The Psychedelic Renaissance Can’t Achieve Its Aims Without Social Workers - Dr. Megan Meyer, University of Maryland School of Social Work

Michael Carrese: Hi everybody, I'm Michael Carrese welcoming you to Raise the Line with Osmosis from Elsevier, an ongoing exploration about how to improve health and health care. 

Even though they're still illegal, millions of Americans currently use psychedelic drugs, and that number will surely jump dramatically after expected FDA approvals of MDMA and psilocybin over the next several years. As regular listeners to Raise the Line know, there's great concern among proponents of psychedelic-assisted therapy that the needed workforce to meet this growing demand won't be developed in time, leading to yet more unsupervised use. 

Well, today we're going to focus on how to reduce the possible risks of non-clinical

consumption of these compounds with Dr. Megan Meyer, an associate professor at the University of Maryland School of Social Work, who tackled this question in an op-ed she co-authored in The Baltimore Sun, in which she made the case that social workers -- as the largest group of mental health providers in the nation -- can play a critical role in minimizing the

risks and realizing the potential of psychedelics. 

Dr. Meyer has formed a collaboration with the University of Maryland schools of Pharmacy and Nursing to survey social workers and nurses regarding their current knowledge about, and desired training needs related to, psychedelics and psychedelic-assisted therapy for addiction.

And we're looking forward to learning more about all of this today. 

Thanks so much for joining us, Dr. Meyer. 

Dr. Megan Meyer: Thanks, I'm excited to be here. 

Michael: I'd like to start with learning more about you and what first got you interested in social work as a career. 

Dr. Meyer: Yeah, I was sort of drawn to the profession, I think, over thirty years ago when I was looking at graduate programs. I was a psychobiology major in undergrad, so I was always interested in the brain and psychology, and I was exploring various programs. I was looking at public health, I was looking at psychology, at PsyD programs, and I think what I really appreciated about social work was its focus both on mental health and on examination of systems -- family systems, community systems, policy -- and how those interact with individual factors to either harm or facilitate health and what we in social work for decades have called and taught in our programs, “the person in environment” perspective. That really is very similar to what is more broadly known as the social determinants of health framework. We've been talking about that forever in social work, and now it's getting more attention, which is really gratifying for us. 

I also really resonated, I think, with the social justice orientation and social change focus in social work, and the profession's commitment to try to foster greater social and economic justice. My parents were somewhat radical activists and educators and artists, and so I think my family values were aligned with social work. So, I chose social work, and I wanted to be a therapist. As I dug deeper into the coursework and my master's program, I got even more turned on by the social change strategies in the profession so I've ended up studying social movements, community organizing, community building practices, and that's what really most of my scholarship has been about. 

I'm not a clinician, and my exploration into psychedelics is a bit of a left turn, but as a systems thinker, I sort of saw what was going on with the policy, I saw what was going on with the clinical research, and it was pretty clear to me that social work needed to be a central player in this landscape. What was really exciting to me was hearing so much about set and setting and the therapeutic container, and that it was not just about the medicine. And so I thought to myself, “Wow, medicine really needs us here. We're the experts in mental health care. The Renaissance needs us. I don't think it can actually achieve its aims without us. 

So, that sort of excited me as both an opportunity for us to gain recognition for the value we bring, as well as a responsibility as an educator to train our workforce. 

Michael: Yeah. And all the folks that we have talked to on the program that have been involved in the clinical trials really emphasize that this is not about the drug as much as it's about the combination of the therapy and the drug...what the drug allows you to do because it opens the mind in a certain way. Which is sort of getting to the point I was making at the beginning: there's a lot of people who are already using psychedelics, and many, many more will start once the FDA approves things. So, it's a great time for people to get their thoughts organized about how this is all going to play out, which is what was so timely about your Baltimore Sun piece. 

Before we get deeper into the psychedelic piece of this, I also noted that social workers --

as you pointed out in your article -- are the largest part of the mental health workforce in the U.S. and you mentioned being a therapist is one of the paths that social workers can take. Help us understand more about their role in the mental health system. 

Dr. Meyer: Well, I think since I am fairly new to this territory -- I really just started digging into this in last January, so less than a year -- but as I talked to neuroscientists and other folks, I was a little surprised actually that social workers weren't completely on their radar. I kind of realized that most folks didn't realize that we simply outnumber other clinical professions in mental health delivery. With approximately 250,000 clinical social workers nationwide, we provide more mental health services than psychologists, psychiatrists, and psychiatric nurses combined. Most folks, I don't think, realize that because we're everywhere. We're embedded in schools, in mental health clinics, in hospice facilities, in nursing homes, in employee assistance programs throughout workplaces, community-based organizations, state and federal government agencies like the VA... we're kind of embedded everywhere and that's why we sort of, in a sense, dominate the mental health delivery space. 

The other thing that is interesting in this is that the Bureau of Labor Statistics has showed projected needs and increases for social workers and that we outpace the average for all of our other professions in those projections, and with the mental health crises and the substance abuse crises we're seeing, those projections are only increasing. Nationwide in the next decade, it's projected to see an 11% increase in the need for mental health social workers, substance abuse social workers, and health care social workers. In Maryland, those numbers are even a lot higher, actually...it’s like 16%, 17%, 18% for that workforce. Frankly, we're not producing enough social workers. That's another op-ed and another podcast for another time. 

Michael: (laughs)

Dr. Meyer: But I think for all those reasons, social workers are going to be a big part of scaling

psychedelic-assisted therapy (PAT) and managing increasing psychedelic use. 

Michael: So, what are you and your colleagues seeing now in terms of the need for harm reduction around non-clinical use? What kinds of problems are arising? 

Dr. Meyer: Well, just a caveat again, I'm not a clinician and I have a lot of clinical colleagues who I think would be able to provide a more nuanced answer to that. I work with amazing people. We have Kathryn Collins, who is known for trauma; we have Paul Sacco, Fernando Wagner, Michelle Tuten and Jodi Frey, all with expertise in addiction -- Jodi also has expertise in suicide and employee assistance -- and John Cagle in palliative care. These are all colleagues I've been talking to about this and while none of them would claim to be experts in psychedelics, I think we all know psychedelic use is increasing and we're curious about the emerging research. 

I don't think we actually know that much about what our clinical social workers are seeing on the ground in their offices. I recently got a small grant to partner with our schools of Pharmacy and Nursing to do a survey of social workers and nurses to get a sense of their attitudes, knowledge, what they're seeing in their clinical practices, what training needs they have, and that may shed a tiny bit of light. But, you know, in terms of the risks that we're aware of that you and other folks you've interviewed have mentioned, they seem relatively low and rare at this point in terms of the heart valve challenge with folks who have that predisposition; the small risk of persistent hallucinations; the increased risk of psychosis for those with those predispositions. 

But, you know, a review that I read that was published about a year ago in the Journal of Psychopharmacology essentially was looking at the medical risks and saying, well, they're relatively small. The addictive potential is relatively low. So, I don't have a lot of knowledge about what we're currently seeing, but I think in general, there's still a big challenge in that most social workers are likely to be hearing more from clients who are curious about psychedelics, are using psychedelics or have intent to use. They're not aware of the latest clinical research risk and benefits. They, therapists, might be uncomfortable talking to clients about this or just feel ill-equipped to talk to them. 

So, essentially, I can't answer that question perfectly because I just don't have the data, but I think there's clearly a need, even though the risks seem relatively small.

Michael: In the Sun article, you talked about the need for training for social workers to have something called Psychedelic Harm Reduction and Integration Training. It would be helpful, I think, for our audience to know more about what's involved with that and what it adds to what social workers already know about harm reduction.

Dr. Meyer: Well, I saw the founders of the national training group Fluence -- that’s Ingmar Gorman and Elizabeth Nielsen -- at a Harvard training back in January and Elizabeth was talking about Psychedelic Harm Reduction Integration or PHRI and I think they coined that. She was saying it really combines a harm reduction approach -- which is to not judge people for their substance use or attempt to get them to stop all their substance abuse or use, but to try to reduce harm from that use -- combined  with integration techniques that both Ingmar and Elizabeth had used in the clinical trials at MAPS that they were involved with.

So, it's the combination of those two to essentially help clients examine their decision-making process about using psychedelics and to go through a careful decision-making process about that use, to understand the risks and benefits of the latest clinical evidence, and to gain insights from their psychedelic experiences as well as process difficult experiences they might have from psychedelic use. So rather than an abstinence-only approach or making the client feel shamed for using, it's about reducing potential harms. 

But it's also about -- and this is the difference from other harm reduction approaches with other substances -- it's about understanding and increasing the potential for healing from the use of psychedelics. I think many social workers already come with a harm reduction approach in the therapeutic practices to substances, but what is different is the potential for healing with psychedelics...the neuroplasticity, the fresh snow, the window of opportunity that may be there.

Again, I don't think social workers know enough about psychedelics. They may not be prepared to guide clients toward evidence-based information or either support services like the Fireside Project. I watched a webinar on them and they're doing some interesting work. And so most social workers may not feel equipped really to or comfortable talking about psychedelics

with their clients as well as the legal issues around the use. 

Michael: Right. So in a way, as I'm listening to this, I'm thinking it could be a prolongation of the integration that happens after the actual session where the drug is administered. In the clinical research protocols, anyway, there's a couple of meetings, sometimes more, but at a certain point, that process stops with those therapists and so you're talking about picking up after that. 

Dr. Meyer: Yeah, as well as just educating the public about psychedelics, even with those not actually getting access to or intending to engage in psychedelic-assisted therapy. We know there's increasing use, like you were saying in the beginning, so if our social workers are on the front lines interfacing with the public, how can they be an educated workforce to educate the public? 

In terms of a curriculum that we're looking at for PHRI, it would include a number of different topics: history of psychedelic use in indigenous cultures, the policy and regulation, regulatory changes and psychopharmacology. And my colleague, Andrew Cooper, over at our School of Pharmacy, he does have expertise in the psychopharmacology of psychedelics. He keeps reminding me that all these psychedelics are very different. We need people to understand these differences and to understand the clinical research for different psychedelics with different kinds of mental health conditions and, really, what's the evidence there? As well as -- and this is something I'm really very mindful and concerned about and is oriented from the social work perspective -- what are the social justice and diversity issues related to access, but also delivery of mental health services? 

So, the curriculum would contain all those things, as well as what are those therapeutic decision-making practices or therapeutic practices to help people make careful decisions. I'd also like to expose social workers to the ecosystem of care. You know, what roles will social workers have? How do they team with other disciplines? What roles do indigenous leaders and healers have? What are the community and group models? So, a foundational PHRI curriculum would include all of that, shy of how to deliver psychedelics in therapy.

Michael: So, what needs to happen to make this training available to a lot of people? 

Dr. Meyer: A lot of collaboration. That's what I've spent my last nine, ten months doing, is a lot of conversations. I'm very committed to try to not recreate the wheel, and that's why I've been in conversation with the Fluence, and there are 250 schools of social work nationwide. I don't think we have a lot of expertise internally in psychedelics, and so I think it's going to require cross-disciplinary collaboration. That's part of the reason I'm doing this grant with our schools of Nursing and Pharmacy.

I think UMB is really well positioned with the professional schools it has on our campus to have an interprofessional approach to this, so I think there needs to be collaboration across disciplines on campuses. I think we also need collaboration across universities. Columbia School of Social Work and University of Pennsylvania School of Nursing are collaborating to build curriculum, and the grant they got seemed to stipulate that they share their content with other universities, so I'm reaching out to them. I think the more we can collaborate across universities and across disciplines -- and even between universities and training institutes -- the stronger our ability will be to get people trained and scale, and I feel like we're already a little bit behind on that. 

Michael: Yeah, I think a lot of the guests we've talked to are really worried about the timing of all of this...that the FDA approvals will come sooner than the system is ready for, and there

could be a lot of downstream consequences of that. 

So, as you look ahead to a post-approval landscape, do you see social workers as being part of the workforce that's in the room helping guide these sessions and doing all the pre-work and post-work involved?

Dr. Meyer: Absolutely, but my focus right now has really been on how do we get people this foundation content, and really, I'm focusing on continuing professional education. We have all of our master's programs and curriculum within our master's program and we have increasing student interest in learning these skills and learning more about psychedelics, but right now, we've got all these licensed clinicians out there that need continuing professional education, and they're on the front lines. They're already licensed, and if we can get them trained in the foundations of PHRI, then when the FDA approves PAT, they then can get that additional training. It could be in MDMA or could be in psilocybin

So, I do see social workers as playing a central role as having both interest in delivering these services and being especially equipped to deliver them well. 

Michael: In the op-ed, you also made the point that social workers are well equipped to address two critical issues facing psychedelic services, and you already touched on the issue of equitable access and also culturally relevant care, so go a little deeper into those for us. 

Dr. Meyer: Sure.  I think aside from our sheer numbers and our strong clinical training, as well as our careful licensing process -- typically a two-year process of supervised clinical practice before getting a clinical license -- we have a really strong code of ethics that commits us to work with and on behalf of clients and constituents, and that's both for greater economic, racial, and social justice. This commits us to working with some of the most vulnerable and marginalized communities in our society -- those below the poverty threshold, those that are Medicaid-eligible -- and we have very strong values for self-determination and empowerment.

When I went to that training earlier in the year, a lot of the clinical psychologists were talking very much about how people are on their own journey and that we are partners, we are assistants to them. Social workers already have that standpoint and want to work with people to help them find their own voice, their own power, and to be very conscious -- and this is the cultural humility part -- of our own biases, of our own privilege, of our power relative to clients. There's a natural power imbalance between social workers who are embedded in all these organizations and who are gatekeepers to resources the clients need, and to be very careful about imposing our own perspectives or biases on clients, and to be aware of the potential harm we can cause by not raising our own awareness. 

I remember Monica Williams – I don't know if you're familiar with her... she's at University of Ottawa in Canada -- she gave a talk on racism and the risks of particularly white practitioners not doing their own work to understand their privilege, understand their biases, and working with BIPOC communities who might, during a psychedelic experience, be talking about racism. If the white practitioner can't go there or hasn't done their own work, that that could re-harm. For social workers, that's baked into our curriculum and our education. We look at structural oppression as well as our own biases. And so for those reasons, I think social workers are very well-equipped to respond well and to deliver PAT carefully. 

We're also a pretty diverse workforce. The latest numbers I've seen are about 40%, I think, of our workforce identifies as non-white. We're also an affordable option, which is not necessarily so great for social workers. The average salaries are rising because of labor shortages, but are around $60,000 a year compared to psychologists, which is more $80,000 or $90,000, and psychiatrists, which are well over $200,000. So again, I think it is going to be an ecosystem of care, but social workers are going to be a well-equipped and affordable way to deal with the scaling challenge. 

Michael: What are some of your other concerns and biggest concerns about the psychedelic renaissance? I know a lot of people are concerned about repeating what happened in the 60s and 70s, where there was a lot of hype and there was a lot of unsupervised use, and then the crackdown came, and that all of this hard progress that’s been made on the research side over the last ten, twenty years, could be unraveled. 

Dr. Meyer: I think one of them certainly is the hype and unrealistic expectations, and I feel there's a continuum of perspectives. On the one hand are folks that are like, “psychedelics are going to save the world,” and on the other end is still sort of the drug war mentality of all substances are bad, so we have to keep them all illegal. We need social workers to be somewhere in the middle. I think they already sort of are, but I think there's also unrealistic expectations because of the hype for what psychedelics can do for people, so I think that definitely is a concern. 

The simple access to mental health services period is an issue, right? And if that's so critical to the efficacy of these medicines, then we just we need to ensure people can get access to mental health services. But I'm also concerned about us moving quickly to scale access combined with our profit motive. I'm not so confident that those that are going to be producing and selling the product care that much about set and setting and I worry about the medicine being divorced from that therapeutic container and community containers. I guess I always just come back to an educated workforce being our best defense against these pressures, and that we better work hard to get there, or like you're saying, we could see not just lost potential, but harms from uncareful use. 

Michael: You know, it seems the more we talk to people about all aspects of the healthcare system, all roads lead to workforce issues of one sort or another.

Dr. Meyer: That's the bigger challenge, I think. We have workforce issues across a number of different professions, but I know we have it in social work. That is another op-ed and podcast, but it's something that we in higher ed are talking a lot about. I think, frankly, it's a money question as well. Even in the state of Maryland, we need to get money into students' hands so they can get their education and we see students going away from humanities and toward other kinds of professions because they can make more money. Social work is not a high paying profession. It's a very meaningful profession, and people enter it to make a difference, and we need to encourage young people to do that. 

Michael: Absolutely. So, as you probably know, Osmosis is a teaching company. We love to fill knowledge gaps. One of our favorite questions in these podcast interviews is to ask the guest to give us some direction about a video we could make or a course we could put together that would fill a gap in knowledge that's of particular interest. What would that be for you? 

Dr. Meyer: That is a great question and thanks for asking it. I think it's an interesting one because it allows me to offer a perspective and build a bridge between psychedelics and my work as a community scholar for twenty-five years, because I've been trying to make that bridge myself since I'm not a clinician. From what I've seen in the movement and in the clinical research, they've done a great job of articulating the importance of set and setting in the therapeutic container. If we can just ensure we don't lose that in our implementation, we don't divorce the medicine from the container, I think that's a huge step in the right direction.

What I haven't heard a lot about in my conversations or in the literature are ways we support integration once someone leaves the PAT therapist's office. You alluded to that earlier. I've seen conversations about how do we use group models to scale PAT, but not as much about

self-directed, sustainable affinity or community-based mutual aid group models that will help sustain integration. Because again, it's not like integration stops the minute someone is finished with their PAT integration sessions, right? That's going to continue and these other kinds of models might help sustain integration and build community for people. 

I don't know if you saw the latest report by the Surgeon General raising the alarm about our epidemic of social isolation. I just started looking at that, and if you just look at the table of contents, it's really all the stuff I've been looking at in my scholarship, which is declines in social capital, cracks in our sense of community and in our communities. And so I'm really interested in looking at innovative community strategies to help people develop deeper connection to networks, to affinity groups, intentional affinity groups and community-based organizations to both continue their process of integration and finding meaning, but also just building stronger civic health, healthier communities. 

I think we as a society tend to default to individual treatment a lot of the times. We identify an individual who's struggling and we say let's fix that individual dysfunction and we put a lot of faith in sort of medical intervention to solve our problems. But solutions to problems are an interplay between treatment and healthy communities. So, where is that bridge in the psychedelic landscape is a question that I want to explore. 

Michael: Yeah, that's really interesting. So, can you give us an example of what that would look like...you know, an affinity model, as you were saying? 

Dr. Meyer: I'm beginning to work on a book on this, actually. For my own health and healing, I recognized almost a decade ago that that would be facilitated by an affinity group. So, I brought together different women who I admired for their intentional focus on their health. They didn't know each other, and we got together and we've been meeting regularly for a very long time now talking about all kinds of topics: about our approach to joy and pleasure and happiness, our approach to perfectionism...I mean, all kinds of topics come up that really help

each of us. We share information, health information. It's a support group, but it's an intentional way to have these conversations and process experiences that we're all having. 

So, I can see that being a similar kind of group for folks who have just gone through PAT. 

Another affinity group model is in my workplace. We've been fortunate enough to hire an associate dean for Diversity, Equity, and Inclusion and she and her office have developed these affinity groups around identity.  I'm in a white accountability group and we are processing Layla Saad's book Me and White Supremacy. We're looking at how to develop our own cultural humility. How do we show up in our organizations? What does that mean for how we interact in meetings and ways that we support our colleagues of color? So, there are a lot of different affinity group models out there that could work well, again, both for continuing integration, as well as just building community. 

Michael: You know, the first model you mentioned...what popped into my head is “book group meets support group.” 

Dr. Meyer: Yeah, but I think what's critical is that it's peer led. There's no therapist facilitating the conversation so it's sustainable. It can be self-directed. That doesn't mean there aren't elements or factors that facilitate the health and sustainability of those groups, but they don't have to be directed by a clinician or an expert.

Michael: Really interesting. So, as we wrap up, another favorite question is to get advice from folks to younger people, and you are around students all the time. What's your go-to advice to people who are entering healthcare careers, particularly at this time where there's just so much disruption and challenge of different kinds?

Dr. Meyer: Well, I have been having more conversations with prospective students, with current students, with recent graduates, all interested, particularly, in getting training in PAT. And a number of them have said that they reached out to groups like MAPS and to Hopkins to get advice on where they should go, what they should do.  I was kind of gratified that a lot of them recommended they go into social work and get a social work degree. My first advice would be, if you're interested in being able to deliver these services, just get the solid clinical foundation to start and degrees like social work provide that. 

But then, again, I think it's so important to be committed to continually checking your own power biases and expertise. Our clients are the pilots. We need to help them pilot well, but we are their partners and assistants.  I think we also have a lot to learn from indigenous healers and communities. I know this is a big conversation in the psychedelic movement, but I think they probably understand set and setting better than anyone in a more holistic way. They don't seem to separate the medicine from community. 

There's a lot that I don't know -- so I know I need to personally listen much more deeply with curiosity to what indigenous healers and communities are saying -- but my impression is that ceremony, community, deep respect for the spiritual aspects of these medicines are fundamental to the healing process. I think we all need to think really critically about the implication of their wisdom to our work. So, how do we listen to what they're saying about how to conduct these practices and what elements to look at, but also the implications of our work on their wellbeing. 

As a university educator, developing training and credentialing programs, we have to examine the potential we have to marginalize those who have been doing this work traditionally. And so I've been asking myself a lot, what is an anti-racist, anti-oppressive PHRI or PAT training and practice? What does that look like? I need to work with a lot of different colleagues to sort of figure that out.

So, I guess my advice for emerging practitioners and all across the health professions is to embrace those conversations, ask critical questions and interrogate your own practice. 

Michael: Boy, this is such an interesting area to explore, and you've given us all so much to think about. I really want to thank you for all of that insight and for taking the time to join us today. 

Dr. Meyer: Sure. It's been a pleasure and I want to thank you for recognizing the value and role of social work in this conversation. 

Michael: Absolutely. Michael Carrese. Thanks for checking out today's show and remember to do your part to raise the line and strengthen the healthcare system. We're all in this together.