used in a medically controlled environment and are non-addictive.
Remarkably, remissions in current trials of between 60–80% are being achieved with only 2–3 dosed sessions in contrast to conventional treatments which require daily medications and/or weekly psychotherapy over decades and lifetimes.
The Hon. Andrew Robb AO, former Trade Investment Minister and a Director of MMA, argues that the development of a government strategy to tackle the burgeoning mental health crisis must include the introduction of innovative treatment options like Medicine-Assisted Psychotherapies. “Remission rates for people experiencing common mental illnesses using the standard treatments of antidepressants and psychotherapy are only about 35 per cent effective. But Medicine-Assisted Psychotherapies have been shown to have remission rates of 60–80% in recent overseas trials after just two to three treatments.”
According to the chairman of MMA, Peter Hunt AM, “A proactive approach to broadening the treatment options available for people who have a mental illness is desperately needed. With the likelihood of the coronavirus pandemic continuing for months to come, many more Australians will experience anxiety, trauma and depression and suicide rates could significantly increase in the absence of affirmative action.”
Tania de Jong AM, Executive Director of MMA, says, “The remission rates that could be achieved with Medicine-Assisted Psychotherapies will release vast financial resources to help governments around Australia develop and fund more proactive agendas to assist the nation’s recovery. The financial burden from mental illness, which represents an enormous amount of human suffering, can be expected to increase significantly in the future if governments don’t take decisive action to introduce new treatment options. Unlike conventional treatments which often require patients to endure years of daily medications and weekly support from a mental health professional, Medicine-Assisted Psychotherapy can be effective after just two to three dosed sessions, and the medicines are safe and non-addictive when properly used in a medically-controlled environment.”
Mind Medicine is seeking to change the mental health paradigm in Australia by significantly increasing the treatments available to medical practitioners and their patients. Key aspects of our strategy involve education of all interested stakeholders, the production of a major International Summit in Melbourne in November 2020, the development and operation of an accredited practitioner training course, funding for relevant clinical trials, the development of an appropriate legal and ethical structure for discussion with regulators, the development of reliable sources of pharmaceutical grade psilocybin and MDMA in Australia, the development of an Asia-Pacific Centre of Excellence based in Australia, maintenance and expansion of international information flows and rollout strategies so that all Australians who need these therapies can access them through the medical system.
It is time to give all Australians, who live with multiple failed attempts at recovery, the opportunity to access treatments that will improve and save lives. We must step up as a nation to innovate and collectively manage our growing mental health crisis. Together, we can create a healthier, happier and more cohesive society to meet the wicked challenges we are facing.
For further information on Medicine-Assisted-Psychotherapies, please visit the MMA website: www.mindmedicineaustralia.org