From Fragmentation to Integration: An Inquiry into Co-Existing Mental Health and Substance Use Challenges

The intersection of mental health and substance use, referred to as Co-Existing Mental Health and Substance Use Difficulties (CEMS), remains one of the most pressing yet neglected challenges in contemporary care systems. Despite growing recognition of the need for integrated support, services remain fragmented, constrained by structural, cultural, and systemic barriers that leave individuals navigating an often inaccessible and inadequate system.
This thesis, grounded in Archer’s morphogenetic framework, critically examines these systemic failures, exposing how biomedical dominance marginalises the sociocultural and contextual factors essential to meaningful intervention. Drawing on Freedom of Information (FOI) data analysis and qualitative interviews, this research explores disparities in service provision, the realities of policy in practice, and the lived experiences of both individuals and professionals entangled in a system that often works against them.

At the heart of this study is the Integrated Morphogenetic Care Model (IMCM), a framework that reimagines CEMS care by aligning structural reform with individual agency. Through a synthesis of empirical evidence and theoretical insight, this thesis moves beyond critique, offering a blueprint for policy reform that prioritises dignity, justice, and empowerment.

Rather than merely identifying gaps in care, this research serves as a call to action, advocating for a fundamental shift in how we approach CEMS treatment. By bridging structural analysis with lived experience, it challenges prevailing assumptions and provides a roadmap for meaningful, lasting change.