Should the NHS use magic mushrooms to treat mental health?

The debate about whether the NHS should embrace psychedelic-assisted therapy, particularly using compounds like psilocybin found in magic mushrooms, to treat debilitating mental health conditions such as depression, is intensifying across the UK. At its heart lie compelling patient testimonies, burgeoning scientific evidence, and significant regulatory hurdles, creating a complex dilemma for doctors, policymakers, and the public.

For individuals like Larissa Hope, psilocybin proved to be a pivotal intervention in her battle with severe mental health issues. Cast in the popular TV drama Skins at 17, the sudden glare of fame unexpectedly unearthed deeply buried trauma. Traditional antidepressants offered little solace, leaving her grappling with persistent distress. It was a single, carefully administered dose of psilocybin, under clinical supervision, that marked a profound turning point. She recalls the experience as transformative, prompting an outpouring of emotion and an unprecedented sensation of "belonging and safety" within her own body. "I kept saying, ‘I’m home, I’m home’," she recounts, nearly two decades later, attributing the experience, coupled with subsequent therapy, to helping her confront and overcome suicidal ideation. Her story provides a powerful personal testament to the potential therapeutic impact of these substances.

However, not all experiences are so positive, underscoring the critical need for caution and rigorous oversight. Jules Evans, a university researcher, recounts a dramatically different and harrowing encounter with LSD at 18, taken for recreational purposes. His trip descended into a "deluded" state, marked by intense paranoia, a belief that he was being constantly criticised, and a terrifying conviction that he had irrevocably damaged his mind. He describes it as "the most terrifying experience of my life," leaving him with years of social anxiety, panic attacks, and a diagnosis of post-traumatic stress disorder (PTSD). Today, Evans directs the Challenging Psychedelic Experiences Project, an initiative dedicated to supporting individuals struggling with adverse after-effects of psychedelic use. His work highlights the undeniable risks and the importance of understanding and mitigating potential harms.

These starkly contrasting narratives frame the central question facing the NHS: can psychedelics be safely and effectively integrated into mainstream mental healthcare? Should doctors be empowered to prescribe treatments that involve these historically stigmatised substances?

The renewed interest in psychedelic medicine, often dubbed the "psychedelic renaissance," has been fuelled by a growing body of new studies. These investigations suggest that psychedelic drugs could offer breakthrough treatments for a range of intractable conditions, including major depressive disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), complex trauma, and various addictions such as alcohol and gambling. Currently, the medical use of psychedelic substances like psilocybin, LSD, DMT, and MDMA is illegal outside of authorised research or clinical trials, classified as Schedule 1 drugs with "no medicinal value" under UK law. Since 2022, however, over 20 such trials have been initiated in the UK, testing various psychedelic medicines for their efficacy in treating these conditions. While many preliminary results indicate promise, others remain mixed or inconclusive, and only a few have definitively shown no benefit.

A pivotal moment is anticipated later this year with the release of results from one of the largest clinical trials into psilocybin use, conducted by UK biotech firm Compass Pathways. The UK’s medicines regulator is keenly awaiting this data, as it will inform decisions regarding the potential relaxation of current restrictions and the possible allowance of psychedelic medicine use beyond research settings.

Professor Oliver Howes, chair of the Royal College of Psychiatrists’ Psychopharmacology Committee, expresses cautious optimism regarding psychedelics as a potential new frontier in psychiatric treatment, including for NHS patients. He acknowledges the urgent need for "more treatments and better treatments for mental health disorders" and notes the intriguing potential of these compounds to "work quicker" than conventional therapies. However, he stresses the absolute necessity for robust evidence from the ongoing trials, warning against "overhyping the potential benefits" before comprehensive data is available. This sentiment is echoed in a September 2025 report from the Royal College of Psychiatrists, which urged caution and highlighted the potential dangers of psychedelics. Medical professionals consistently warn that recreational use of these drugs remains illegal and carries significant risks.

The journey of psychedelic drugs in modern medicine is a winding one, deeply intertwined with social and cultural shifts. While substances like magic mushrooms, opium, and cannabis have been used for millennia in rituals and recreation, their scientific exploration gained momentum in the mid-20th century. By the 1960s and 1970s, LSD became synonymous with the counterculture movement, epitomised by figures like Harvard psychologist Timothy Leary, who famously encouraged young people to "turn on, tune in, drop out" – a call to awaken inner potential, engage with societal realities, and challenge prevailing norms. However, this association with social unrest and perceived moral decline led to widespread bans in the late 1960s and early 1970s, effectively halting scientific research for decades and ushering in a period of strict prohibition.

The re-emergence of serious scientific inquiry began in the 2010s, largely spearheaded by Professor David Nutt and his team at Imperial College London. Their groundbreaking studies on psilocybin in depressed patients indicated that it could be at least as effective as conventional antidepressants, with potentially fewer side effects. A key advantage, according to Prof. Nutt, was its rapid action. He posited that while traditional antidepressants might take eight weeks to modulate the brain regions associated with depression, psilocybin could achieve a similar effect in "a few minutes." This bold assertion, while scientifically promising, has not been without controversy. Prof. Nutt was famously dismissed in 2009 from his role as chair of the government’s Advisory Committee on the Misuse of Drugs after making public comments comparing the risks of horse-riding to ecstasy, which were deemed incompatible with his advisory position. Nevertheless, his pioneering work undeniably reignited global interest, sparking numerous investigations into the therapeutic potential of other psychedelic compounds.

At University College London, neuroscientist Dr. Ravi Das is at the forefront of understanding how habits solidify into addictions and whether psychedelics can help dismantle them. His current study recruits heavy drinkers to investigate if dimethyltryptamine (DMT), a short-acting psychedelic, can target the brain’s memory and learning systems to disrupt addictive behaviours. Building on evidence that psilocybin can break habitual patterns, Dr. Das explains the mechanism: "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 early-stage research holds significant promise, with the ultimate goal of offering such treatments within the NHS, pending regulatory approval. Dr. Das advocates for accessibility: "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."

Unlike psilocybin, DMT, LSD, and MDMA, which face stringent Schedule 1 restrictions, ketamine occupies a different legal category in the UK, allowing its use as part of medical treatment. Dr. Das remains hopeful that mounting scientific evidence will compel the government to revise the scheduling of other psychedelic drugs.

However, a critical analysis published in the British Medical Journal in November 2024 by Cédric Lemarchand and colleagues raised important questions about the precise attribution of psychedelic drug effects. The report 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." Furthermore, it cautioned 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."

The road to widespread clinical adoption is fraught with obstacles. Prof. Howes, while supporting research, maintains that, with the exception of ketamine, psychedelic treatments should not be routine medical practice in the UK outside of controlled research settings until larger, more rigorous trials provide undeniable evidence of their safety and effectiveness. He warns against 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."

His concerns 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% describing it as "one of the five most difficult experiences of their life." Disturbingly, 6.7% considered harming themselves or others following such an experience, and 8.9% reported being "impaired" for more than a day. Jules Evans notes that some individuals required medical or psychiatric assistance and continued to feel worse for weeks, months, or even years, reinforcing his plea for greater understanding of adverse effects and recovery pathways before these therapies are broadly endorsed.

Despite these warnings, researchers like Prof. Nutt, Prof. Howes, and Dr. Das argue that the slow pace of progress into clinical application is primarily due to the arduous process of obtaining permission for medically supervised clinical trials. Prof. Nutt passionately states, "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 advocates for these medicines to be made available through the NHS once proven safe and effective, to prevent them from becoming an exclusive treatment for the wealthy, mirroring the trajectory of medical cannabis. Prof. Howes concurs, urging 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 government has acknowledged the need for reform, backing plans to ease licensing requirements for certain clinical trials approved by the Medicines and Healthcare products Regulatory Agency (MHRA) and Health Research Authority (HRA). A cross-government working group is coordinating a cautious rollout, pending pilot project results. However, critics like Prof. Howes contend that changes are "painfully slowly," with "a lot of red tape holding things up."

Supporters hold out hope that the upcoming phase three trials by Compass Pathways will pave the way for further regulatory relaxations, at least for research purposes. Larissa Hope’s transformative journey with psilocybin underscores the profound potential. Her experience of gaining insight into suicidal ideation and trauma, and feeling her "nervous system began, for the first time, to recognise what peace felt like," serves as a powerful reminder of the stakes involved in this ongoing debate. The question for the NHS is not simply whether magic mushrooms work, but how to navigate the complex interplay of scientific promise, patient need, and public safety in a way that serves all who desperately seek relief.