In our mission to expand access, are we defining healing too narrowly?
Editor’s note: Meredith Thomas is executive director of Thank You Life. Soltara and SANCTUM are providers in its network.
Leonard Pickard has seen the full arc of psychedelics in America. A chemist and author who came of age in the first wave of the 1960s, he later spent two decades in federal prison on LSD manufacturing charges, and since his release in 2020 has become one of the field’s most reflective elder voices. Earlier this year, he said something that has stayed with me.
We were at Soltara, a healing center nestled between Costa Rica’s tropical forests and the Pacific coast, where Indigenous Shipibo healers from Peru hold ayahuasca ceremonies. A small group of us, Thank You Life supporters, board members, staff had gathered to sit with the medicine together, to deepen our shared commitment to expanding access to psychedelic care.
In conversation, Pickard reflected on the first wave of the psychedelic movement in the United States during the 1960s, when he was coming of age. He told me that many in that early community had an explicit agreement: these medicines would be offered only to people who were psychologically stable. Recognizing their power and the very real possibility of destabilization, the goal was to create some safety in the exploration of consciousness, creativity, and what it meant to be human. Only the well need apply.
Today, in the emerging era of regulated psychedelic therapy, the gatekeeping logic has flipped. To access these medicines legally in clinical settings or supported retreat contexts, you increasingly need to be unwell. You need a diagnosis and documented suffering. You need to be broken enough to qualify.
There are exceptions. Oregon and Colorado have built non-medical access models where no diagnosis, referral, or prescription is required. Any adult 21 or older can work with psilocybin at a licensed service center or healing center after completing a preparation session with a facilitator. But those two states remain narrow openings in a field whose center of gravity, from FDA trials to ketamine clinics to insurance logic, still runs through the diagnostic model.
I don’t say this to dismiss the life-changing impact of psychedelic therapies in treating, for example, depression, PTSD, addiction, grief, and trauma, or the groundbreaking research continuing to expand their application to a growing range of mental and physical health conditions. Nor do I dismiss the equally vital work of bringing these therapies into mainstream medicine through regulatory progress and expanded insurance coverage. All of this matters deeply, and it is the work Thank You Life was built to support by helping remove financial barriers while broader access continues to evolve.
But Leonard’s observation planted a question I’ve been sitting with ever since, and one that has now become a live debate inside our organization: Must a diagnosis remain the primary gateway to access? Or are there other legitimate reasons to seek these medicines that also deserve our support?
What We Set Out to Do
Thank You Life, a nonprofit that removes financial barriers to legal psychedelic care, was founded with a simple, unanswered question: Do people who have benefited from psychedelic therapy want to pay it forward for others who can’t afford it?
The answer, it turns out, is yes, and with a generosity I have not encountered anywhere else in two decades of social impact work. There is something that opens in people who have done this work. A quality of heart that I’ve witnessed again and again, and that drives everything we do.
Thank You Life began with a focus on those facing the greatest need and the greatest barriers: veterans navigating the crisis of suicide, and people from historically marginalized communities. We began with ketamine, at the time the only psychedelic medicine legally available in clinics nationwide. Over time, as the field matured and our network of healing partners grew to more than 200 providers and retreat centers, so did our understanding of what we were being called to address. That network now spans a range of medicines and legal contexts: ketamine clinics in the United States, licensed psilocybin service centers in Oregon and Colorado, and ayahuasca, ibogaine, and iboga providers operating where those medicines are permitted.
Today, Thank You Life works across trauma, depression, addiction, grief and loss, spiritual disconnection, anxiety, and gender-related suffering. The common denominator is a financial barrier standing between a person and the healing that could change their life. Our model removes that barrier.
Healing, we have always believed, should be determined by need, not by means.
But need, it turns out, is a more complicated word than it first appears.
A Donation That Opened a Door
A few months ago, an extraordinary thing happened. A donor came to us with a significant gift, designated specifically to fund supported ayahuasca retreats at Soltara Retreat Center for individuals facing financial barriers.
The donor envisioned something more expansive. Not limited to those with diagnosed mental health conditions. Not restricted to any particular population. Anyone facing economic constraint, for whatever reason they might want to make this journey.
That framing quietly cracked something open in how we think about our mission.
Because if the qualifier is truly economic, if financial barrier is the common denominator, then why are we also requiring a medical or psychological justification on top of it? Why does a person need to prove they are suffering enough to deserve support?
We are currently preparing to open applications for these supported retreats. And in doing so, we have found ourselves in a conversation that I believe the broader psychedelic community needs to be having.
The Debate We’re Having
This is not a settled question inside Thank You Life. It is an ongoing discussion between board members, staff, and advisors who care deeply about this mission and have different instincts about where its edges should be.
The more conservative position has real moral weight. People in acute suffering, those with severe depression, debilitating PTSD, active addiction, or conditions like Parkinson’s or MS face the most urgent need. When resources are limited, shouldn’t they go first? Isn’t expanding access beyond the clearly sick a dilution of purpose?
I understand that argument. I’ve made versions of it myself.
But here is where I am starting to land: the logic of requiring documented suffering to deserve healing replicates, in subtler form, the same gatekeeping we are supposedly dismantling. It says: you must be broken to belong here. You must present your wounds as credentials.
But it overlooks something fundamental: these medicines have long served purposes that extend beyond the treatment of illness.
The Well Becoming More Well
The C-suite executive who has spent six figures on ayahuasca retreats in the past three years doing it, she says, because it makes her a better leader, a better mother, a more present human, is not sick, at least by conventional diagnosis. She is using these medicines not to treat illness, but to cultivate growth, integration, and expansion.
The artist whose creative practice has stalled, who has never received a formal diagnosis but who recognizes in themselves a spiritual flatness, a disconnection from the generative current that used to move through them… are they not someone whose healing matters?
A conversation with Skippy Mesirow, founder of SANCTUM, a healing center in Aspen, Colorado and a provider in the Thank You Life network, has also shifted my thinking. SANCTUM is dedicated to supporting changemakers across many walks of life: educators, healthcare professionals, nonprofit leaders, public servants, veterans, artists, founders, and others who believe that their own growth enables them to better serve the people and communities around them. Mesirow’s vision is that access to this kind of transformational work should not be reserved for those with financial means. In that framing, supporting one person’s healing is not only a private good. It may also become a public one.
I find that argument compelling because it asks us to think beyond a false choice. Supporting people in profound suffering and expanding opportunities for growth need not be competing visions of access.
What Access Actually Means
Thank You Life is not, at this moment, ready to declare a policy change. We are continuing, outside of this special opportunity at Soltara Retreat Center, to support those who are experiencing the deepest suffering. What I can say is that we are in the middle of one of the most interesting organizational conversations I have encountered in this work. And I believe it reflects a question the entire psychedelic ecosystem will need to reckon with as access expands.
The science continues to advance. Regulatory pathways, however imperfect and uneven, are slowly opening. The number of clinics, retreat centers, and community-based programs continues to grow worldwide. I’m glad to see the medical model bringing these medicines into the mainstream, where for some people they will be a better option than what is currently on offer. As this field matures however, the question is no longer simply whether these therapies work. It is, who should have access to them, and for what purpose? If the answer is “only the diagnosably ill,” we will have built an important and effective mainstream health treatment but also something that replicates the narrowness of the current mental health system. We will have created a new gatekeeping regime, justified this time by the quality of the therapeutic agent, but gatekeeping nonetheless.
If access is expanded not only for those with a diagnosis, but also for those seeking growth, meaning, creativity, healing, or deeper connection, we may begin to recover a broader understanding of what these medicines can offer. Not only relief from illness, but opportunities for greater wisdom, presence, connection, and human flourishing.
I don’t think we have to choose. I think we can hold both. But we have to be honest that the question is open and that the answer we settle on will shape the movement for a generation.
Healing, I still believe, should not be determined by means.
But what it means to need healing… that, I’m learning, is worth a much longer conversation.
