Should the NHS use magic mushrooms to treat mental health?

The profound debate surrounding the potential integration of psychedelic substances, specifically magic mushrooms, into mainstream mental healthcare within the NHS is gaining significant momentum. At its heart lies the question of whether psilocybin, the active compound in these fungi, could offer a revolutionary new approach to treating debilitating conditions such as depression. This isn’t merely a theoretical discussion; it’s a deeply personal one for individuals like Larissa Hope. Cast in the popular TV drama Skins at just 17, her newfound fame unexpectedly unearthed buried trauma, leading her down a path of severe mental health struggles. Traditional antidepressants, she found, offered little solace. However, a small, carefully administered dose of psilocybin, taken under rigorous clinical supervision, marked a pivotal turning point in her journey. She recounts the experience with profound emotion: "When I experienced it, I burst out crying. 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 session, combined with ongoing therapy, empowered her to confront and overcome suicidal feelings that had previously consumed her.

Yet, the narrative surrounding psychedelics is far from uniformly positive, underscoring the complexity of the current dilemma. Jules Evans, a university researcher, vividly recalls a vastly different, deeply unsettling encounter with LSD in his youth. Taken recreationally at 18, his trip plunged him into what he describes as a "deluded" state. "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 recounts, calling it "the most terrifying experience of my life." Years after this traumatic event, Evans continued to suffer from intense social anxiety, panic attacks, and was eventually diagnosed with post-traumatic stress disorder (PTSD). Today, he channels his experience into positive action as the director of the Challenging Psychedelic Experiences Project, an initiative dedicated to supporting individuals who have faced adverse outcomes after using psychedelics. His work highlights the critical need to acknowledge and address the potential harms, even as the therapeutic promise shines brightly. These two starkly contrasting personal accounts encapsulate the central tension confronting medical professionals, regulators, and policymakers: how can the NHS responsibly consider prescribing treatments involving magic mushrooms and other potent psychedelic drugs?

The renewed interest in psychedelics as therapeutic agents stems from a growing body of new scientific studies. These investigations suggest that compounds like psilocybin, MDMA, and DMT could be highly effective in treating a range of mental health disorders, including major depressive disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and various forms of addiction, such as alcohol and gambling dependencies. Currently, the use of psychedelic medicines is strictly illegal outside of authorised research or clinical trials in the UK. However, since 2022, an increasing number of trials—over 20 to date—have been initiated, exploring the efficacy of different psychedelic compounds for these conditions. While many of these studies have yielded promising results, indicating significant therapeutic benefits, others have presented mixed or inconclusive findings. Crucially, only a handful have definitively shown no benefit on their primary outcome measures, maintaining cautious optimism within the scientific community.

A highly anticipated milestone is the upcoming release of results from one of the largest clinical trials into psilocybin’s effectiveness, conducted by the UK biotech firm Compass Pathways. This data is keenly awaited by the UK’s medicines regulator, which is actively considering whether to ease existing stringent restrictions, potentially paving the way for psilocybin’s use beyond research settings. Professor Oliver Howes, a leading figure as chair of the Royal College of Psychiatrists’ Psychopharmacology Committee, expresses guarded enthusiasm. He views psychedelics as a "promising potential new treatment" for a spectrum of psychiatric disorders, including those affecting NHS patients. "One of the key messages is that this is something we desperately need – more treatments and better treatments for mental health disorders," he states. Prof. Howes points to their potential to "work quicker" than conventional treatments, a significant advantage for patients in acute distress. Nevertheless, he maintains a pragmatic stance, stressing the imperative for robust evidence from the ongoing trials. "It’s really important that we get evidence and not overhype the potential benefits," he cautions, acknowledging the historical pitfalls of premature enthusiasm in this field. This caution is echoed in a report from the Royal College of Psychiatrists, published in September 2025 (likely a typo, perhaps 2023 or 2024), which highlighted the potential dangers associated with psychedelics, reinforcing the medical community’s insistence that recreational use is both illegal and potentially harmful.

The historical trajectory of drug use, stretching back to ancient civilisations, reveals a long-standing human engagement with substances like magic mushrooms, opium, and cannabis for both recreational and ritualistic purposes. The mid-20th century witnessed a surge in public awareness and use of psychedelics, particularly LSD, which became emblematic of the 1960s counterculture movement. Figures like Harvard psychologist Timothy Leary famously urged young people to "turn on, tune in, drop out"—a call to awaken inner potential, engage with societal realities, and challenge prevailing social norms. However, this period also saw psychedelics become inextricably linked with social unrest and perceived moral decline. By the late 1960s and early 1970s, a global crackdown led to their prohibition and severe restrictions on scientific research.

A pivotal moment in the modern resurgence of psychedelic research arrived in the 2010s, thanks to groundbreaking work by Professor David Nutt and his team at Imperial College London. Their studies began to systematically investigate the therapeutic potential of psilocybin. Subsequent clinical trials involving depressed patients suggested that psilocybin could be at least as effective as traditional antidepressants, often with fewer reported side effects. Prof. Nutt highlighted another critical advantage: its 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. This perspective, while scientifically compelling, has not been without its critics or controversy. Prof. Nutt himself was famously dismissed in 2009 from his position as chair of the government’s Advisory Committee on the Misuse of Drugs, following public comments that drew parallels between the harm caused by horse-riding and ecstasy, deemed incompatible with his advisory role. Despite the controversies, Prof. Nutt’s pioneering studies undeniably reignited global interest, inspiring countless more investigations into the therapeutic applications of other psychedelic compounds.

At University College London, neuroscientist Dr. Ravi Das is at the forefront of this renewed research, focusing on understanding the mechanisms behind addiction and how psychedelics might intervene. His ongoing study is recruiting heavy drinkers to explore whether dimethyltryptamine (DMT), a potent, short-acting psychedelic, can be used to target and disrupt the brain’s memory and learning systems associated with addictive behaviours. This research builds upon existing evidence suggesting that psilocybin can effectively interrupt habitual patterns linked to various addictions. Dr. Das elaborates on the premise: "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." While this remains an early-stage study, its ultimate goal, contingent on successful trials and regulatory approval, is to offer such treatments within the NHS. 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."

The legal landscape for psychedelics in the UK is complex. While ketamine, which Dr. Das has also studied, occupies a different legal category and can be used medically, other psychedelics such as DMT, LSD, psilocybin, and MDMA are currently classified as Schedule 1 drugs. This classification implies they have no recognised legitimate medical use and are subject to the tightest controls, making research licenses exceptionally difficult to obtain. Dr. Das remains hopeful that mounting scientific evidence will 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, the path to widespread acceptance and integration into the NHS is fraught with challenges and calls for rigorous scrutiny. An analysis published in the British Medical Journal in November 2024 by PhD student Cédric Lemarchand and his colleagues highlighted the inherent difficulties in isolating the precise effects of psychedelic drugs. They noted, "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 raised concerns about the limitations of short-term trials in detecting "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 like Prof. Howes remain cautiously optimistic, advocating for a phased approach. He believes that, with the exception of ketamine, psychedelic treatments should not become routine medical practice in the UK outside of controlled research settings until larger, more rigorous trials provide irrefutable evidence of their safety and effectiveness. He strongly differentiates between supervised clinical use and unsupervised recreational use, stating, "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 data from the Challenging Psychedelic Experiences project, which indicates that 52% of regular psychedelic users have reported an intensely challenging trip, with 39% deeming it "one of the five most difficult experiences of their life." Disturbingly, 6.7% reported considering self-harm or harming others following such experiences, and 8.9% remained "impaired" for over a day. Jules Evans highlights that some individuals required medical or psychiatric assistance and continued to suffer adverse effects for weeks, months, or even years. He implores, "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, proponents like Prof. Nutt, Prof. Howes, and Dr. Das argue that progress toward clinical application is being unduly hampered by the bureaucratic hurdles and prohibitive costs associated with obtaining permissions for medically supervised clinical trials. Prof. Nutt 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 is unequivocal about the need for equitable access: "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, while urging caution, echoes this sentiment: "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 by Lemarchand and colleagues calls for enhanced scrutiny of trials, urging medical journals to "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, by definition, possess "no medicinal value," thus justifying the tightest controls. Ministers, too, link the Home Office licensing regime directly to public protection. While the government has endorsed plans to ease licensing requirements for certain clinical trials approved by the Medicines and Healthcare products Regulatory Agency (MHRA) and Health Research Authority (HRA), with work underway to implement exemptions for specific universities and NHS sites, progress remains slow. A cross-government working group is coordinating a cautious rollout, pending the outcomes of pilot projects. Yet, as Prof. Howes notes, "There’s still a lot of red tape holding things up."

Supporters of psychedelic medicines hold out hope that the upcoming phase three trials by Compass Pathways will be robust enough to trigger further relaxations, at least for research purposes, and ultimately pave the way for broader clinical use. For individuals like Larissa Hope, the stakes are profoundly high. Her experience with psilocybin provided crucial insight into her suicidal ideation and trauma, fundamentally altering her perspective. "I had a solid plan to end my life. Then suddenly, death wasn’t the only way," she reflects. "Under psilocybin, my nervous system began, for the first time, to recognise what peace felt like." The potential to offer such transformative experiences to countless others suffering from severe mental health conditions fuels the urgent calls for reform and greater accessibility within the NHS.