Psychedelic perceptions: mental health service user attitudes to psilocybin therapy

Corrigan and colleagues place this study in the context of a rapidly evolving translational psychedelic science. Early clinical findings suggest that combining psychedelic compounds with psychological support may improve outcomes in conditions such as major depressive disorder, treatment-resistant depression and some addictions, and exploratory work has examined psilocybin in obsessive–compulsive disorder, eating disorders and headache syndromes. At the same time, psychedelic compounds produce highly variable subjective experiences, have neurobiological actions centred on 5-HT2A receptor activation and are contraindicated in psychosis-spectrum and manic disorders; these factors, together with rising recreational use, create both therapeutic opportunity and safety concerns that require careful, high-quality research and clear communication with service users and the public. This study aimed to characterise attitudes to psychedelics and psilocybin therapy among mental health service users. The investigators deployed a questionnaire to capture demographics, diagnoses, prior recreational drug use and specific attitudinal items about psilocybin therapy, with the goal of identifying which subgroups hold more favourable or cautious views and what concerns might influence acceptability of psilocybin in clinical practice. The authors framed this as a step towards informing public health messaging and stakeholder dialogue as psilocybin approaches clinical translation.

The researchers conducted a cross-sectional survey of mental health service users recruited from two sites: the Tallaght Community Mental Health Service (outpatients) and St Patrick's University Hospital (inpatients on open wards). Recruitment occurred between September and December 2020 for outpatients and October to December 2020 for inpatients. Eligible participants were aged over 18 years and fluent in English; inpatients on an acute locked ward were excluded. Outpatient recruitment involved verbal consent during routine telephone clinics (COVID-19 context) followed by postal or email delivery of the participant pack, with telephone completion offered. Inpatients were approached in person and provided written materials and the questionnaire. The bespoke questionnaire, informed by prior studies, collected demographic details (including education, employment and religion), clinical diagnosis and lifetime/recent recreational drug use. Attitudes to psychedelics and psilocybin therapy were measured using a 5-point Likert scale (strongly agree to strongly disagree). A free-text option probed reasons for unwillingness to discontinue medications to accept psilocybin therapy. For diagnostic analyses, diagnoses were collapsed into five groups (depression/anxiety, bipolar affective disorder, psychotic disorders, personality disorders and addiction disorders); eating disorder data were excluded from diagnostic subgroup analyses due to n=1. The investigators defined ‘‘possible indication’’ groups (depression/anxiety and addiction) and ‘‘contra-indication’’ groups (psychotic disorders and bipolar affective disorder) for comparative analyses. Analysis used ‘‘net agree’’ percentages (summing agree and strongly agree). Two-tailed chi-square tests in SPSS v26 tested differences between net Agree and net Disagree proportions, with GraphPad used for figures. IBM SPSS Text Analytics for Surveys analysed free-text responses. The extracted text does not report adjustments for multiple comparisons; the authors later note this as a limitation.

Ninety-nine participants completed the survey: 56 from the Tallaght community service and 43 inpatients at St Patrick's. The outpatient response rate was 53% (56 of 105), and the inpatient response rate was 95%. Overall sample characteristics reported in the extracted text include 52% female and a mean age of 42 years (reported in the abstract but not reiterated in the Results section of the extraction). Attitudes to therapeutic indications: 36% agreed that psilocybin could be useful for some mental disorders. Agreement rates for specific conditions were 34% for chronic pain, 31% for depression, 24% for anxiety, 20% for addiction disorders, 15% for psychotic disorders, 13% for eating disorders and 11% for smoking cessation. Regarding personal acceptability and perceived effects, 35% reported being knowledgeable about psychedelics and 26% about magic mushrooms (psilocybin). Forty percent agreed psilocybin could increase connection to nature, 34% agreed it could increase connection to other people, and 52% agreed it could lead to a mystical experience. Thirty percent agreed psilocybin would be useful for their own mental health problem, 55% would accept psilocybin therapy if a doctor recommended it, and 55% would be willing to come off their current medications to receive psilocybin therapy. Safety and legal attitudes: 72% agreed that psilocybin should be tested for medicinal value, 59% believed it should be granted medical treatment status, and 52% thought the government should fund psilocybin studies. Thirty-six percent agreed psilocybin could be safely enjoyed recreationally, while 30% believed it should remain illegal for recreational purposes. Twenty-one percent considered psychedelics addictive and 20% thought they were unsafe even under medical supervision. Prior drug use: 35% reported lifetime psychedelic use overall, with 27% reporting lifetime use of magic mushrooms; 7% had used psilocybin in the last 12 months and 1% in the last month. Lifetime LSD use was 21%, lifetime DMT 6%, mescaline 1%, and psychedelic microdosing in the last 12 months was reported by 2% of respondents. Of those with prior psychedelic use, 68% characterised it as a positive experience. Subgroup analyses identified multiple statistically significant associations. Participants with prior psychedelic experience were more likely to report knowledge about psychedelics (p = 0.01) and magic mushrooms (p = 0.003), to view psilocybin as therapeutic for depression (p = 0.050), anxiety (p = 0.009) and even psychotic disorders (p = 0.01), to endorse personal benefit (p = 0.008), to accept physician recommendation (p = 0.008) and to be willing to come off medications (p = 0.006). Prior users were less likely to support criminalisation of recreational use (p = 0.001) and more likely to agree psilocybin increases connection to nature (p = 0.004). Gender and age effects: Males reported significantly higher lifetime psychedelic use (p = 0.01) and magic mushroom use (p = 0.002), greater knowledge about magic mushrooms (p = 0.048) and higher lifetime use of cocaine, ecstasy and MDMA (p-values 0.02, 0.006 and 0.01 respectively). Younger participants reported greater psychedelic experience (p = 0.002), more knowledge about psychedelics (p = 0.016) and magic mushrooms (p = 0.001), were more likely to view psilocybin as safe recreationally (p = 0.034) and the youngest group were less likely to support illegality (p = 0.001). Religion and diagnosis: Participants reporting no religious beliefs held more favourable attitudes on multiple items (e.g. recreational safety p = 0.02, connection to nature p = 0.03, accepting doctor recommendation p = 0.006). Diagnostic group differences were observed for previous psychedelic use (p = 0.006), endorsement of psilocybin for depression (p = 0.036) and connection to nature (p = 0.003), as well as support for medicinal testing (p = 0.031) and government funding (p = 0.006). Post hoc tests showed fewer people with depression/anxiety had previously used psychedelics (p = 0.03) but they were more likely to support government-funded studies (p = 0.02). Those with addiction disorders reported higher prior psychedelic use (p = 0.01) but were less likely to agree the government should fund studies (p = 0.01). Participants with psychotic disorders disagreed that psychedelics increase connection to nature (p = 0.01). Other findings: When students and retirees were excluded, unemployed participants were less likely than employed participants to agree that psilocybin could be used to treat drug and alcohol disorders (p = 0.01). Education level showed no significant associations with attitudes. Concerning willingness to discontinue medication, 29 respondents provided free-text reasons for not doing so; the most frequent concerns were fear of adverse effects (n = 10), satisfaction with current treatment (n = 9), lack of knowledge (n = 7), insufficient research (n = 5), illegality (n = 3), worry about relapse (n = 2), prior addiction (n = 1) and prior negative experience (n = 1).

The investigators interpret their findings as evidence that most mental health service users sampled are supportive of further research into psilocybin therapy: 72% endorsed testing for medicinal value, 59% supported granting medical treatment status and 52% favoured government-funded studies. Approximately one-third of participants believed psilocybin could be useful for some mental disorders and 30% thought it might help their own condition; just over half would accept it if recommended by a doctor and would consider stopping current medications to receive it. Younger people, prior psychedelic users and those without religious beliefs held relatively more favourable attitudes. Corrigan and colleagues note a potential public health concern: a minority of participants, including some with psychotic disorders or bipolar affective disorder—conditions considered contraindications—thought psilocybin could be useful for them. The authors regard this as therapeutic misalignment that highlights the need for improved shared scientific understanding and clear communication about risks, especially since recreational use is rising and unsupervised experiences carry harms. They contrast their higher lifetime psilocybin rate (27%) and 7% past-year use with lower nationally representative estimates, acknowledging sampling bias toward people engaged with mental health services. The discussion situates the survey results alongside other attitudinal studies, noting parallels with college student and psychiatrist surveys regarding broad support for research and greater enthusiasm among males and younger respondents. The authors also remark on divergent responses about microdosing, observing the low microdosing rate in their sample (2%) compared with much higher rates in global drug surveys, and they reference emerging controlled-trial data that have not shown clear benefits for microdosing. Concerns expressed by participants—fear of adverse effects, lack of information, insufficient research, illegality and relapse risk—mirror themes seen in larger surveys. Finally, the authors argue for continued rigorous phase 2 and phase 3 trials to determine efficacy and safety, and for a ‘‘precise-personalised’’ therapy paradigm that combines high-quality therapeutic support with multi-stakeholder, open-science approaches. They suggest legal reclassification could expedite research and clinical integration but stress that public interest and therapeutic outcomes should guide development. The authors acknowledge substantial limitations that temper interpretation: the community sample may suffer non-response bias, many neutral responses indicate limited knowledge in the sample, drug histories were self-reported, key clinical details (history of mania, suicide attempts, family psychiatric history, reasons for use, sourcing of substances and emergency presentations) were not collected, numerous chi-square tests were not corrected for multiple comparisons and diagnostic coding lacked detail (e.g. bipolar I versus II and current episode phase).

The study found majority support among surveyed mental health service users for further research into psilocybin therapy (72%), with younger individuals, those with prior psychedelic experience and those without religious beliefs expressing the most favourable attitudes. A small subset of participants with conditions that could be exacerbated by psilocybin nonetheless viewed it as potentially useful, signalling a need for clearer public health messaging. The authors conclude that improved communication between researchers, clinicians, service users and the public is necessary to build a shared scientific understanding and to guide the safe translational trajectory of psychedelic therapy.