A Landmark Shift: England Finally Unites Mental Health and Addiction Care

emcat55
2 days ago
2 min read

ON 10th December 2025, the Department of Health and Social Care and NHS England published the long-awaited Co-occurring mental health and substance use delivery framework: summary of actions.

For the first time, England has a single, system-wide plan that treats drug and alcohol problems and mental ill-health as what they so often are: inseparable and interconnected.

No more “you have to get clean/sober first before we can treat your depression”.

No more bouncing between siloed services.

No more invisible patients falling through the cracks.

This new framework is built around four pillars every commissioner, service leader, clinician and workforce planner needs to understand:

1. Strategic leadership & service model design

New statutory duty to co-operate guidance (Health & Care Act 2012) on the way
CQC assessments will directly examine how services support people with co-occurring conditions
NHS England will publish a positive practice guide to strengthen collaboration between talking therapies and drug/alcohol teams

2. Data & monitoring

ASSIST-Lite screening to be rolled out across all mental health services
Upgrades to the MHSDS and NDTMS will finally make co-occurring need visible in national datasets

3. Workforce & training

More addiction placements in clinical psychology doctoral programmes
New addiction psychiatry training posts
Feasibility work toward a Centre for Addiction and a professional body for the drug and alcohol workforce
Commitment to training that meets the needs of diverse populations

4. Commissioning & incentives

Substance use formally recognised as a complexity factor in the NHS payment system—higher tariffs when addiction and mental illness co-exist
Exploration of direct financial incentives for joint working
Joint commissioning across mental health and drug/alcohol teams is now an explicit expectation

Why this matters

Up to 60% of people in drug and alcohol treatment have a mental illness. Up to 50% of people in secondary mental health care have problematic substance use.

Yet these issues have historically been treated as if they belong to different worlds.

The evidence couldn’t be clearer: integrated care works. It improves retention, reduces hospital admissions, and dramatically boosts recovery outcomes. And this framework isn’t a passive guidance document—it brings statutory levers, regulatory scrutiny from the CQC, new payment signals, and a focus on real-world implementation.

To every ICS leader, trust CEO, local authority commissioner, clinical lead and frontline practitioner: your job description just changed.

Now is the time to: