Dr Simon Bratt (PhD) 💭

Through the Cracks Layered Care · Episode

Layered Care – Episode 1: Welcome

From a 6am doorway on the streets to the prison wing where I first met “Jayne,” this episode asks what happens when #MentalHealth and #SubstanceUse collide.
#Podcast #LayeredCare #Addiction #SocialWork

open.spotify.com/episode/0eh6...

Layered Care Podcast · Simon Bratt · Pain comes first – drugs come later. Hosted by Simon Bratt, this podcast explores the realities of co-existing mental health and substance use challenges. With solo episodes an...

open.spotify.com/show/0ul9zra...

Structural and cultural barriers to integrated care for co-existing mental health and substance use: a morphogenetic analysis - Discover Public Health Co-existing mental health and substance use challenges (CEMS) remain a critical barrier to integrated care due to systemic fragmentation, rigid eligibility criteria, and risk-averse service cultures. ...

🧠📄 New paper just published in Discover Public Health:
“Structural and cultural barriers to integrated care for co-existing mental health and substance use”

Read 👉 link.springer.com/article/10.1...

#CEMS #MentalHealth #Addiction #SocialWork #IntegratedCare

🧵After 20 years in social care and health, I’m writing about the quiet force that shapes who we help—and who we leave behind.
I call it: helpability.
painfirstdrugslater.substack.com/publish/post...

#MentalHealth #AddictionServices #SocialCare

🩸 Stigma Kills: How Care Systems Decide Who Deserves to Live What if stigma wasn’t a feeling—but a function? A structural logic that decides who gets care, and who gets left to die?

Stigma kills.
My latest Substack explores how services judge, exclude, and moralise those in pain:
“Stigma Kills: How Care Systems Decide Who Deserves Help”
painfirstdrugslater.substack.com/p/stigma-kil...

#Addiction #MentalHealth #CEMS #Stigma #HarmReduction

The End of NHS England: What It Means for Mental Health and Substance Use Services

open.substack.com/pub/sbratt/p...

Mental Health and Homelessness: A Complex Interplay of Trauma, Survival, and Systemic Failures The relationship between mental health and homelessness is as intricate as it is urgent. Homelessness is often associated with a range of mental health symptoms—primarily anxiety and depression—but…

Mental health & homelessness are deeply intertwined. People adapt to the chaos of the streets—but when they finally get housed, the silence can be unbearable.
time-to-listen.com/2025/02/15/m...
#Homelessness #MentalHealth

Pain comes first. The drug comes next. Always. If we want to address addiction, we need to treat the pain—especially the psychological pain—first. #Addiction #MentalHealth #Trauma #HarmReduction #EndStigma”

Addiction isn’t just about the drug. It’s about where you are. Who you are. What you have to fall back on when the high is gone.

We’ve been discussing this for over 22 years, yet stigma and discrimination against people who use alcohol or other substances persist. This must change! #EndStigma #AddictionAwareness #Equality

Taxpayers foot the bill to ferry addicts to inject free heroin Thousands of pounds of taxpayers' money has been spent on hiring taxis to take drug addicts to an NHS clinic to be injected with 'free' heroin.

Trust the @dailymail.co.uk to use stigmatising language that further alienates an already vulnerable group of people. This is exactly why I avoid that paper! www.dailymail.co.uk/news/article...

🎄 Merry Christmas! 🎄 This season reminds me of the importance of integration—not just in co-existing mental health & substance use care but in our communities too. Here’s to fostering connection, compassion, and change. Wishing you all a joyful holiday and a hopeful New Year!

Fragmented care systems fail those with mental health & substance use challenges. My research calls for national integration model - a framework that bridges gaps, reduces stigma, & centers lived experiences. #CEMS #IntegratedCare #PolicyReform

Over 80% of individuals with co-existing mental health & substance use challenges face barriers accessing care due to stigma or service eligibility rules. This has to change. #CEMS #DignityInCare

Mental health & substance use care systems are broken—fragmented, stigmatising, & ineffective. We need to shift from silos to integrated care. #CEMS #IntegratedCare #PolicyReform

Honoured to be recognised by social work apprentices—it truly means the world to me. This reminder of why I’m passionate about teaching and supporting future social workers is deeply meaningful. Thank you to the cohort—it’s a privilege to witness your potential. #Gratitude #SocialWork

Shelter condemns ‘shocking’ 14% rise in homelessness across England Charity says soaring private rents, rising evictions and lack of affordable social housing are to blame

Homelessness is not just a housing issue—it’s a symptom of our deeply individualist society. We need more than homes; we need a shift toward a collective mindset that prioritises solidarity, community, and shared responsibility. #Homelessness #SocialChange
www.theguardian.com/society/2024...

4/4 We need to critically examine how diagnostic labels are applied and whether they help or harm those seeking support. It’s time to ask deeper questions about how we define and treat mental health challenges. #MentalHealthReform

3/4 But are we also grappling with an epistemic fallacy in psychiatry? Diagnoses often focus on categorising symptoms rather than understanding the complex causes of distress. Is this holding us back from truly person-centred care? #PsychiatryMatters

2/4 These diagnostic shifts often expose individuals to significant stigma and discrimination. EUPD/BPD, in particular, carries a heavy burden of misunderstanding, even within healthcare settings. This impacts the quality of care people receive. #MentalHealthAwareness

1/4: I love psychiatry, but my faith is being tested. Diagnostic labels like schizophrenia or bipolar disorder are often reassessed and changed to EUPD/BPD. While diagnostic refinement is vital, it can have unintended consequences. 🧵 #MentalHealth #Psychiatry

Liver disease profile, December 2024 update

Shocking stats:

📈 64% rise in alcohol-related liver disease deaths (2006–2023)
📈 4.6% increase in just one year (2022–2023)

Alcohol deaths are spiralling. We need urgent action: prevention, better care, & policy reform.

How do we turn the tide? www.gov.uk/government/s...

#AlcoholAwareness

Kate Middleton speaks out on addiction saying ‘it is not a choice’ 'Everyone suffering from addiction is another human being with a story of their own.'

Addiction is not a choice—it’s a serious mental health condition. Princess Catherine’s words call for compassion and healthcare-led solutions. It’s time to prioritise people’s mental health first—and address addiction as part of the whole. #CEMS
metro-co-uk.cdn.ampproject.org/c/s/metro.co...

Dive into the world of #MentalHealth, #SubstanceUse, and #PolicyReform with curated insights, top accounts, and resources.

go.bsky.app/7yEba3c

Apple’s 2024 Review is out, and let’s face it—it’s basically a tribute to our dogs. 🐾 From muddy paw prints to sofa snuggles, they’ve made this year unforgettable #bestfriends #YearOfOurDogs 🐶

10/ Boys are not immune. While mental health needs appear lower, 39% of boys in substance misuse treatment still require support. Let’s not overlook their struggles. #CEMS #MentalHealthForAll

9/ Girls face unique challenges. With higher rates of mental health needs, self-harm, and sexual exploitation, services must adopt gender-sensitive, trauma-informed approaches to co-existing care. #CEMS #GenderInformedCare

8/ The rise of ketamine & inhalants (e.g., nitrous oxide) signals deeper distress. Ketamine misuse has jumped to 8.4%, surpassing cocaine. These substances often mask severe mental health struggles. #CEMS #SubstanceUseCrisis

7/ Alcohol misuse affects 39%. It’s more than a drinking problem—it’s tied to self-harm, depression, and anxiety. Young people need care that tackles both addiction and mental health. #CEMS #SubstanceUse

6/ Cannabis is the most common substance, misused by 87% of young people in treatment. But it’s not just a “soft drug”—it can worsen anxiety, depression, and even psychosis. Mental health services must adapt. #CEMS #MentalHealth