An Inquiry into Co-Existing Mental Health and Substance Use Challenges.
Doctoral thesis · Staffordshire University · March 2025 · 347pp
This is the doctoral thesis I completed at Staffordshire University in March 2025 — six years of work in the Department of Social Work, Law and Criminology. It’s a freestanding piece. Not a draft of the book, not a derivative of it. The book came a year later and draws on themes that emerged here, but it’s a separate argument with its own framing and audience.
The thesis is the first place I developed and defended the Integrated Morphogenetic Care Model (IMCM) — a framework grounded in Margaret Archer’s morphogenetic social theory, aligning structural reform with individual agency in services for people with co-existing mental health and substance use needs. In the book, I later reworked the IMCM into a more practice-ready expression: the Layered Care Model (LCM).
Combines empirical and theoretical methods to examine why services for people with co-existing needs continue to fail despite repeated reform efforts.
The thesis is an empirically-grounded social-scientific inquiry: it makes its argument through data and qualitative evidence, and develops the IMCM. The book is a philosophical critique that takes those concerns into a different theoretical register — engaging Cartesian dualism, biomedical reductionism, neoliberal individualism — and translates the IMCM into the practice-facing Layered Care Model. They share concerns; they don't share method.
Researchers, postgraduates, and practitioners working at the intersection of mental health, substance use, and policy. Anyone interested in the methodological detail behind the book's claims will find it here.
Supervised by Jo Turner (Director of Studies), with Naomi Ellis and Sarah Page as co-supervisors. With thanks to the late Margaret Archer for her correspondence on the morphogenetic framework, and to the research participants whose contributions made the work possible.
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 socio-cultural 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.