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Hanifa Nayo Washington has spent three decades creating spaces for healing and liberation, from local psilocybin ceremonies to a global psychedelic support line. Now she's tackling one of the movement's biggest challenges: making psychedelic therapy accessible to people who can’t afford it.

We asked Hanifa what Fireside Project's 30,000+ calls taught her about who really needs support, how she's building the evidence base for Medicaid coverage, and what truly equitable access to psychedelic-assisted therapy looks like.

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How did you find your way to working at the intersection of healing justice and psychedelics?

I don't see it as an intersection, actually. I see healing justice and psychedelics as very central to each other. They've gone hand in hand since humans have been working with these medicines to reconnect. All of my work over the past 30 years has been geared toward the healing and liberation of people, whether that was youth development and environmental education with inner city kids, creating a food co-op, or becoming a reiki master practitioner.

My family taught me how to organize around and prioritize healing justice because of our own needs and our incredible capacity to support the healing of others. My biggest teachers are my late, eldest brother who was born with sickle cell anemia in the early seventies, and my mom who dedicated her life to making sure he was well, organizing around that, and supporting other families who had children with sickle in Detroit. By the time I was five or six, he'd already had one stroke, and I learned very early to empathize and look for signs if he was going into crisis. My grandmother was a nurse who would wake me up after her night shifts and ask me to put my hands on her knees and feet. She told me I had healing hands but to keep it quiet because people might not understand. When I found Reiki later, I was like, "Oh, this makes sense. I feel like I've been doing this naturally my entire life."

Though I first encountered psychedelics when I was in college, I started working with psychedelics with respect and reverence in my early thirties. Like many people, I had my own profound experiences and wanted to share them because they helped me to begin healing from shame, trauma, and depression. They connect in a way that nothing else does. I started sitting with psilocybin in the underground, mostly with Black women, doing music and sound healing and Reiki work. Then after an illuminating experience with ayahuasca, I got a strong message from Spirit that it was time to start saying yes to more invitations, do more exploring, and get outside my comfort zone because there was bigger work for me to do with psychedelics. That's how I ended up at Burning Man in 2019, meeting Joshua White, and launching Fireside Project in 2021 as part of the cofounding team.

By now, Fireside Project has handled over 30,000 calls. What have you learned about who needs the most support?

Wow, we learned so much! One of the big lessons we learned through our volunteer training was the power of witnessing. So much of holding space is about listening. We trained volunteers in reflective listening, normalizing language, and the role of silence. Many volunteers came with different  backgrounds— licensed therapists, underground facilitators, crisis line workers—but we had to teach them to hang up their credentials at the door and just be witnesses.

The biggest challenge was training people not to want to fix things. It's such a human knee-jerk response. Someone might be angry, and if you have your own thing about anger, you might want to walk them away from it. But your role is to witness and reflect: "It sounds like you're really angry right now. Where are you feeling that in your body?" Those skills transfer into all parts of life. The building block of trust in any relationship is listening.

A significant surprise was that 50% of their calls were coming from people seeking integration support after their psychedelic experience. That was unexpected; we thought most people would be calling during a challenging experience. Now entering its fifth year, Fireside still sees about the same 50/50 split between these types of calls, which has underscored that the need for support goes well beyond the acute experience itself. The calls have also shaped how the volunteer community was built. Fireside has trained over 500 volunteers, with about 60% from marginalized communities, because we learned that representation, choice, and shared power matter in providing effective psychedelic peer support.

Building on the emphasis on choice, Fireside is launching TripCheck. Starting August 27, the service will let people proactively schedule check-ins during their experiences. Someone can call or text ahead and say, “Can you call me at 4pm and 6pm to check on me during my mushroom trip?” It’s based on the simple but powerful idea that your future self might need a friend.

Now you're working to get Medicaid coverage for psychedelic therapy through Psychedelic Mental Health Access Alliance. What are the biggest hurdles to making that happen?

The biggest challenge is that there are 50 states, so there are 50 different matrices of decision makers that need policy-ready evidential data to change and develop coverage policy for safe and effective psychedelic-assisted therapy care models. It's a lot to bite off, especially for an organization with just two core staff.

States want to see if they're giving funds toward this treatment, how it will impact their budget. Will they see fewer people in the emergency room? Will people adhere to their other medical treatments better? Could they be more productive contributors to the state economy? The challenge is showing that.

Each state will look to others and ask, “How did you do this? What’s the return on investment?” At the end of the day, they have to manage their bottom line. It's about demonstrating a positive cost analysis.

What we learned in our first year from listening to psychedelic practitioners, researchers, health, equity leaders, and medical administrators is that we cannot create effective access without a strong Medicaid strategy. PMHA Alliance also has to partner with existing health equity and mental health organizations because they are already reaching the populations we want to reach. How do we integrate into existing infrastructure rather than creating something entirely new?

What kind of evidence does Medicaid actually need to see before they'll start covering psychedelic treatments? How do you collect it?

States don’t say yes because something sounds inspiring; they say yes when the proof is clear. That proof rests on four simple pillars. First, it works: people actually get better, and the data backs it up. Second, people need it: it tackles what other treatments can’t touch. Third, it’s safe when delivered by the right hands, with the right guardrails. And fourth, it’s worth it: the numbers show it saves the system money. Importantly, all of this evidence has to come from real-life Medicaid populations in real-world settings. That’s the difference between clinical research and implementation research, and it’s what turns promising ideas into policies that stick.

We have to do feasibility studies first to show that our models of care are safe. Then you can do implementation studies that capture effectiveness, quality of care, and economic components. Our first study will be in New Mexico, which recently passed the Medical Psilocybin Act. In partnership with the University of New Mexico and the New Mexico Department of Health, we’re supporting the implementation of an 18-month pilot feasibility study with 36 participants. The study will test a group psilocybin care model and include a three-month ongoing integration support program following the treatment phase. Participants will include veterans, first responders, women who are survivors of sexual violence, and Indigenous populations suffering from depression.

What's missing when it comes to Medicaid populations is the consideration of social determinants of health and barriers to care. For example, you have to look at transportation; can people get to therapy? If they're missing weeks of work, what support is available? Can childcare be covered? What other social services need to be packaged into a care model that Medicaid would cover and, more importantly, that Medicaid already covers?

What does truly equitable access to psychedelic-assisted therapy look like?

To me, it looks like it’s affordable. Affordability might come through Medicaid coverage, but practitioners also need competitive reimbursement rates. You can have the service covered, but if the reimbursement rate is laughable, practitioners won't accept it. Physical proximity matters, too. You shouldn't have to leave your city to access care.

Equitable access also means the care team is multidisciplinary. Yes, you need people with licenses to legally administer medicine, but you also need traditional healers, peer navigators, and skilled and experienced psychedelic facilitators. We have to consider cultural safety, not just physical safety. Are we giving choice? Do individuals feel safe with their care team? Some people might want an all-female team; others might want someone who shares a specific aspect of their lived experience as a Black, Indigenous, or person of color, for instance. Let’s lift up practices that center whole-person care and avoid repeating systemic harm that is baked into the mental health and medical fields.

After any psychedelic treatment program—especially for folks from marginalized populations—real effectiveness depends on ongoing integration support. People need a place to land after these experiences. They need a steady source of community-based care and support that helps them keep growing long after the program ends. In my view, that support should last at least two years. It can take many forms: affinity-based virtual circles, one-on-one sessions, therapeutic support, mindfulness practices, life coaching, nutrition guidance, behavioral health care. The right mix depends on the person. The point is to create the conditions for people to keep reaping the benefits of their psychedelic experience and continue making positive changes in their lives.

Want more from Hanifa?

Check out her personal offerings, sign up for the PMHA Alliance newsletter, or join the waitlist for her Sanctuary for Women of Color program with Beckley Retreats.

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DISCLAIMER: This newsletter is for educational and informational purposes only and is not intended as a substitute for professional medical advice. The use, possession, and distribution of psychedelic drugs are illegal in most countries and may result in criminal prosecution.