Should the NHS use magic mushrooms to treat mental health?

Larissa Hope, a former actress who gained early fame in the TV drama Skins, found herself facing a profound mental health crisis at 17. The sudden spotlight unexpectedly unearthed deeply buried trauma, leading to severe depression and suicidal ideation. Traditional antidepressants proved ineffective in alleviating her distress. It was a single, carefully administered dose of psilocybin, the active compound in magic mushrooms, taken under strict clinical supervision, that marked an extraordinary turning point in her recovery. "When I experienced it, I burst out crying," she recalls today, her voice still reflecting the profound impact. "It was the first time in my life I had ever felt a sense of belonging and safety in my body. I kept saying, ‘I’m home, I’m home’." Nearly two decades later, Larissa firmly believes that this unique experience, combined with ongoing therapy, empowered her to confront and overcome the suicidal feelings that once consumed her, fundamentally altering her relationship with her past trauma.

However, not every encounter with psychedelics yields such a transformative, positive outcome. Jules Evans, a university researcher, vividly recounts a dramatically different experience from his youth. At 18, a recreational LSD trip plunged him into what he describes as a "deluded" state, marked by intense paranoia and a terrifying sense of losing his mind. "I believed that everyone was talking about me, criticising me, judging me. I thought, I’ve permanently damaged myself; I’ve permanently lost my mind," he says, emphasizing, "It was the most terrifying experience of my life." The repercussions were long-lasting; Evans suffered from debilitating social anxiety and panic attacks for years, eventually receiving a diagnosis of post-traumatic stress disorder (PTSD). Today, he directs the Challenging Psychedelic Experiences Project, an initiative dedicated to supporting individuals who have encountered difficulties after taking psychedelics. His work underscores the critical need for understanding and mitigating potential adverse effects.

These two starkly contrasting narratives – one of profound healing, the other of enduring psychological distress – lie at the very heart of the complex dilemma confronting medical professionals, regulatory bodies, and politicians across the UK. The central question is whether doctors should be empowered to prescribe treatments involving magic mushrooms and other potentially therapeutic psychedelic drugs, given both their promising efficacy and their undeniable risks.

The renewed focus on magic mushrooms and other psychedelics as potential treatments for mental health conditions has been driven by a wave of new research. Over 20 clinical trials have been initiated since 2022, investigating various psychedelic medicines for a spectrum of disorders including treatment-resistant depression, obsessive-compulsive disorder (OCD), PTSD, trauma, and a range of addictions such as alcoholism and problem gambling. Many of these early-stage studies have reported encouraging results, suggesting that these treatments can be remarkably effective, particularly for patients who have not responded to conventional therapies. While some trials have yielded mixed or unclear findings, only a handful have definitively shown no benefit on their primary outcome measures. A pivotal moment for the UK will be the eagerly awaited results from one of the largest global clinical trials into psilocybin use, conducted by UK biotech firm Compass Pathways, expected later this year. The UK’s medicines regulator is poised to review this data, which could pave the way for relaxing current stringent restrictions and allowing the supervised medical use of psilocybin outside of research settings.

Prof Oliver Howes, a distinguished figure and chair of the Royal College of Psychiatrists’ Psychopharmacology Committee, maintains a stance of cautious optimism. He views psychedelics as a genuinely promising avenue for novel treatments for a range of psychiatric disorders, including for future NHS patients. "One of the key messages is that this is something we desperately need – more treatments and better treatments for mental health disorders," Prof Howes asserts. He highlights their unique potential: "These treatments are really interesting because they’ve shown promise in these small-scale studies… and have the potential to work quicker." However, his enthusiasm is tempered by a strong emphasis on the necessity of robust, large-scale trial data, cautioning against "overhyping the potential benefits" before conclusive evidence is available. This cautious approach is echoed in a report published by the Royal College of Psychiatrists in September 2025, which explicitly warned of the inherent potential dangers associated with psychedelics, reinforcing the medical community’s stress that unsupervised use is not only illegal but can be profoundly harmful.

The history of drug use is as ancient as human civilization itself, with magic mushrooms, opium, and cannabis having been integral to both recreational activities and sacred rituals across diverse cultures for millennia. The mid-20th century saw a brief but significant period of scientific inquiry into psychedelics, only for it to be largely halted by the social and political upheavals of the 1960s and 70s. During this era, LSD, or "acid," became synonymous with the counterculture movement, famously championed by Harvard psychologist Timothy Leary, who exhorted young people to "turn on, tune in, drop out" – an appeal to awaken inner potential, connect with societal consciousness, and shed conventional norms. However, as these substances became increasingly associated with social unrest and perceived moral decline, governments globally moved to ban them, imposing severe restrictions that effectively stifled scientific research for decades.

This scientific vacuum began to shift dramatically in the 2010s, thanks to groundbreaking work by Prof David Nutt and his team at Imperial College London. Their pioneering studies, utilizing advanced brain imaging techniques, revealed how psilocybin appears to "reset" the brain’s default mode network – a circuit often overactive in depression – fostering a state of enhanced neuroplasticity that could facilitate therapeutic breakthroughs. Subsequent clinical trials on depressed patients suggested that psilocybin, when administered in a controlled therapeutic setting, was not only at least as effective as conventional antidepressants but also appeared to have fewer side effects. A significant advantage, according to Prof Nutt, was its remarkably fast-acting nature. "We thought rather than wait for eight weeks for antidepressants to switch off the part of the brain associated with depression, maybe psilocybin could switch it off in the space of a few minutes," he explained. This revolutionary perspective, while scientifically compelling, was not universally accepted without controversy. Prof Nutt, a highly respected scientist, was famously dismissed in 2009 from his role as chair of the government’s Advisory Committee on the Misuse of Drugs by then-Home Secretary Alan Johnson, following public comments comparing the harm of horse-riding to ecstasy. This incident highlighted the deep-seated societal and political resistance to re-evaluating these substances, even in a scientific context. Nevertheless, Prof Nutt’s pioneering work reignited global interest, sparking numerous further investigations into the therapeutic potential of various other psychedelic drugs.

A crucial question now is whether these treatments should realistically become available on the NHS. At University College London, neuroscientist Dr Ravi Das is leading research into understanding the mechanisms behind addiction and how habits solidify. He believes psychedelics could offer profound insights and solutions. His ongoing study recruits heavy drinkers to investigate whether dimethyltryptamine (DMT), a potent, short-acting psychedelic, can be used to target and disrupt the brain’s memory and learning systems. This research builds upon existing evidence that psilocybin can effectively break down habitual behaviours linked to addiction. "Every time someone drinks, a bit like Pavlov’s dog, you’re learning to associate things in the environment with the rewarding effect of alcohol," Dr Das explains. "We’ve been focusing on whether certain drugs, such as psychedelics, can break down those associations." This is an early-stage study, but if successful, and with regulatory approval, the ultimate aim is to integrate it as an accessible treatment within the NHS. "If psychedelic therapies prove to be both safe and more effective than current treatments, I would hope to see them made accessible via the NHS – rather than to just the privileged few who can afford them privately," he stresses, highlighting the importance of equitable access.

Currently, the legal landscape for psychedelics in the UK is complex. Ketamine, following a previous trial by Dr Das, occupies a distinct legal category and can be used medically under certain conditions. However, other potent psychedelics such as DMT, LSD, psilocybin, and MDMA are classified as Schedule 1 drugs under the Misuse of Drugs Regulations 2001. This classification designates them as having "no legitimate medical use" and places them under the tightest possible controls, meaning their use is permitted only for highly restricted and exceptionally difficult-to-obtain research licenses. Dr Das remains hopeful that a growing body of positive trial results will eventually compel a re-evaluation of these classifications. "I hope if there’s sufficient evidence, the government will be open to revising the scheduling of these drugs," he states. However, an analysis published in the British Medical Journal in November 2024 by PhD student Cédric Lemarchand and his colleagues raised significant concerns. They questioned the ease of accurately determining the precise therapeutic effects of psychedelics, noting, "Because hallucinogens are often combined with a psychotherapy component, it is difficult to separate the effects of the drug from the therapeutic context, complicating comprehensive evaluations and product labelling." The analysis also warned that short-term trials might not adequately detect "the potential for harm and serious adverse events from long-term use of hallucinogens… The potential for abuse or misuse must also be considered."

Despite the promising research, doctors remain acutely cautious about the broader rollout of psychedelic treatments. Prof Howes firmly believes that, with the exception of ketamine which has undergone rigorous regulatory assessment, psychedelic treatments should not become routine medical practice in the UK outside of controlled research environments until larger, more rigorous trials provide unequivocally robust evidence for their safety and long-term effectiveness. He issues a stark warning: "In a clinical trial setting, it’s very carefully evaluated. If people take these on their own or in a backstreet clinic, then there is no guarantee of that and the safety issues start becoming a major issue." These warnings are substantiated by alarming data collected by Jules Evans’ Challenging Psychedelic Experiences project. Their findings indicate that 52% of respondents who regularly use psychedelic drugs reported experiencing an intensely challenging trip, with 39% of those considering it "one of the five most difficult experiences of their life." Furthermore, 6.7% admitted to considering harming themselves or others following a difficult experience, and 8.9% reported being "impaired" for more than a day. Evans highlights that some individuals required medical or psychiatric intervention and continued to experience worsening symptoms for weeks, months, or even years after their adverse trips. "Ideally, I would love doctors and regulators to know more about these adverse effects, and how people can recover from them, before they say, any of these therapies are safe," he argues passionately.

Yet, despite these legitimate concerns, a chorus of voices including Prof Nutt, Prof Howes, and Dr Das contend that progress towards clinical integration is being severely hampered by bureaucratic hurdles and the immense difficulty in obtaining permissions for medically supervised clinical trials. "There are so many people suffering unnecessarily," Prof Nutt told BBC News, his frustration evident. "And some of them are dying, because of the unreasonable barriers to research and treatment that we face in this country. It is, in my view, a moral failing." He adds, "When these medicines are proven to be safe and effective, I think it is vital they are made available through the NHS to all who need them, not limited to the private sector, as happened with medical cannabis." Prof Howes, despite his caution, shares this sentiment, stating, "There are big barriers to doing this research, so we do ask for the government to review the regulations of these substances, for research, because it does lead to long delays, and, we desperately do need new treatments."

The critical analysis from Mr. Lemarchand’s team calls for heightened scrutiny of all trials. "To guarantee that hallucinogens are rigorously vetted before endorsing them as safe and effective treatments medical journals must appraise the evidence more critically, fully account for limitations, avoid spin and unsubstantiated claims, and correct the record when needed." The Advisory Council on the Misuse of Drugs remains firm, stating that Schedule 1 contains drugs with "no medicinal value," thus justifying the tightest controls, a position reinforced by ministers who link the Home Office licensing regime directly to public protection. While the government has signalled support for easing licensing requirements for some clinical trials approved by the Medicines and Healthcare products Regulatory Agency and Health Research Authority, with work underway to implement exemptions for certain universities and NHS sites, a cross-government working group is coordinating a cautious rollout, pending pilot project results. However, some doctors, including Prof Howes, feel these changes are agonizingly slow. "There’s still a lot of red tape holding things up," he laments.

Supporters of psychedelic medicines hold out hope that the completion of the crucial phase three trials by Compass Pathways will be a watershed moment, leading to further relaxations, at least for research purposes, and ultimately for wider clinical application. For Larissa Hope, the personal impact of psilocybin remains undeniable. Her experience, she believes, provided unparalleled insight into her past trauma and helped her navigate suicidal ideation. "I had a solid plan to end my life. Then suddenly, death wasn’t the only way," she concludes, a testament to the profound potential of these substances. "Under psilocybin, my nervous system began, for the first time, to recognise what peace felt like." Her powerful testimony serves as a poignant reminder of the human stakes involved in this complex, evolving debate.