Falling Through the Cracks: a Constructivist Grounded Theory of How Service Provision Impacts the Experiences of those with Co-Occurring Mental Health Difficulties and Problems with Substance Use

Existing literature focusing on co-occurring mental health difficulties and problems with substance use predominantly focuses on prevalence and associated risk factors. This research aimed to explore how service provision impacts the experiences of people with both mental health difficulties and problems with substance use, living in Luton. Semi-structured interviews were carried out with 10 adults, with current or historic experiences of co-occurring mental health difficulties and problems with substance use. Data was analysed using a Constructivist Grounded Theory (GT) methodology. A theoretical model was co-constructed, showing process-oriented understanding of participant experiences. These experiences were categorised as social processes between participants and structural issues; ‘Navigating Services Working in Silos’, service level issues; ‘Swallowing the Jagged Pill’ and interpersonal interactions; ‘Doubting Adequacy of Support’. Through collaborating, understanding and trusting, other processes were facilitated, such as, ‘Becoming One of the Lucky Ones’, underpinned by ‘Benefitting from Relationships’. The research goes beyond existing literature, focusing on the direct impact of wider structures, discourses and political agendas affecting service provision. The GT model presented presents dynamic interactions of social processes and mechanisms that help to explain how and why individuals might remain ‘stuck’ within service provision, and why some can benefit and, consequently, move forward with recovery. The importance of positive relational interactions has been highlighted as key to support being beneficial to those accessing services. The findings have led to recommendations for anyone working with this group, as well as policymakers and commissioners.