Substance use and mental ill health

20 May 2025

From fragmentation to integration?

Kadra Abdinasir, David Woodhead and Andy Bell

Mental health problems can drive problem substance use, and vice versa. But people struggling on both fronts routinely face closed doors to care, refused mental health support until they stop using substances.

In collaboration with Professor Dame Carol Black, we convened a roundtable to address the profound inequalities faced by people experiencing both mental ill health and problem substance use. Substance use and mental ill health highlights the key themes and insights shared by our participants, who represent a diverse range of national and local organisations.

The briefing explores several significant barriers faced by people seeking support for mental health and substance use problems. It finds that these co-occurring challenges often lead to stigma, discrimination, and fragmented care, particularly for marginalised groups such as homeless people, people from racialised and LGBTQ+ communities, and people in the criminal justice system. The briefing also highlights the need to address systemic issues in services, including a lack of integrated care, insecure funding and workforce shortages.

Bold change is needed to overcome the inequalities faced by people with mental health and substance use problems. The ten-year health plan is a vital opportunity for the Government to invest in integrated, effective, compassionate support that truly meets people’s needs and enables their recovery.    

Infographic illustrating barriers to support for mental health and substance use problems: a lack of integrated care means that people struggling on both fronts are turned away from services for being ‘too complex’; underinvestment in holistic services prevents people from getting support that meets their needs (e.g. Workforce shortages, Funding pressures on services, Compounded stigma & trauma); Fragmentation between NHS, local authority services and voluntary sector services leads to people falling through the gaps; Inequity
means that people from LGBTQ+ and racialised communities, as well as people within the criminal justice system, face even greater challenges in getting support; a lack of access to secure housing means that people can find their wider support needs hidden by homelessness.

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