Should the NHS use magic mushrooms to treat mental health?

Larissa Hope, a former actress who found early fame in the TV drama Skins, offers a powerful testament to the transformative potential of psilocybin. At 17, the pressures of her burgeoning career unearthed deep-seated trauma, leading to a severe mental health crisis. Traditional antidepressants proved ineffective, leaving her feeling adrift. It was a carefully administered, small dose of psilocybin, taken under strict clinical supervision, that marked a pivotal turning point in her journey. "When I experienced it, I burst out crying," she recounts, reflecting on the profound emotional release. "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 this single psychedelic experience, combined with subsequent therapy, was instrumental in helping her confront and ultimately overcome suicidal ideation, guiding her towards a path of healing and stability.

However, the narrative surrounding psychedelics is not uniformly positive. Jules Evans, a university researcher, vividly recalls a profoundly distressing experience from his youth. At 18, a recreational dose of LSD plunged him into a "deluded" state of intense paranoia. "I believed that everyone was talking about me, criticising me, judging me," he explains. "I thought, I’ve permanently damaged myself; I’ve permanently lost my mind. It was the most terrifying experience of my life." Evans suffered from social anxiety and panic attacks for years afterward, eventually being diagnosed with post-traumatic stress disorder (PTSD) stemming from the incident. Today, as director of the Challenging Psychedelic Experiences Project, he dedicates his work to supporting individuals who encounter difficulties after taking psychedelics, highlighting the critical need to understand and mitigate potential adverse effects. These two starkly contrasting experiences encapsulate the core dilemma confronting medical professionals, regulators, and policymakers: how can the NHS responsibly harness the therapeutic promise of psychedelics while safeguarding against their inherent risks?

The renewed interest in "magic mushrooms" and other psychedelic compounds for mental health treatment stems from a growing body of scientific evidence. Numerous new studies suggest that these substances could offer effective treatments for a range of intractable conditions, including major depressive disorder, obsessive-compulsive disorder (OCD), PTSD, complex trauma, and various addictions such as alcohol and gambling. Currently, the use of psychedelic medicine remains illegal in the UK, permissible only within the confines of authorised research and tightly controlled clinical trials. Since 2022, over 20 such trials have been initiated, investigating different psychedelic compounds for conditions like depression, PTSD, and addiction. While many of these studies have reported promising results, showing significant therapeutic benefits, others have yielded mixed or inconclusive findings. Crucially, only a handful have definitively concluded no benefit on their primary outcome measures, underscoring the need for more robust and large-scale investigation.

A particularly anticipated development is the forthcoming results from one of the largest clinical trials into psilocybin’s efficacy, conducted by UK biotech firm Compass Pathways. The UK’s medicines regulator is keenly awaiting this data, as it will be a crucial factor in determining whether to ease the stringent current restrictions and potentially permit the use of psilocybin-assisted therapy outside of research settings. Professor Oliver Howes, chair of the Royal College of Psychiatrists’ Psychopharmacology Committee, expresses cautious optimism. He views psychedelics as a "promising potential new treatment for psychiatric disorders," including for NHS patients, emphasizing the urgent need for more effective mental health interventions. "One of the key messages is that this is something we desperately need – more treatments and better treatments for mental health disorders… These treatments are really interesting because they’ve shown promise in these small-scale studies… and have the potential to work quicker." However, Professor Howes also stresses the imperative for rigorous, peer-reviewed evidence, warning against "overhyping the potential benefits" before comprehensive data is available. This cautious stance is echoed in a report published by the Royal College of Psychiatrists in September 2025, which highlighted the potential dangers associated with psychedelics and reiterated that unsupervised use remains both illegal and potentially harmful.

The therapeutic application of psychoactive substances is not a modern phenomenon, with magic mushrooms, opium, and cannabis having deep roots in ancient civilizations for both recreational and ritualistic purposes. The mid-20th century saw a brief but intense period of psychedelic exploration, particularly with LSD, which became synonymous with the 1960s counterculture movement. Figures like Harvard psychologist Timothy Leary famously urged young people to "turn on, tune in, drop out," advocating for an awakening of inner potential and a questioning of societal norms. However, this era of widespread, largely unregulated use led to significant social anxieties, with psychedelics becoming associated with social unrest and moral decline. Consequently, by the late 1960s and early 1970s, these drugs were banned, and scientific research into their potential medical benefits was severely curtailed, pushing them into decades of obscurity.

A pivotal moment in the modern resurgence of psychedelic research occurred in the 2010s, thanks to the pioneering work of Professor David Nutt and his team at Imperial College London. Their groundbreaking scientific developments began to challenge the long-held assumptions about these compounds. Subsequent clinical trials involving depressed patients indicated that psilocybin could be at least as effective as conventional antidepressants, often with fewer reported side effects. A significant advantage, according to Professor Nutt, is the rapid onset of action. "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, suggesting a profound shift in brain activity that could quickly alleviate depressive symptoms by disrupting rigid thought patterns.

While Professor Nutt is a highly respected scientist, his outspoken assertions have not been without controversy. In 2009, he was famously dismissed as chair of the government’s drugs advisory body, the Advisory Committee on the Misuse of Drugs, by then-Labour Home Secretary Alan Johnson. This dismissal followed public comments, such as his claim that there was "not much difference" between the harm caused by horse-riding and ecstasy, which were deemed incompatible with his role as a government adviser. Nevertheless, Professor Nutt’s seminal studies served as a catalyst, sparking a global wave of investigations into the potential therapeutic benefits of various psychedelic drugs.

The question of whether these treatments should be made widely available on the NHS is complex. At University College London, neuroscientist Dr. Ravi Das is at the forefront of research aiming to understand the mechanisms of addiction. His current study involves recruiting heavy drinkers to investigate whether dimethyltryptamine (DMT), a short-acting psychedelic, can target the brain’s memory and learning systems to disrupt entrenched addictive behaviours. This research builds upon existing evidence suggesting that psilocybin can help break habitual patterns linked to addiction. Dr. Das explains, "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. 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, the long-term aim is to gain regulatory approval and offer it as an NHS treatment. Dr. Das passionately argues for equitable access: "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."

It is important to note the varying legal classifications of these substances. Ketamine, which Dr. Das has also studied, occupies a different legal category in the UK and can already be used as part of medical treatment for certain conditions, particularly treatment-resistant depression. In contrast, psychedelics like DMT, LSD, psilocybin, and MDMA are currently classified as Schedule 1 drugs under the Misuse of Drugs Regulations 2001. This classification implies they have "no legitimate medical use" and are subject to the tightest controls, making research licenses extremely difficult and costly to obtain. Dr. Das hopes that accumulating positive scientific evidence will compel the government to revise the scheduling of these drugs. "I hope if there’s sufficient evidence, the government will be open to revising the scheduling of these drugs," he states.

However, a critical analysis published in the British Medical Journal in November 2024 by PhD student Cédric Lemarchand and his colleagues urged caution regarding the precise determination of psychedelic drug effects. They highlighted that "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 pointed out that short-term trials might not 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." This nuanced perspective underscores the need for rigorous methodology and long-term follow-up studies to truly understand the benefits and risks.

Despite the promising research, medical professionals remain cautious about widespread implementation. Professor Howes firmly believes that, with the exception of ketamine, psychedelic treatments should not become routine medical practice in the UK outside of highly controlled research settings until larger, more rigorous trials provide robust evidence of their safety and effectiveness. He warns against the dangers of unsupervised use: "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 supported by data collected by Jules Evans’ Challenging Psychedelic Experiences project, which indicates that 52% of respondents who regularly use psychedelic drugs have experienced an intensely challenging trip, with 39% describing it as "one of the five most difficult experiences of their life." Disturbingly, 6.7% reported considering harming themselves or others following a challenging experience, and 8.9% felt "impaired" for more than a day. Some individuals even required medical or psychiatric assistance and continued to experience adverse effects for weeks, months, or even years. Mr. Evans argues, "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."

Conversely, Professor Nutt, Professor Howes, and Dr. Das are united in their belief that progress towards clinical integration is being unduly hampered by the bureaucratic difficulties of obtaining permissions for medically supervised clinical trials. Professor Nutt passionately asserts, "There are so many people suffering unnecessarily… 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 argues that once these medicines are unequivocally proven safe and effective, they must be made available through the NHS to all who need them, rather than becoming a privilege of the private sector, as has been seen with medical cannabis. Professor 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 analysis from Mr. Lemarchand’s team reiterates the call for greater scrutiny of trials, advocating that 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 maintains its stance that Schedule 1 drugs possess "no medicinal value," justifying the tightest controls. Ministers, too, consistently link the Home Office licensing regime directly to public protection. While the government has indicated 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, progress is slow. A cross-government working group is coordinating a cautious rollout, pending the results of pilot projects. However, Professor Howes notes, "There’s still a lot of red tape holding things up."

Supporters of psychedelic medicines are hopeful that the upcoming Phase 3 trials by Compass Pathways will pave the way for further regulatory relaxations, at least concerning research. Larissa Hope, reflecting on her own journey, underscores the profound importance of these ongoing trials. Her experience with psilocybin, she believes, provided invaluable insight into her suicidal ideation and trauma. "I had a solid plan to end my life. Then suddenly, death wasn’t the only way," she concludes. "Under psilocybin, my nervous system began, for the first time, to recognise what peace felt like." Her story, alongside the accelerating pace of scientific discovery, keeps the question firmly on the table: how much longer can the NHS afford to overlook the potential of magic mushrooms in the urgent fight against mental illness?