DVA to fund psychedelic-assisted psychotherapy

Veterans can now access funding for psychedelic-assisted psychotherapy treatments to address post-traumatic stress disorder (PTSD) and treatment-resistant depression (TRD), the Federal Government announced this week.
 
These include medications with MDMA to treat veterans with PTSD, as well as psilocybin to help patients with TRD, which authorised psychiatrists are able to prescribe under changes put in place by the Therapeutic Goods Administration (TGA) in 2023.
 
The move, which was a world-first, attracted both praise and controversy with some questioning whether there was enough evidence around the efficacy and safety of the treatments.
 
Dr Karen Spielman, Chair of RACGP Specific Interests Psychological Medicine, has been closely following discussions around psychedelics for difficult-to-treat psychiatric conditions, particularly through her work with patients with eating disorders.
 
She believes GPs’ longitudinal understanding of patients will prove central for assessing their suitability and sees an important role for GPs to work with psychiatrists to manage medication withdrawal.
 
She also notes the treatments are targeted at patients who have not responded to previous interventions.
 
‘We’re all aware that there’s no one-size-fits-all for psychiatric treatments, and it’s really important that we are aware of the changing landscape,’ Dr Spielman told newsGP.
 
‘It’s certainly worth considering because in a group of people that are hard to treat it’s offering hope.
 
‘Psychedelics provide quite a hopeful paradigm shift for treating complexity, whether it’s treatment-resistant depression or PTSD.
 
‘Certainly, for my patients, it’s been lovely to be able to talk hopefully about new treatments and see authorised prescribers who have experience, and the research being implemented locally.’
 
The Department of Veterans’ Affairs (DVA) says ‘greater clinical scrutiny’ will be applied to any funding requests ‘due to the risks associated with emerging treatments’, with no funding to be provided without prior approval from an authorised prescriber.
 
The treatments are a fourth-line clinical option, with the DVA stating ‘there needs to be evidence of multiple prior treatments of typical agents or therapies and how they have failed’ before they are considered. 
 
Associate Professor Caroline Johnson, who sits on the RACGP Expert Committee – Quality Care and its Mental Health Working Group, notes that with an emerging evidence base the requirements ‘seem sensible’.   
 
‘For GPs, it will mean knowing what an ‘adequate trial’ of ‘multiple’ (i.e.: two, according to the guidelines) other accepted therapies for PTSD and TRD look like and then knowing where to find psychiatrists who are willing to treat eligible veterans,’ she told newsGP. 
 
‘Ideally these will be prescribers who are working in practices where ongoing rigorous research is conducted into both the benefits and harms of these emerging treatments.’
 
When the changes to the medicine scheduling took place in 2023, the TGA said its decision acknowledged the ‘current lack of options for patients with specific treatment-resistant mental illnesses’.
 
‘It means that psilocybin and MDMA can be used therapeutically in a controlled medical setting,’ the regulator stated.
 
‘However, patients may be vulnerable during psychedelic-assisted psychotherapy, requiring controls to protect these patients.’
 
The DVA said the decision to fund treatment is a welcome move for veterans with ongoing symptoms.
 
‘The approval of these treatments is encouraging news for the veteran community, particularly for those who have been diagnosed with PTSD or depression and have persistent symptoms despite undergoing usual evidence-based treatments,’ it stated.
 
It said retrospective applications for funding will not be approved.
 
Current serving Australian Defence Force members and veterans visiting or residing overseas are not eligible for the treatment.
 
More details about accessing the treatment are available on the DVA website, including information for providers.
 
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MDMA PAP psychedelic-assisted psychotherapy