A philosophical critique of co-existing mental health and substance use challenges — and a practical case for redesigning the systems that fail them.
Sources: Royal College of Psychiatrists (2025) UK figures; SAMHSA (US, 2024); AIHW Alcohol and Other Drug Treatment Services (Australia); ONS rough sleeping snapshot (UK).
For years we’ve been debating co-existing mental health and substance use challenges. Since 2002, policy has said an integrated approach is the only way forward — and a no-wrong-door approach should be in place. The reality is very different. 54% of all suicides are linked to substance use. 70% of people in substance use services struggle with their mental health. People openly say that substance use is a survival. Yet we moralise and stigmatise.
This is because our system is designed on a false ontology — based on the ideology of individualism, choice, worthiness and responsibility. We will not improve if we do not address the underlying ideology that services are built on.
Statistics can show the scale of a problem, but they cannot hold the weight of a life.— Chapter 1, “The Lived Reality”