How to Help a Loved One Consider Psychedelic Therapy

Watching someone you love cycle through treatments that do not work is its own kind of exhaustion. If you have started reading about psychedelic medicine — esketamine, ketamine-assisted psychotherapy, the new psilocybin frameworks — you are probably carrying two questions at once: could this help them? and is it my place to bring it up? This guide is for the second question as much as the first. It covers what the legal routes in Europe actually require, how to raise the subject without damaging trust, and the practical work a family member, partner or close friend can genuinely take on. It stays inside the clinical and legal frame: what these treatments are, who provides them lawfully, and how decisions get made.

TL;DR In Europe, legal psychedelic medicine is gated by documented treatment resistance — most routes require proof that at least two antidepressants failed at adequate dose and duration. You cannot make the decision for your loved one, and pushing usually backfires; what you can do is listen, offer information when asked, and take on the paperwork. The most valuable single act is helping assemble a written medication history, because that document decides eligibility more than anything else. If treatment starts, they will need a ride home after every session and support between sessions. Never source substances yourself. In a crisis, call 112.

When standard treatment is not working

There is a moment many families recognize: the third or fourth medication change, the same flat weeks afterwards, and a creeping sense that the plan has become "try the next one" without much conviction. Clinical systems have a name for part of this experience. Across Europe, treatment-resistant depression is usually defined as a moderate-to-severe depressive episode that has not responded to at least two different antidepressants, each taken at an adequate dose for an adequate duration (EMA).

That definition matters to you for one reason: it is the gateway criterion for the most accessible legal route in Europe — esketamine (Spravato), which is reimbursed in most of continental Europe precisely for people who meet it. Some countries ask for slightly more (an augmentation attempt, or three failed strategies), but the two-failed-antidepressants threshold is the common core; our reimbursement map lists each country's exact criteria.

Two gentle points about this label. First, it is not a verdict on your loved one — "resistant" describes the episode's response to particular drugs, not the person, and it is common: a meaningful share of people with depression meet the definition at some point. Second, and more usefully, many people qualify without knowing it, because nobody has ever written their treatment history down in one place. If your loved one has been unwell for years, there is a fair chance the doorway is already open — it just has not been documented yet.

How to bring it up without pushing

The evidence-based frame here is shared decision-making: clinicians and patients deciding together, with the patient's own values and preferences carrying real weight (NICE guideline NG197). The same logic applies to families. You can bring information into the room; you cannot — and should not try to — carry the decision out of it.

What that looks like in practice, drawing on guidance for families from mental-health organizations (Mind, EUFAMI):

Ask before informing. "I read something about a treatment for depression that hasn't responded to medication — would you want to hear about it?" is a different act from arriving with printouts. If the answer is no, the answer is no for now.
Offer it as one option, not the answer. Overselling any treatment sets up disappointment and erodes your credibility for the conversations that follow. The honest pitch is modest: regulated, supervised, evidence-backed for specific diagnoses, with real screening and real exclusions.
Let them set the pace. Depression slows decisions. A conversation that ends with "think about it, I'll help with the boring parts if you ever want" respects that.
Keep it about them, not the substance. The question is never "will you try psilocybin?" — it is "do you want to look at what else exists for what you're going through?" The specific route is for them and a clinician to choose.

One conversation, left open, is worth more than a campaign.

What you can practically do

While the decision is theirs, most of the preparatory work is not clinical at all — it is administrative. This is where you can carry real weight.

Assemble the medication history document. This is the most useful thing a family member can do, full stop. Every legal route in Europe — reimbursed esketamine, private clinic screening, insurer pre-approvals, trial eligibility — runs on documented treatment history, and assembling it is exactly the kind of sustained, fiddly task depression makes hard. With your loved one's agreement, build a single written record containing:

Every antidepressant tried: name, the highest dose reached, how long it was taken at that dose, what effect it had, what side effects occurred, and why it was stopped;
Augmentation attempts (for example lithium or an antipsychotic added to an antidepressant), with the same details;
Psychotherapy: type, roughly how many sessions, over what period, with what result;
Diagnoses and any hospital admissions, with dates and discharge letters if available;
Current medicines — all of them, not just psychiatric — plus significant physical conditions, especially heart and blood-pressure history;
The names of treating clinicians past and present.

Old prescriptions, pharmacy records and discharge summaries are your raw material; the GP's records can fill gaps. "Adequate dose for an adequate duration" is what assessors look for, so dates and doses matter more than impressions. In countries where an insurer's physician pre-approves treatment, this document is literally what gets read.

Research the routes in their country. The legal picture differs sharply between countries, and knowing it in advance saves your loved one from dead ends and from marketing. Our country guides cover every legal route in Germany, the Netherlands, Poland, Switzerland, the UK, France, Spain and Czechia, and the Europe-wide comparison shows the whole map at once.

Suggest a validated screener as preparation — not as diagnosis. Structured self-screeners (the kind clinicians themselves use as first-pass tools) can help your loved one put words and numbers to their state before a first appointment, which makes that appointment more productive. Our eligibility check links validated instruments, and a fuller screening library is available at statesofmind.com/screening — a States of Mind project from the same group as this directory. A screener result is conversation material for a clinician, never a diagnosis.

If they say yes: what to expect

Suppose the conversation lands, an appointment happens, and a route opens. Here is the realistic shape of what follows, and where you fit in it.

Screening comes first. Before any treatment, a clinician reviews the psychiatric and medication history, checks cardiovascular health and current medicines, and screens for contraindications such as a personal or family history of psychosis. Expect this to take one or several appointments. If your loved one wants you at these — many people do — most services welcome an accompanying family member at assessment stage; ask the clinic.

Treatment days need a driver. Whether it is a supervised esketamine session with an observation period of roughly two hours, or a ketamine infusion with recovery time, one rule is universal: no driving for the rest of the day (EMA). Arranging the ride home — every time, across what may be months of recurring sessions — is unglamorous and genuinely important. During dosing itself you will usually be in the waiting room, not the treatment room; clinics differ, so ask.

The work between sessions is where support matters most. Serious providers wrap medicine in follow-up: symptom measurement, psychotherapy or integration sessions, coordination with the regular psychiatrist. Your part is quieter — protecting time for rest after treatment days, noticing and naming changes ("you've been cooking again") and staying patient when progress is uneven. Improvement, when it comes, is usually a slope rather than a switch.

What not to do

Do not pressure, bargain or set deadlines. "Promise me you'll call them by Friday" converts an option into an obligation, and guidance for families is consistent that you cannot force an adult into treatment — and that trying costs you the trust that makes help possible (Mind). Do not book assessments behind their back, and do not frame any treatment as the last chance — it is not true, and it is a crushing thing to carry into a clinic.

Do not try to obtain substances yourself — ever. However slow the legal routes feel, buying psilocybin, MDMA, ketamine or anything else outside licensed medical care is illegal nearly everywhere in Europe and dangerous in exactly the ways that matter here: no screening for the conditions that make these substances risky, no medical supervision, no known content or purity, and legal exposure for you and for the person you are trying to help. There is no safe version of this shortcut, which is why this guide says nothing more about it. If the legal options in your country are closed, the honest alternatives are clinical trials — free by definition — or a vetted provider in a country where a route is open.

When it cannot wait

Everything above assumes there is time to research, document and decide. Sometimes there is not.

If your loved one has harmed themselves, or tells you they intend to, treat it as an emergency now. Call 112 — the emergency number everywhere in the EU — or go with them to the nearest emergency department, and do not leave them alone. If they are safe for the moment but struggling, most European countries operate crisis lines, including the 116 123 emotional-support number in many of them; Mind's pages on supporting someone in crisis cover what to say and do. Planned treatments — all of them, this field included — are for later. Crisis services are for now.

Frequently asked questions

Can I book an appointment or apply for treatment on their behalf?

No — and a service that would let you should worry you. Consent to medical treatment is personal: assessments, applications and treatment decisions belong to the patient, everywhere in Europe. What you can do is everything around the decision: gather the records, research the routes, offer to make the call together, and drive.

Can I go with them to appointments and sessions?

Usually yes to assessments and consultations, if they want you there — being in the waiting room alone reassures many people. During supervised dosing sessions you will generally not be in the room, but you are needed afterwards: nobody drives themselves home from a treatment day. Ask each clinic about its own policy.

What will it cost, and who pays?

It depends entirely on the route and country. Reimbursed esketamine costs little or nothing out of pocket in much of continental Europe; private ketamine clinics are self-pay almost everywhere; psilocybin and MDMA therapy are essentially unavailable outside trials and a few narrow national programs. Our reimbursement map has the country-by-country picture, and clinical trials are free.

What if they refuse to consider it?

Then that is the answer, for now. An adult's right to decline treatment includes treatments you have hopes for. Keep the door open ("if you ever want, the folder is ready"), keep offering the support they do accept, and look after yourself — carer organizations such as EUFAMI's national members exist precisely because supporting someone who is unwell is hard. Refusing this option is not refusing you.

Is psychedelic therapy safe?

Under licensed medical supervision, with proper screening, the approved and program-based treatments in Europe are generally well tolerated — that is what the screening, monitoring and observation requirements exist to ensure. They are not safe for everyone: cardiovascular conditions, psychosis history and several other factors can rule them out, which is exactly why the assessment happens before anything else (EUDA). Outside medical settings, the safety picture is entirely different — see "What not to do" above.

Sources

This guide is for general information only and is not medical advice, a diagnosis, or a recommendation of any treatment. Eligibility and treatment decisions always belong to the patient and their clinician; regulations and reimbursement rules change, so verify current requirements in the country concerned. If you or someone close to you is in crisis, contact your local emergency number or a crisis line immediately.

This guide awaits review by a licensed medical professional.