Structural and cultural barriers to integrated care for co-existing mental health and substance use: a morphogenetic analysis

Abstract 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. Despite policy commitments to coordination, individuals with CEMS face exclusion, crisis-driven interventions, and stigma, reinforcing cycles of disengagement. This study applies Archer’s (Being human: the problem of agency, 2004) morphogenetic framework to analyse structural and cultural barriers to integration. Using qualitative methods, it examines Freedom of Information (FOI) data from NHS mental health trusts and open interviews with professionals and individuals with lived experience. Findings reveal persistent service silos, abstinence-based eligibility policies, and professional constraints that sustain morphostasis, preventing reform. The Integrated Morphogenetic Care Model (IMCM) is proposed as a framework to promote structural flexibility, and co-produced service design. Urgent reforms are needed to ensure person-centred, trauma-informed care for individuals with CEMS.