New from Palgrave Macmillan · 2026

Pain comes first.
Drugs come later.

A philosophical critique of co-existing mental health and substance use challenges — and a practical case for redesigning the systems that fail them.

Simon Bratt · Liverpool Hope University Palgrave Macmillan · 2026 ISBN 978-3-032-13179-9
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70%
of people in UK community substance use treatment also live with a co-occurring mental health problem.
1 in 2
people with mental illness in the US will also experience a substance use disorder in their lifetime.
63%
of people in Australian alcohol and drug treatment have a diagnosed mental health condition.
20%+
rise in UK rough sleeping in recent years — entangled with substance use and distress.

Sources: Royal College of Psychiatrists (2025); national treatment data summarised in Chapter 1.

The premise

The failure is not a resourcing accident. It is structural.

Across the UK, the US, Australia and Europe, mental distress and substance use co-occur at extraordinary rates — and the systems built to respond to them remain split down the middle. People are referred and re-referred, dropped for missing appointments, or turned away in crisis because they are “too high” for mental health care or “too distressed” for substance use services.

Our systems are not failing because of a few bad policies or underperforming services; they are failing because they are built on a broken ontology. This is not an individual failing. It is design. And design can be changed. — From the Preface
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