Mental health support during ongoing substance use: are people being asked to get well before they can access help?

Purpose This study aims to explore how people with lived experience, members of local and recovery communities, and service representatives understand barriers to accessing mental health support in the context of ongoing substance use, and what their perspectives suggest about how support could better respond to co-occurring needs. Design/methodology/approach This study used a community-based participatory research-informed approach through a Greater Manchester Recovery Network Spotlight event involving around 45 participants. Three participant-led groups explored experiences of seeking mental health support, what happens when mental health and substance use services do not work together and what better support might look like. Participant-generated written and visual materials and recordings of plenary feedback were analysed using reflexive thematic analysis. Findings Four interconnected themes were developed: seeing the substance, missing what sits underneath; one person, separate systems; being heard, understood and responded to as a person; and bridging the gap through lived experience. Participants described mental health and substance use as potentially interconnected while support could remain divided across services, professional roles and pathways. The findings suggest that meaningful access involves more than reaching a service. It also concerns whether the relationship between mental health and substance use is recognised, whether people feel heard and understood, and how responsibility for maintaining connections between services is managed. Lived experience was identified as having a potential role in strengthening understanding and connection between people, professionals and services. Originality/value This study brings lived-experience, community and professional perspectives together within a participatory setting to examine how barriers and possible responses to co-occurring mental health and substance use needs are collectively understood. It extends discussion of fragmented provision by suggesting that fragmentation may affect not only access to services but also how interconnected needs are understood. The findings highlight the importance of maintaining understanding and responsibility across service boundaries, while suggesting that lived experience may help strengthen connections between people, professionals and services.