Psychedelic perceptions: mental health service user attitudes to psilocybin therapy

Abstract

Introduction: Despite the rapid advance of psychedelic science and possible translation of psychedelic therapy into the psychiatric clinic, very little is known about mental health service user attitudes.

Objectives: To explore mental health service user attitudes to psychedelics and psilocybin therapy.

Methods: A questionnaire capturing demographics, diagnoses, previous psychedelic and other drug use, and attitudes to psychedelics and psilocybin therapy was distributed to mental health service users.

Results: Ninety-nine participants completed the survey (52% female, mean age 42 years). The majority (72%) supported further research, with 59% supporting psilocybin as a medical treatment. A total of 27% previously used recreational psilocybin, with a male preponderance (p = 0.01). Younger age groups, those with previous psychedelic experience, and those with non-religious beliefs were more likely to have favourable attitudes towards psilocybin. A total of 55% of the total sample would accept as a treatment if doctor recommended, whereas 20% would not. Fewer people with depression/anxiety had used recreational psychedelics (p = 0.03) but were more likely to support government funded studies (p = 0.02). A minority (5%) of people with conditions (psychosis and bipolar disorder) that could be exacerbated by psilocybin thought it would be useful for them. One fifth of the total sample viewed psychedelics as addictive and unsafe even under medical supervision. Concerns included fear of adverse effects, lack of knowledge, insufficient research, illegality, and relapse if medications were discontinued.

Conclusions: The majority supported further research into psilocybin therapy. Younger people, those with previous recreational psychedelic experience, and those with non-religious beliefs were more likely to have favourable attitudes towards psilocybin therapy.

Keywords: Attitudes; Hallucinogens; Lysergic acid diethylamide; Psilocybin; Psilocybin therapy; Psychedelics; Psychiatry.

Fig. 1

Total Sample attitudes to psilocybin therapy. A Psilocybin therapy for various conditions; 36% agreed that psilocybin could be useful for some mental disorders, 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. B Attitudes and acceptability: 35% reported being knowledgeable about psychedelic drugs and 26% about magic mushrooms (psilocybin). Exactly 40% agreed that psilocybin could increase connection to nature, 34% increase connection to other people, and 52% could lead to a mystical experience. A total of 30% agreed that 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 medications to avail of psilocybin therapy. C Attitudes to safety and legality: 72% agreed that psilocybin should be tested for medicinal value and 59% believed that psilocybin should be granted medical treatment status; 52% thought that the government should fund psilocybin studies. Exactly 36% agreed that psilocybin could be safely enjoyed recreationally, whereas 30% agreed that it should remain illegal for recreational purposes. A total of 21% thought that psychedelics are addictive and 20% agreed that psychedelics are unsafe even under medical supervision

Fig. 2

Previous psychedelic use associated with more favourable attitudes to psilocybin therapy. A Thirty-five percent of the total sample self-reported lifetime psychedelic use. Exactly 27% previously used magic mushroom (psilocybin), 7.1% in the last 12 months, and 1% in last month. B Males self-reported higher lifetime use of psychedelics (p = 0.01) and magic mushrooms (p = 0.002) compared to females. Males also reported higher lifetime use of powder cocaine use (p = 0.02), ecstasy (p = 0.006), and MDMA (p = 0.01). Males reported being more knowledgeable about magic mushrooms (p = 0.048). C Compared to those who have never used psychedelics, participants that had previously used psychedelics were more likely to self-report being knowledgeable about psychedelics (p = 0.01) and magic mushrooms (p = 0.003) agree that psilocybin could be a therapeutic tool for depression (p = 0.050), anxiety (p = 0.009), and psychotic disorders (p = 0.01) and would benefit their own mental health condition (p = 0.008). They were more like to accept psilocybin if a doctor recommended it (p = 0.008) and to come off medications (p = 0.006). They were less likely to think that recreational psilocybin should be illegal (p = 0.001) and more likely to agree that psilocybin can increase people’s connection to nature (p = 0.004)

Fig. 3

Younger age and non-religious beliefs associated with more favourable attitudes to psilocybin therapy. A Younger age groups reported higher levels of previous psychedelic use (p = 0.002), more knowledge about psychedelics (p = 0.016), and magic mushrooms (p = 0.001) were more likely to view psilocybin safe for recreational use (p = 0.03), and the youngest age group was less likely to agreed that psilocybin should be illegal (p = 0.001). B Participants with no religious beliefs were more likely to agree that psilocybin is safe recreationally (p = 0.02), increase nature connection (p = 0.033), increase connection to others (p = 0.048), benefit my mental health problem (p = 0.038), accept if doctor recommended (p = 0.006), and willing to come off medication (p = 0.03) compared to those with religious beliefs

Fig. 4

Influence of diagnosis on attitudes to psilocybin therapy. A Fewer people with depression/anxiety previously used psychedelics (p = 0.03) yet were more likely to agree that the government should fund studies (p = 0.02). More people with addiction disorders previously used psychedelics (p = 0.01), and this group was less likely to agree that the government should fund studies (p = 0.01). Participants with psychotic disorders disagreed that psychedelics increase connection to nature (p = 0.01). B Diagnoses with a possible therapeutic indication were more likely to agree that psilocybin may be useful for some mental health disorders (p = 0.003), for depression (p = 0.003), anxiety (p = 0.048), chronic pain (p = 0.03), safe recreationally (p = 0.03), increases connection to nature (p < 0.001), should be tested for medicinal value (p = 0.009), granted medical treatment status (p = 0.004), would accept if doctor recommended (p = 0.016), and willing to come off medications (p = 0.08). Those with diagnoses with a possible therapeutic indication were more likely to disagree that psychedelics are unsafe even under medical supervision (p = 0.009)

Fig. 5

Concerns about discontinuing medication to accept psilocybin therapy. Web diagram of those who answered the question why they would not come off their medication to accept psilocybin therapy (n = 29). The most frequent answer cited was a fear of adverse effects (n = 10). Other reasons cited were satisfaction with their current treatment regime (n = 9), lack of knowledge (n = 7), insufficient available research (n = 5), illegal status of psychedelics (n = 3), worries about relapse of mental illness (n = 2), prior history of addiction (n = 1), and prior negative experience (n = 1). Blue dot size represents the number of participant responses in that category. The grey lines connecting two blue dots represent shared responses, and the line width reflects the number of participants who shared response categories