The readiness of psychiatrists to implement psychedelic-assisted psychotherapy

Psychedelic-assisted psychotherapy (PAP) is emerging as a promising treatment approach in psychiatry, with growing research interest particularly for depressive disorders, cancer-related anxiety and alcohol dependence. Classical psychedelics are serotonergic hallucinogens that act via 5-HT2A receptor agonism and are increasingly framed as relatively safe, low-abuse-potential medicines with rapid therapeutic effects. Despite accumulating clinical trial evidence and regulatory attention (for example, psilocybin’s FDA “breakthrough therapy” designation in 2019), it is unclear whether the clinical workforce is prepared to provide PAP in routine services. Murnane and colleagues designed a pilot study to assess the awareness, knowledge and attitudes of National Health Service (NHS) psychiatrists towards PAP, and to identify perceived barriers and facilitators to its implementation within a nationalised healthcare system. The study focused on classic hallucinogens (LSD, psilocybin, mescaline, etc.), deliberately excluding related agents such as MDMA and ketamine, and combined a cross-sectional survey with focus groups to capture both quantitative breadth and qualitative depth of views. Secondary aims included exploring whether demographic factors such as age or training grade related to preparedness to deliver PAP.

The study used a mixed-methods design comprising a cross-sectional electronic survey and follow-up focus groups, conducted within a single large NHS mental health trust in England. The trust serves nearly 1.7 million people across a diverse geographic area. The investigators limited questions to classic hallucinogens and excluded MDMA and ketamine. For the survey, an invitation was emailed to all 323 psychiatrists employed by the trust in January 2021; a reminder was sent about two weeks later. The sampling frame included trainees (n = 48) and non-training grade clinicians (consultants and specialty doctors, n = 275). The anonymised questionnaire was developed, piloted and hosted on Qualtrics to elicit familiarity with psychedelics and PAP, views on the effectiveness of existing treatments for non-psychotic disorders, self-rated confidence to refer for or deliver PAP, and sources of information about PAP. Basic descriptive statistics summarised responses. An a-priori analysis examined whether age group (≤34, 35–54, ≥55 years) predicted preparedness, using chi-squared tests. Qualitative data were collected via two virtual focus groups, recruited purposively via the survey invitation. Each session was facilitated by two members of the research team, began with a brief explanatory overview of PAP, and followed a predetermined schedule to explore attitudes, barriers and facilitators. Sessions were audio-recorded, transcribed and anonymised; audio files were subsequently destroyed. Two researchers performed thematic analysis following Braun and Clarke’s approach to develop codes, sub-codes and overarching themes. Ethical oversight: the authors report that NHS research ethics approval was not required for this work, although ethical procedures were followed; the study was sponsored by Sussex Partnership NHS Foundation Trust.

Survey response and sample characteristics: Of 323 psychiatrists invited, 83 responded (25.7%). Respondents comprised 63 non-training grade clinicians (75.9%) and 20 trainees (24.1%), meaning a greater proportion of trainees responded relative to the number invited (41.7% vs 22.9%). Most respondents were aged 35–54 years (57.8%), 20.5% were over 54 years and 16.9% were 34 or younger. Community general adult psychiatry was the largest specialty represented (43.4%), followed by old age psychiatry (21.7%) and inpatient general adult psychiatry (14.4%). The majority identified as White British/White other (82.0%), and there were slightly more male than female participants (55.4% vs 43.4%). Views on existing treatments: Participants generally judged current psychotherapeutic and pharmacological treatments for anxiety and depression to be moderately or extremely effective. In contrast, treatments for substance use disorders were viewed as less effective: 49.4% regarded psychotherapeutic approaches for substance use as only slightly effective or ineffective, and 77.1% regarded pharmacological options similarly. Familiarity with psychedelics and PAP: All respondents had heard of at least one psychedelic, with LSD, magic mushrooms/psilocybin and mescaline being the most recognised. Around 33.7% believed psychedelics should be decriminalised in the UK and 20.5% thought benefits outweighed harms. A majority (77.2%) believed there was a role for controlled or therapeutic use of psychedelics. However, 60.2% reported being not familiar or only slightly familiar with therapeutic uses of psychedelics, while 9.6% felt very familiar. Only two respondents (both trainees) reported direct experience participating in PAP. Trainees were generally better informed than non-training grade psychiatrists, more often having read journal articles or attended academic lectures; the popular press was also cited as a source, particularly by trainees. Preparedness to be involved with PAP: Overall, psychiatrists felt unprepared to participate in delivering PAP: most did not feel ready to prescribe psychedelics, act as PAP guides, or support psychologists in PAP delivery. Respondents showed somewhat greater confidence to discuss PAP with patients or to refer patients for PAP, but readiness to deliver the intervention themselves was low. There was no significant association between age group and preparedness or confidence to deliver PAP (chi-squared test, p = 0.78). Focus group findings: Two focus groups (each with 3–4 participants due to drop-outs) generated three overarching themes through thematic analysis. Theme 1, “Need for knowledge,” captured calls for a stronger evidence base, well-funded research, and wider public education; many psychiatrists reported learning about PAP through informal networks. Theme 2, “Openness to change,” reflected optimism that PAP might rapidly benefit patients who have not responded to existing treatments, alongside questions about societal readiness to accept therapeutic psychedelic use. Theme 3, “Uncertainty,” encompassed ambiguity about psychiatrists’ specific roles in PAP, concerns about risks for some patients, and scepticism about whether current legislative, NHS and professional governance structures are prepared to support PAP implementation. The authors note that a thematic map and exemplar extracts were compiled, with further detail provided in supplementary material.

Murnane and colleagues interpret their mixed-methods findings as indicating that while NHS psychiatrists are largely familiar with psychedelic substances and generally open to the idea of controlled therapeutic use, they do not feel prepared to deliver PAP within routine services. The survey showed that trainees tended to be better informed than non-training grade clinicians, possibly reflecting trainees’ broader engagement with emerging literature and preparatory learning for examination, although PAP is not yet part of postgraduate curricula in the UK. Compared with a prior US survey, UK psychiatrists in this sample appeared less stigmatising toward psychedelics, with 77.2% supporting a role for controlled or therapeutic use versus a substantial minority in the US sample who viewed hallucinogens as unsafe even under supervision. The authors emphasise the prominent training and workforce-development needs identified: psychiatrists lacked confidence to prescribe, guide or otherwise participate in PAP, and this shortfall did not vary by age. Focus group data added nuance, showing not only professional uncertainty about roles and risks but also concerns about the readiness of supporting structures—legal, NHS, and professional—to enable safe implementation. The investigators argue that public education and broader societal shifts will be required alongside professional training to support adoption. Strengths and limitations reported by the authors include the comprehensive sampling frame within a large NHS trust and the mixed-methods design, which yielded richer insights than either approach alone. Limitations noted were a modest response rate (25.7%), potential response bias favouring clinicians already interested in PAP, disproportionate trainee participation, limited focus-group size that may have constrained thematic saturation, and uncertain generalisability beyond UK settings. The authors conclude that even strong trial evidence for PAP’s efficacy will be insufficient to ensure implementation within NHS services without substantial investment in workforce training, formal guidelines, accreditation, and public engagement. They note external recommendations (for example, proposals for national advisory councils) as one potential model for coordinating training and regulation, and suggest that multidisciplinary efforts will be needed before psychiatrists will feel ready to participate in routine delivery of PAP.