Psychiatry Infrastructure Lags Psychedelic Momentum, With Gus Alva, MD

Psychiatry currently lacks the infrastructure and trained workforce required to safely deliver psychedelic-assisted therapies at scale, despite accelerating policy and research momentum, according to Gus Alva, MD, psychiatrist and medical director of ATP Clinical Research. Speaking in the context of recent federal efforts to expand access and research, Alva emphasized that adaptability exists within the field, but implementation capacity remains limited.

He noted that patients with risk factors such as bipolar disorder, psychosis vulnerability, or cardiovascular disease may require careful screening, including detailed psychiatric and family histories and trauma-informed assessments. Current trial protocols, he explained, rely on highly trained therapists, often requiring > 100 hours of specialized preparation.

“The reality is that we right now don't have a therapist pool in the US that would be able to actually fill in this particular slot,” Alva said. “Bear in mind also that these sessions require about 6 to 8 hours of dosing with facilitators, as well as medical backup…physical space, and integration sessions that are done before and after.”

He highlighted integration expertise as central to potential benefit, noting that clinicians must help patients process experiences during a period of heightened neuroplasticity. He also emphasized the importance of safety protocols, including contingency planning for difficult psychological responses, emergent suicidality, psychotic symptoms, or cardiovascular events.

Alva’s comments follow the April 18 executive order signed by President Donald J. Trump directing federal agencies to accelerate research and regulatory pathways for investigational psychedelic therapies.1,2 Alva cautioned that infrastructure development must keep pace with policy changes.

“What this executive order basically brought to the surface is that the way or the conduit for actually exploring psychedelics is going to become a little bit easier,” he said.

According to Alva, the executive order may help address persistent treatment gaps in major depressive disorder (MDD) or PTSD, where many patients do not achieve remission with current therapies. However, he raised concerns about applying Right to Try pathways to Schedule I psychedelics without sufficient safeguards. Although he characterized expanded clinical trial activity as necessary, he emphasized that premature adoption without adequate training, monitoring, and infrastructure could introduce risks.

“[A] training pipeline would certainly be one of the requisites that we'd be looking at,” Alva said.

Watch part 1 of our interview with Alva here: White House Order Accelerates Psychedelic Research for Mental Illness, With Gus Alva, MD

Relevant disclosures for Alva include Teva Pharmaceuticals, Otsuka America Pharmaceuticals, AbbVie Inc., Axsome Therapeutics, Janssen Pharmaceuticals, and more.

References

1. O’Neil G. Accelerating Medical Treatments for Serious Mental Illness. The White House. Published on April 18, 2026. Accessed April 20, 2026. https://www.whitehouse.gov/presidential-actions/2026/04/accelerating-medical-treatments-for-serious-mental-illness/

2. Kotkiewicz J. Fact Sheet: President Donald J. Trump is Accelerating Medical Treatments for Serious Mental Illness. The White House. Published April 18, 2026. https://www.whitehouse.gov/fact-sheets/2026/04/fact-sheet-president-donald-j-trump-is-accelerating-medical-treatments-for-serious-mental-illness/