Psychedelics are increasingly described as a new therapeutic approach in a variety of mental disorders including depression. Oral psychedelics such as psilocybin have an acute effect evolving over 6-8 h and are generally given in combination with psychological support. There is debate on the exact role of this support and how and by whom it should be delivered. This has significant implications for real-world implementation in health services post-licensing. In this feature, we discuss these issues and outline a model for psychological support delivery in publicly funded health services such as the National Health Service. We also suggest further research to explore the exact role of support in psilocybin treatment and identify the essential elements to direct service plans for clinical implementation. These steps are important: over recent decades, there have been few new treatments for depression, moreover, psychedelic drugs are appealing to patients, and accumulating data suggest that their efficacy may be long-lasting. However, realistic plans for implementation must be based on high-quality evidence and the needs of the whole patient population. This will ensure that these treatments, if licensed, are available not only for those able to pay but to all on an equitable basis.