Assessing readiness for implementation of psychedelic-assisted mental health therapy, in low- and middle-income countries

Abstract Mental health disorders (MHD) rank among the top 10 global causes of disease burden, with significant economic and social costs. Current treatments often have limited efficacy or tolerability, and there has been little recent innovation in treatments. In the past decade, clinical research on Psychedelic-Assisted Therapies (PAT) for treating MHD has increased in high-income countries, while most MHD burdens are in low and middle-income countries. This study assesses the readiness of implementing PAT in 136 low- and middle-income countries. We used indicators from the Lancet Commission on Global Mental Health, cultural and legal dimensions around psychedelics, and databases such as 2019 Global Burden of Disease study and Mental Health Atlas. A literature review identified countries with historical psychedelic use and existing retreats. Each country was evaluated based on thirty-four criteria in eight domains: disease epidemiology, mental health infrastructure, prevention, workforce, payment coverage, historical or cultural psychedelic use, legal retreats, and 1971 Convention of Psychotropic Drugs signatories. We assigned one of three rankings for each criterion, conducting analyses with and without missing data. Summary scores in each domain identified top-ranking countries. A country's readiness depends on high potential demand (burden of MHD), capacity to meet that demand (infrastructure, insurance coverage), less stringent legal prohibitions, and cultural familiarity with psychedelics. South Africa, Thailand, Mexico, Brazil, and Jamaica ranked among the top tertiles across seven out of eight domains in both analyses. Malaysia, Colombia, Costa Rica, Peru, Ecuador, Equatorial Guinea, Mauritius, Tunisia, China, Sri Lanka, Türkiye, Belize, and Samoa ranked in the top ten percent. 25 countries did not achieve top rankings in any domain. Study limitations include data reliability and complexities in defining readiness indicators. Eighteen low- and middle-income nations on five continents demonstrate promise for PAT implementation, with five nations standing out. Further research should validate readiness and explore additional conditions.