By Katja Ridderbusch, KFF Health News

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

ASHEVILLE, N.C. — A few months ago, Waynesville Police Sgt. Paige Shell was about to give up hope of getting better. The daily drip of violence, death, and misery from almost 20 years in law enforcement had left a mark. Her sleep was poor, depression was a stubborn companion, and thoughts of suicide had taken root.

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Shell, who works in a rural community about 30 miles west of Asheville, tried talk therapy, but it didn’t work. When her counselor suggested ketamine-assisted psychotherapy, she was skeptical.

“I didn’t know what to expect. I’m a cop. It’s a trust thing,” she said with a thin smile.

Combining psychotherapy with low-dose ketamine, a hallucinogenic drug long used as an anesthetic, is a relatively new approach to treating severe depression and post-traumatic stress, especially in populations with high trauma rates such as firefighters, police officers, and military members. Yet evidence of the efficacy and safety of ketamine for treatment of mental health conditions is still evolving, and the market remains widely unregulated.

“First responders experience a disproportionately high burden of trauma and are often left without a lot of treatment options,” said Signi Goldman, a psychiatrist and co-owner of Concierge Medicine and Psychiatry in Asheville, who began including ketamine in psychotherapy sessions in 2017.

Signi Goldman, a psychiatrist and owner of Concierge Medicine and Psychiatry in Asheville, North Carolina, began including ketamine in psychotherapy sessions in 2017 to help patients with severe depression. (Katja Ridderbusch/KFF Health News/TNS)

Law enforcement officers in the U.S., on average, are exposed to 189 traumatic events over their careers, a small study suggests, compared with two to three in an average adult’s lifetime. Research shows that rates of depression and burnout are significantly higher among police officers than in the civilian population. And in recent years, more officers have died by suicide than been killed in the line of duty, according to the first-responder advocacy group First H.E.L.P.

Ketamine is a dissociative drug, meaning it causes people to feel detached from their body, physical environment, thoughts, or emotions.

The Food and Drug Administration approved it as an anesthetic in 1970. It became a popular party drug in the 1990s, and in 1999, ketamine was added to the list of Schedule III nonnarcotic substances under the Controlled Substances Act.

The death of “Friends” actor Matthew Perry in 2023, which was attributed to ketamine use, further tainted the drug’s reputation.

But starting with a 1990 animal study and followed by a landmark human trial, research has shown that low doses of ketamine can also rapidly reduce symptoms of depression. In 2019, the FDA approved esketamine — derived from ketamine and administered as a nasal spray — for treatment-resistant depression.

All other forms of ketamine remain FDA-approved only for anesthesia. If used to treat psychiatric disorders, it must be prescribed off-label.

“This is a situation where the clinical practice is probably ahead of the evidence to support it,” said John Krystal, chair of the Department of Psychiatry at the Yale School of Medicine and a pioneer of ketamine research.

Krystal has studied the effect of ketamine on veterans and active-duty military members — a population comparable to first responders in their exposure to trauma. While research shows strong evidence of ketamine’s antidepressant effects, he said further studies are needed on its potential role in PTSD treatment.

The regulatory environment for ketamine also remains a concern, Krystal said. State oversight varies, and federal regulations don’t outline dosing, administration methods, safety protocols, or training for providers.

In this regulatory patchwork, more than 1,000 ketamine clinics have sprung up across the country. At-home ketamine treatments have flooded the market, prompting the FDA to issue a warning.

Side effects of ketamine can range from nausea and blood pressure spikes to suppressed breathing. The drug can also cause adverse psychological effects.

“Being on a psychedelic puts people in an extremely vulnerable state,” Goldman said. People can get retraumatized as they relive disturbing memories. That’s why it’s critical that a mental health provider guide a person through a ketamine session, she said.

With proper precautions — and when other treatments have failed — Rick Baker thinks ketamine-assisted psychotherapy is a good fit for first responders. Baker is CEO and founder of Responder Support Services, which provides mental health treatment exclusively to police officers, firefighters, and other first responders in North Carolina, South Carolina, and Tennessee.

As a population, first responders are more resistant than civilians to traditional therapy, said Baker, who is a licensed clinical mental health counselor. Ketamine provides a potential shortcut into the trauma memory and works “like an accelerant to psychotherapy,” he said. “It strips away people’s armor.”

When used for mental health treatment, a dose of ketamine — typically half a milligram per kilogram of body weight, less than for anesthesia — creates a mildly altered state of consciousness, Goldman said. It makes people look at their own traumatic memories at a distance “and tolerate them differently,” she said.

The ketamine sessions in her practice are usually two hours long, and clients are under the drug for about 45 minutes. The drug is administered as an IV drip, an intramuscular injection, under-the-tongue lozenges, or a compounded nasal spray. The drug is short-acting, meaning its dissociative effects largely wear off within about an hour.

But most insurers won’t pick up the cost of ketamine-assisted psychotherapy, which can be more than $1,000 per session for the IV drip.

“That’s certainly prohibitive for first responders,” Goldman said.

The Department of Veterans Affairs covers some forms of ketamine treatment, including ketamine-assisted psychotherapy, for eligible veterans on a case-by-case basis.

In Shell’s case, a donation made to Responder Support Services covered what her insurance wouldn’t when she decided this spring to try ketamine-assisted psychotherapy with Baker, her counselor.

Revisiting the most gruesome calls in her nearly two decades as a police officer was not something Shell wanted to do. But Hurricane Helene, which caused catastrophic flooding in western North Carolina last year, pushed the 41-year-old “over the edge,” she said.

“Some of the sessions were rough,” said Shell, who is also a member of her agency’s SWAT team. “Things came up that I didn’t want to think about, that I’d buried during my entire career.”

The badly mangled victim in a fatal car crash. A murder-suicide, in which a man cut his pregnant girlfriend’s throat then slit his own.

Under ketamine, the images came to life as still pictures, she said, like a surreal slideshow replaying some of her darkest memories. “Then I would sit there and cry like a baby.”

As of early October, Shell had undergone 12 ketamine sessions. They have not provided a sudden miraculous cure, she said. But her sleep has improved, and bad days are now bad moments. She also finds it easier to manage stress. “And I smile more than I used to,” she said.

She was hesitant to share her experience within her department because of the ongoing stigma associated with seeking help in the hard-charging police culture.

“I just didn’t want my people to think that I couldn’t handle the job,” she said. “I didn’t want them to feel that I’m posing a risk to them.”

The perception of ketamine plays a role as well, said Sherri Martin, national director of wellness services at the Fraternal Order of Police, an organization representing more than 377,000 sworn law enforcement officers. Many cops are used to ketamine as an illegal street drug, she said, or think of it as a counterculture psychedelic.

“So, when they are supposed to accept this as a treatment, that’s hard for them to grasp,” she said.

Few if any police departments provide clear guidance on ketamine-assisted psychotherapy. If it were medically prescribed, it would likely be viewed the same as taking an antidepressant, Martin said.

Shell ultimately shared her story with colleagues, most of whom were curious and supportive, and she now encourages other officers to speak up about their struggles. She believes seeking mental health treatment — in her case, ketamine-assisted psychotherapy — has made her a better and safer police officer.

“It’s hard to help other people when you can’t take care of yourself,” she said.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By JUSTIN SPIKE, Associated Press

BUDAPEST, Hungary (AP) — Hungary’s nationalist Prime Minister Viktor Orbán on Friday celebrated his country’s status as the host of upcoming talks between U.S. President Donald Trump and Russia’s Vladimir Putin, a meeting where the two leaders are expected to discuss an end to the war in Ukraine.

Trump on Thursday announced his second meeting this year with Putin a day before he was to sit down with Ukraine’s Volodymyr Zelenskyy at the White House. A date for the meeting has not been set, but Trump said it would take place in Hungary’s capital, Budapest, and suggested it could happen in about two weeks.

Hungary opposes the West’s support of Ukraine

Speaking to state radio on Friday, Orbán, a close Trump ally and considered Putin’s closest partner in the European Union, suggested that his long-standing opposition to the West supplying Ukraine with military and financial aid for its defense against Russia’s invasion had been crucial in making Budapest the site of the talks.

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“Budapest is essentially the only place in Europe today where such a meeting could be held, primarily because Hungary is almost the only pro-peace country,” Orbán said. “For three years, we have been the only country that has consistently, openly, loudly and actively advocated for peace.”

Orbán, who has often taken an adversarial stance toward Ukraine and Zelenskyy, has consistently portrayed his position as pro-peace, while casting as warmongers his European partners that favor assisting Kyiv in its defense. Yet Orbán’s critics view Hungary’s position as favoring the aggressor in the war and splintering European unity in the face of Russian threats.

Since Russia launched its full-scale invasion in February 2022, Hungary, a NATO member, has refused to supply Ukraine with weapons or allow their transfer across its borders. Orbán has threatened to veto certain EU sanctions against Moscow and held up the bloc’s adoption of major funding packages to Kyiv.

Meanwhile, Hungary has actively resisted weaning off of Russian fossil fuels that help fund Moscow’s war, and, in contrast to almost all of the EU’s other 26 countries, has even increased its supplies since the 2022 invasion.

Péter Krekó, director of the Political Capital think tank in Budapest, told The Associated Press he believes that the Trump-Putin talks being scheduled in Hungary — without the participation of any Ukrainian or EU officials — appeared to be a “huge victory” for Putin.

“He can use the platform of a NATO country for these kinds of so-called peace negotiations, and around a table where no leaders are sympathetic towards Ukraine and no leaders seems to be very staunch defenders of the sovereignty of Ukraine,” Krekó said.

Organizing a meeting with Putin is complicated

The meeting in Budapest comes after Trump failed to secure an agreement to end the war in Ukraine during an August meeting with Putin in Alaska. Falling short of his campaign pledge to quickly stop the bloodshed, Trump rolled out the red carpet for the man who started it.

A trip to Budapest for Putin would require him flying through the airspace of several NATO member countries, a potential complicating factor in organizing the meeting. Yet while Putin’s assets have been frozen by the EU, he is not subject to a travel ban in Europe. Russian planes are banned from entering the bloc, but member countries are permitted to allow certain flights in.

Hungary is also a signatory to the International Criminal Court, based in The Hague, Netherlands, which in 2023 issued an arrest warrant for Putin for war crimes. As a signatory, Orbán’s government would be required to arrest Putin if he set foot on Hungarian soil.

However, Orbán said in April that his country would begin the process of withdrawing from the court after he gave red carpet treatment in Budapest to Israeli Prime Minister Benjamin Netanyahu, who also faced an ICC warrant on suspicion of crimes against humanity, which he denies.

Krekó, the analyst, said Putin’s visit to Budapest would underline a common thread in the foreign policies of Trump, Putin and Orbán: “They are all hostile to multilateralism.”

“The EU is irrelevant, NATO to a certain extent is irrelevant, the ICC is irrelevant. What matters is when strong men are sitting around the table and deciding over the fate of the world,” Krekó said.

Budapest a symbolic location for talks

Budapest hosting the Trump-Putin meeting also holds symbolic significance: It was in the Hungarian capital in 1994 that the United States, the United Kingdom and Russia granted Ukraine assurances of sovereignty and territorial integrity in exchange for Kyiv giving up its nuclear weapons.

Sergiy Gerasymchuk, deputy director of the Kyiv-based Ukrainian Prism think tank, said that many Ukrainians hold “negative associations” toward the 1994 Budapest Memorandum, which has become a symbol of promises that carried no weight after Moscow shredded the agreement first with the annexation of Crimea in 2014 and then with the full-scale invasion in 2022.

When hearing that the next round of Trump-Putin talks would take place in Hungary, Gerasymchuk said, “The first thing that came to my mind was, ‘Okay, another Budapest memorandum, another memorandum where Ukraine should give up its interests for nobody knows what.’”

The choice of Budapest as a venue, he continued, could be viewed as an attempt by Trump to provide a political boost for his ally Orbán, who is set to face the most challenging election of his last 15 years in power in April.

“Bearing in mind that Viktor Orbán keeps his peacemaking image high on the agenda of the upcoming elections, (the talks) can be a success story,” Gerasymchuk said. “(Orbán) can finally prove that he has achieved something — if not peace in Ukraine, then at least a visit of world leaders to Budapest.”

On Friday, Orbán said that while the upcoming negotiations in Budapest were “not about Hungary,” the capital’s hosting of the meeting could be viewed as “a political achievement.”

Associated Press writer Lorne Cook contributed from Brussels. Béla Szandelszky contributed from Kyiv, Ukraine.

By GLENN GAMBOA

The first foreign trip Joel Holsinger took in 2019 after joining the board of directors at the global health nonprofit PATH convinced him that he needed to do more to raise money for charities.

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The investment manager, who is now also a partner and co-head of alternative credit at Ares Management Corp., saw firsthand how a tuberculosis prevention program was helping residents of Dharavi, India’s largest slum. He also saw that the main hurdle to expanding the program’s success was simply a lack of funding.

“I wanted to do something that has purpose,” Holsinger told The Associated Press. “I wanted a charitable tie-in to whatever I do.”

Shortly after returning from India, Holsinger created a new line of investment funds where Ares Management would donate at least 5% of its performance fee, also known as the “promote,” to charities. The first two funds of the resulting Pathfinder family of funds alone have raised more than $10 billion in investments and, as of June, pledged more than $40 million to charity.

Holsinger wanted to expand the model further. On Wednesday, he announced Promote Giving, a new initiative to encourage other investment managers to use the model, which launches with funds from nine firms, including Ares Management, Pantheon and Pretium. The funds that are now part of Promote Giving represent about $35 billion in assets and could result in charitable donations of up to $250 million over the next 10 years.

Unlike broader models like ESG investing, where environmental, social and governance factors are taken into account when making business decisions, or impact investing, where investors seek a social return along with a financial one, Promote Giving seeks to maximize the return on investment, Holsinger said. The donation only comes after investors receive their promised return and only from the manager’s fees.

“We’re not doing anything that looks at lower returns,” Holsinger said. “It’s basically just a dual mandate: If we do good on returns for our institutional investors, we will also drive returns that go directly to charity.”

Charities, especially those who do international work, are in the midst of a difficult funding landscape. The dismantling of the U.S. Agency for International Development and massive cuts to foreign aid this year have affected nearly all nonprofits in some way. Those nonprofits who don’t normally receive funding from the U.S. government still face increased competition for grants from organizations who saw their funding cut.

Kammerle Schneider, PATH’s chief global health programs officer, said this year has shown how fragile public health systems are and has reinforced the need for “agile catalytic capital” that Promote Giving could provide.

“There is nothing that is going to replace U.S. government funding,” said Schneider, adding that the launch of Promote Giving offers hope that new private donors may step in to help offer solutions to specific public health problems. “I think it comes at a time where we really need to look at the overall architecture of how we’re doing this and how we could be doing it better with less.”

Sal Khan, founder and CEO of Khan Academy, which offers free learning resources for teachers and students, says the structure of Promote Giving could provide nonprofits stable income over several years that would allow them to spend less time fundraising and more time on their charitable work.

“It’s actually been hard for us to raise the philanthropy needed for us to have the maximum impact globally,” said Khan. While Khan Academy has the knowledge base to expand rapidly around the world and numerous countries have shown interest, Khan said the nonprofit lacks enough resources to do the expensive work of software development, localization and building infrastructure in every country.

Khan hopes Promote Giving can grow into a major funder that could help with those costs. “We would be able to build that infrastructure so that we can literally educate anyone in the world,” he said.

Holsinger hopes for that kind of growth as well. He envisions investment managers signing on to Promote Giving the way billionaires pledge to give away half their wealth through the Giving Pledge and he hopes other industries will develop their own mechanisms to make charitable donations part of their business models.

Kate Stobbe, director of corporate insights at Chief Executives for Corporate Purpose, a coalition that advises companies on sustainability and corporate responsibility issues, said their research shows that companies that establish mission statements that include reasons for existing beyond simply profit generation have higher revenue growth and provide a higher return on investment.

Having a common purpose increases workers’ engagement and productivity, while also helping companies with recruitment and retention, said Stobbe, who said CECP will release a report that documents those findings based on 20 years of data later this week. “Having initiatives around corporate purpose help employees feel a connection to something bigger,” she said. “It really does contribute to that bottom line.”

That kind of win-win is what Holsinger hopes to create with Promote Giving. He said many of the world’s problems don’t lack solutions. They lack enough capital to pay for the solutions.

“We just need to drive more capital to these nonprofits and to these charities that are doing amazing work every day,” he said. “We’re trying to build that model that drives impact through charitable dollars.”

Associated Press coverage of philanthropy and nonprofits receives support through the AP’s collaboration with The Conversation US, with funding from Lilly Endowment Inc. The AP is solely responsible for this content. For all of AP’s philanthropy coverage, visit https://apnews.com/hub/philanthropy.

By WAFAA SHURAFA, Associated Press

DEIR AL-BALAH, Gaza Strip (AP) — Hamas moved Friday to shore up its brittle ceasefire agreement with Israel by reaffirming its commitment to the terms of the deal, including a pledge to hand over the remains of all dead Israeli hostages.

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The group’s statement released in the early hours Friday follows a dire warning from U.S. President Donald Trump that he would green-light Israel to resume the war if Hamas doesn’t live up to its end of the deal and return all of the hostages’ bodies.

Hamas, however, maintains that some bodies were buried in tunnels that were later destroyed by Israel, and heavy machinery is required to dig through rubble to retrieve them.

The group also criticized Israeli Prime Minister Benjamin Netanyahu over his call to cut aid to Gaza, saying it was an attempt to manipulate humanitarian needs “for political gains.”

In a follow-up statement Friday, Hamas urged mediators to increase the flow of aid into Gaza, expedite the opening of the Rafah border crossing with Egypt and start the reconstruction process, especially for homes, hospitals and schools. It also called for work to “start immediately” on setting up a committee of independents who will run the Gaza Strip and for Israeli troops to continue pulling back from agreed-upon areas.

The ceasefire plan introduced by Trump had called for all hostages — living and dead — to be handed over by a deadline that expired Monday. But under the deal, if that didn’t happen, Hamas was to share information about deceased hostages and try to hand them over as soon as possible.

Netanyahu has said that Israel “will not compromise” and demanded that Hamas fulfill the requirements laid out in the ceasefire deal about the return of hostages’ bodies.

Obstacles to retrieving bodies

Hamas has assured the U.S. through intermediaries that it’s working to return dead hostages. American officials say retrieval of the bodies is hampered by the scope of the devastation, coupled with the presence of dangerous, unexploded ordnance.

The group has also told mediators that some bodies are in areas controlled by Israeli troops. Hamas crews were seen Friday in Hamad City, near Khan Younis, searching for the bodies of hostages.

On Wednesday, Israel received the remains of two more hostages shortly after its military said that one of eight bodies previously handed over wasn’t that of a hostage. Israel is waiting for the bodies of 28 hostages to be returned.

Hamas released all 20 living Israeli hostages on Monday. In exchange, Israel freed around 2,000 Palestinian prisoners and detainees.

Israel has also returned to Gaza the bodies of 90 Palestinians for burial. Israel is expected to turn over more bodies, though officials have not said how many are in its custody or how many will be returned. It is unclear whether the remains belong to Palestinians who died in Israeli custody or were taken from Gaza by Israeli troops. Throughout the war, Israel’s military has exhumed bodies as part of its search for the remains of hostages.

A Palestinian forensics team examining the remains said some of the bodies showed signs of mistreatment.

The fighting has killed nearly 68,000 Palestinians, according to the Health Ministry, which is part of the Hamas-run government in Gaza. The ministry maintains detailed casualty records that are seen as generally reliable by U.N. agencies and independent experts.

Thousands more people are missing, according to the Red Cross and the Palestinian Central Bureau of Statistics.

France says international force for Gaza is in the pipeline

Meanwhile, France said it’s working with its ″British and American partners″ to propose a U.N. resolution in the coming days that would provide a framework for the international force for Gaza.

French Foreign Ministry spokesman Pascal Confavreux told a news conference Thursday that Arab countries are “very insistent” on having a U.N. mandate for this force.

″This resolution would allow a framework for the deployment of this mission, in support … of Palestinian security forces, who are in the process of evaluating what they will need and what they are capable of doing,″ he said.

He wouldn’t say whether France could eventually take part or what its role would be. ″First the mandate,″ he said, followed by which countries will be involved, and then specifics about who is providing what, which could include equipment, training, money.

Confavreux said aid, reconstruction and security efforts should be centralized within the U.N. system.

Killings in Gaza fray nerves

Hamas was also put on the defensive after Trump warned that “we will have no choice but to go in and kill them ” if the group didn’t cease killings of rival factions inside Gaza.

Trump said it won’t be U.S. forces that will mete out any punishment but “people very close, very nearby that will go in and they’ll do the trick very easily, but under our auspices.”

The president did not specify if he was speaking of Israel, but action by Israeli forces could risk violating terms of the ceasefire agreement.

A Hamas official Thursday defended the killings of alleged gang members that the group carried out in Gaza since Monday.

Speaking in Beirut, Hamas’ political representative in Lebanon Ahmed Abdul-Hadi said the individuals who were killed “caused death and corruption in Gaza and killed displaced persons and aid seekers.”

Hadi said the decision to sentence them to death had come from the “judiciary,” apparently referring to tribal customary judicial procedures. There are no functioning formal courts in the war-battered enclave.

“This was done by a Palestinian national and tribal consensus,” he said. “I mean, their clan agreed to this and not just Hamas.”

Wait for a large infusion of aid into Gaza goes on

The U.N. said the flow of humanitarian aid into Gaza remains constrained because of continued closures of crossings and restrictions on aid groups.

According to the U.N. dashboard that monitors the movement of aid trucks into Gaza, only 339 trucks reached the territory and were offloaded for distribution since the ceasefire began on Oct. 10. Under the ceasefire agreement, 600 aid trucks would be allowed to enter Gaza daily.

The U.N. figures varied widely from those provided by COGAT, an Israeli defense body overseeing humanitarian aid in Gaza. A spokesperson for the U.N. Office for the Coordination of Humanitarian Affairs said COGAT had reported 950 trucks crossing on Thursday and 716 on Wednesday. Crossings were closed on Monday and Tuesday for the exchange of hostages and prisoners and for a Jewish holiday.

U.N. aid chief Tom Fletcher said rapid and unimpeded access, sustained fuel entry, restored infrastructure, protection of aid workers, and adequate funding are needed for the U.N.’s 60-day aid delivery plan to work.

Currently, only 15 humanitarian organizations are authorized by Israel to deliver aid into Gaza.

Gaza’s truck drivers’ association, which organizes pickups of aid from the Gaza side of the border after Israeli inspection, said there has been no significant ramping up of supplies arriving since the ceasefire. But it cited improved security that has prevented looting or gangs intercepting aid convoys.

“There is no breakthrough,” said Nahed Sheheiber, the head of Gaza’s private truckers’ union. “There is no improvement except in one thing, the security of trucks that enables them to reach the warehouses.”

Only 70 trucks entered Gaza on Thursday, Sheheiber said, adding that the wait time for truck inspections and coordination is still long.

Since the beginning of the ceasefire, at least nine humanitarian organizations have gradually resumed services in Gaza City and parts of northern Gaza for displaced families and returnees, according to the U.N. humanitarian affairs report released Thursday.

Associated Press writer Angela Charlton in Paris contributed to this report.