Layered Care

Simon Bratt
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  • Mental Health
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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 and interviews, it brings together frontline insight, research, and lived experience to rethink what care means. For practitioners, policy-makers, students, academics, and anyone navigating the cracks in the system. Real talk, hard questions, and layered answers.

Episodes

  1. May 3

    The Invisible Architecture

    Twenty years of policy has told services to integrate care for people with co-existing mental health and substance use needs. Twenty years of "no wrong door" commitments. And yet, in 2026, substance use is still being used as a gatekeeping criterion to refuse mental health support. Why? In Episode 1, I told the story of Jayne — a woman in prison who was discharged from both mental health and substance use services because she was using heroin to manage years of trauma. I ended that episode with a question: if everyone agrees the system is broken, why does nothing change? This episode answers that question. The answer has a name. It's called neoliberalism - and most people who work inside the system have never been taught to name it, even though it shapes every decision they make. The Invisible Architecture is about how an ideology rooted in individualism, competition, and personal responsibility has become the operating logic of public services. It's about the 2012 Health and Social Care Act that hardwired the silos into law. It's about the morality trick that turns systemic failure into personal failing. And it's about why the silence in MDTs and commissioning panels - the total absence of structural critique from the rooms where decisions are made - is the thing that keeps Jayne, and people like her, locked out. Drawing on James Davies, Margaret Archer, Joanna Moncrieff, and Mark Fisher, this episode dismantles the philosophical and political foundations of a system that was designed to fragment care. Pain Comes First is the first season of the Layered Care podcast, built on the argument of my book A Philosophical Critique of Co-Existing Mental Health and Substance Use Challenges (Palgrave Macmillan, 2025). Twelve episodes. One sustained argument.

    34 min
  2. Pain Comes First

    Apr 1

    Pain Comes First

    Pain comes before everything. Before the substance use. Before the diagnosis. Before the referral. In this first episode, Simon Bratt —social worker, senior lecturer and researcher — introduces co-emergence: a way of understanding why mental distress and substance use cannot be pulled apart, and why our systems keep trying. Through three lives that fell through the cracks, we see what happens when care is built around the wrong starting point. Based on the A Philosophical Critique of Co-Existing Mental Health and Substance Use Challenges: Pain Comes First, Drugs Come Later(Palgrave Macmillan, 2026).

    14 min
  3. Through the Cracks

    08/16/2025

    Through the Cracks

    What happens when mental health and substance use collide? Too often, people fall through the cracks. Hosted by frontline social worker and researcher Simon Bratt, this podcast digs into stories from prisons, streets, and crisis services — exposing why the system fails, and how we can build care that bends to people, not the other way around.

    21 min
  4. Trailer – Welcome to Layered Care

    Trailer

    Trailer – Welcome to Layered Care

    In this short trailer, you’ll hear what Layered Care is all about — and why it matters. It sets the tone for a podcast grounded in pain, survival, and systems that too often fail to care. This is where the story begins.

    1 min

Trailer

About

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 and interviews, it brings together frontline insight, research, and lived experience to rethink what care means. For practitioners, policy-makers, students, academics, and anyone navigating the cracks in the system. Real talk, hard questions, and layered answers.

Information

  • Creator
    Simon Bratt
  • Episodes
    4
  • Rating
    Explicit
  • Copyright
    © Simon Bratt
  • Show Website
    Layered Care