CHAD/FPH webinar – Pain Comes First, Drugs come Later: Rethinking Co-Existing Mental Health and Substance Use Through a Layered Lens
On 22nd September 2025, CHAD and the Faculty of Public Health hosted this webinar with Dr Simon Bratt, a part-time lecturer at the University of Staffordshire and a Mental Health Social Worker at North Staffordshire Combined Healthcare NHS Trust. Here, Simon gave an overview of his research around co-existing mental health and substance use.
Simon began by outlining the background of the research, commenting that 70% of people in drug services have a mental health problem, and 54% of suicides among people with mental health problems involve substance use. People use substances for many reasons, but mainly for psychological pain and social structure difficulties. Simon is clear – the message is about rethinking the starting point when working with people.
Simon’s research was a qualitative study, with two lenses of critical realist and phenomenology. The question was: what challenges do people with co-existing mental health and substance use (CEMS) face, and how do these shape treatment and recovery? Simon explained the morphogenic framework he used, which outlines how structures and people work together.
Simon talked through his findings. The key message was that people use substances as a survival technique to psychological, structural or social pain that is already present. However, services are built on the opposite assumption – they are looked at as separate entities instead of one. Change is possible when structure and agency align. Simon explains that until services are built around pain, exclusion will remain policy by default. Simon’s research demonstrates that it needs to be an integrated system which starts with mental health. Pain comes first.
You can read more about Simon’s work in this recent journal article:
Bratt, S. (2025) Structural and cultural barriers to integrated care for co-existing mental health and substance use: a morphogenetic analysis. Discover Public Health 22, 354. https://doi.org/10.1186/s12982-025-00743-y
You can download the speaker’s slides here.
A recording of the webinar is available below.
