The Layered Care Framework
A practical, critical-realist model for responding to co-existing mental health and substance use.
Structural Flexibility
Systems fail when they cannot bend. Structural flexibility means designing care that adapts to changing circumstances without pushing people out. It challenges the rigid criteria-based logic that fragments support.
Integrated Social Determinants
Distress and substance use are shaped by housing, poverty, trauma, stigma, and exclusion. This pillar ensures that care responds to the person’s world, not just their symptoms.
Enhanced Agency
People make choices within constraints. Agency is not about independence; it is about supporting meaningful action in the context of pressure, survival, and limited options.
Contextualised Care
Care must fit the person, not the other way around. This pillar grounds practice in lived experience rather than abstract diagnostic categories.