On a gray wintry morning, psychiatrist Azin Bekhrad is enthusing about her solo outpatient psychiatry practice for the Johns Hopkins Personalized Care program at Green Spring Station. “Luckily, I’m able to treat patients as young as preschool age all the way into adulthood,” she says. “I love that longitudinal care, which allows for forming relationships with families and patients over years.”

And while she pioneers a treatment model at Johns Hopkins Medicine, she says she is also broadening her own therapeutic skills by learning how to treat individuals recovering from difficulties following a psychedelic experience.

Johns Hopkins Personalized Psychiatry, which opened in July 2024, offers comprehensive care for patients of all ages, integrating pharmacological management, therapy and family work, as well as opportunities to consult with other Johns Hopkins providers. Bekhrad shares a suite of offices with primary care physicians in concierge personalized care.

Bob Roca, professor of clinical psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, says the new outpatient program was launched to expand access to psychiatric care. Requiring payment at the time of service, it operates outside insurance networks.

“There's a lot of pressure on psychiatrists to see patients at a pretty rapid clip and focus mainly on medication treatment,” he says. “In some treatment settings, patients may see a psychiatric nurse practitioner for treatment with medications, and a social worker or licensed professional counselor for psychotherapy.

“The model here is that the fee pays the doctors ‘something close’ to what they could earn in private practice by themselves. This allows the doctor the time to provide both psychotherapy and medication treatment. The doctor and the patient together decide what’s best.”

Bekhrad is excited about returning to the world of Johns Hopkins. After completing her general adult psychiatry residency and child/adolescent fellowship at the institution, Bekhrad served as a faculty instructor before leaving to work at a private mental health practice, The Ross Center in Washington, D.C., and serving as medical director for the Episcopal Center for Children, a therapeutic school in Washington. In 2020, she opened her own private practice near Washington, treating a diverse and complex group of children, families and adults of all ages.

By working again at Hopkins, Bekhrad has also gained access to its ongoing research. She spends one day each week at Johns Hopkins Bayview Medical Center with colleagues at the Johns Hopkins Center for Psychedelic & Consciousness Research (CPCR), the world’s largest psychedelic science research center.

She is learning how to treat patients who have difficulties following a psychedelic experience. These include anxiety, dissociation, feelings of disconnection, hallucinogen persisting perception disorder (a less common and poorly understood condition involving perceptual or visual disturbances), and even psychosis. In partnership with the CPCR, patients experiencing these symptoms are referred to her for consultation and treatment at Johns Hopkins Personalized Psychiatry, making it one of a few academic and evidence-based centers to offer this treatment. She will also help collect data to help establish best practices for treating the range of difficulties that can occur following psychedelic use.

While recent clinical studies indicate that medically supervised psychedelic experiences can be helpful for treating a variety of mental health conditions, there is less information about the effects of using the drugs recreationally. Consequently, some individuals who encounter adverse outcomes after taking psychedelics are misdiagnosed and given medications that may not be appropriate for what they are experiencing. This clinic, the first of its kind in the United States, will apply best practices based on the emerging research.

“For the most part, [psychedelics] seem to be medically safe and very low in terms of addiction potential,” Bekhrad says. “However, as media attention has increased, there is a lot of unregulated use in naturalistic or recreational settings, which means there is a lot we don’t know about the risks of psychedelic experiences. And when some individuals have negative experiences they don’t know how to deal with, many will turn to online forums, friends or fringe communities, or suffer in silence.”

She says the most common adverse reaction is a high level of anxiety. “The first thing is to understand it and take a nonstigmatizing approach. Treatment might involve time and support and reassurance, or it might involve something more targeted, either pharmacologic or psychotherapeutic.”

She says the next goal is to start developing treatment standards for different situations. “What are best practices? What do we need to do? Is there a standard of care? Recognizing patterns in drug type, dosage, frequency, co-occurring substances or medications, as well as in predisposing factors such as pre-existing psychiatric illness, family history, temperament, life story or genetic vulnerabilities will help us develop an understanding of who’s at risk for adverse experiences.”