{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T02:07:57Z","timestamp":1789092477920,"version":"build-2803163510"},"reference-count":115,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR300616"],"award-info":[{"award-number":["NIHR300616"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>There is an acknowledged care gap for patients with co-occurring substance use and mental ill-health. This study sought to use complexity theory to help make sense of the experiences of people who deliver or commission formal care for patients with alcohol use disorder and depression across one specific health and social care system.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Method<\/jats:title>\n<jats:p>Qualitative interviews with 26 health and social care professionals in the North East and North Cumbria Integrated Care System, England, were conducted. Data analysis was undertaken using reflexive thematic analysis and informed by key concepts from complexity theory.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Three main themes were identified: (1) how the interplay between risk, stigma and resource pressures influences how care professionals interpret and apply practice guidelines; (2) how individualised and disjointed practices have structural and historical roots, in particular the impact of health service commissioning cycles; (3) ways in which practitioners have been able to adapt and engage in creative practice to temporarily plug gaps in care.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The pressure of working with increasingly scarce resources, within a highly fragmented, shifting, and risk-averse care infrastructure, adversely affected professionals\u2019 capacity to provide consistent, patient-centered support. Innovations have emerged that address some of these barriers, but further investment is needed to better support the substance use and mental health workforce, including lived experience peer workers.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0334524","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T17:33:32Z","timestamp":1760549612000},"page":"e0334524","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Care professionals\u2019 accounts of providing support and treatment for people with co-occurring alcohol use disorder and depression in the North East of England, UK: A qualitative study informed by complexity theory"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4071-9434","authenticated-orcid":true,"given":"Amy","family":"O\u2019Donnell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen","family":"Kaner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Hanratty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eilish","family":"Gilvarry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Wigham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,10,15]]},"reference":[{"issue":"9682","key":"pone.0334524.ref001","doi-asserted-by":"crossref","first-page":"2223","DOI":"10.1016\/S0140-6736(09)60746-7","article-title":"Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders","volume":"373","author":"J Rehm","year":"2009","journal-title":"Lancet"},{"issue":"8","key":"pone.0334524.ref002","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1001\/jamapsychiatry.2015.0584","article-title":"Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III","volume":"72","author":"BF Grant","year":"2015","journal-title":"JAMA Psychiatry"},{"issue":"5","key":"pone.0334524.ref003","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-021046","article-title":"Alcohol-related harm to others in England: a cross-sectional analysis of national survey data","volume":"9","author":"C Beynon","year":"2019","journal-title":"BMJ Open"},{"key":"pone.0334524.ref004","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.drugalcdep.2015.05.031","article-title":"Prevalence of comorbid substance use, anxiety and mood disorders in epidemiological surveys, 1990-2014: A systematic review and meta-analysis","volume":"154","author":"HMX Lai","year":"2015","journal-title":"Drug Alcohol Depend"},{"issue":"4","key":"pone.0334524.ref005","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1001\/jamapsychiatry.2014.2502","article-title":"Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis","volume":"72","author":"ER Walker","year":"2015","journal-title":"JAMA Psychiatry"},{"issue":"3","key":"pone.0334524.ref006","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/0376-8716(95)01160-4","article-title":"Comorbidity between DSM-IV alcohol use disorders and major depression: results of a national survey","volume":"39","author":"BF Grant","year":"1995","journal-title":"Drug Alcohol Depend"},{"key":"pone.0334524.ref007","article-title":"Alcohol and Alcohol Use Disorders.","volume-title":"Mental, Neurological, and Substance Use Disorders Disease Control Priorities 4","author":"M Medina-Mora","year":"2015"},{"key":"pone.0334524.ref008","unstructured":"Black C. Review of drugs part two: Prevention, treatment, and recovery. Department of Health and Social Care. Accessed. 2021;4.https:\/\/www.gov.uk\/government\/publications\/review-of-drugs-phase-tworeport\/review-of-drugs-part-two-prevention-treatment-and-recovery"},{"issue":"8","key":"pone.0334524.ref009","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1176\/appi.ps.56.8.954","article-title":"Use of mental health care and substance abuse treatment among adults with co-occurring disorders","volume":"56","author":"KM Harris","year":"2005","journal-title":"Psychiatr Serv"},{"key":"pone.0334524.ref010","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.jsat.2015.09.006","article-title":"Treatment Access Barriers and Disparities Among Individuals with Co-Occurring Mental Health and Substance Use Disorders: An Integrative Literature Review","volume":"61","author":"MA Priester","year":"2016","journal-title":"J Subst Abuse Treat"},{"issue":"4","key":"pone.0334524.ref011","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.apnu.2017.04.013","article-title":"A Qualitative Study of Barriers to Care for People With Co-Occurring Disorders","volume":"31","author":"M Sorsa","year":"2017","journal-title":"Arch Psychiatr Nurs"},{"key":"pone.0334524.ref012","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jsat.2018.10.009","article-title":"Health literacy in substance use disorder treatment: A latent profile analysis","volume":"96","author":"TJ Degan","year":"2019","journal-title":"J Subst Abuse Treat"},{"issue":"3","key":"pone.0334524.ref013","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1080\/18374905.2014.11081898","article-title":"Mental health stigma update: A review of consequences","volume":"12","author":"AE Sickel","year":"2014","journal-title":"Advances in Mental Health"},{"issue":"8","key":"pone.0334524.ref014","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1093\/bjsw\/bch212","article-title":"Domestic Violence and Substance Use: Tackling Complexity","volume":"35","author":"C Humphreys","year":"2005","journal-title":"British Journal of Social Work"},{"key":"pone.0334524.ref015","volume-title":"Hard Edges: Mapping severe and multiple disadvantage in England","author":"G Bramley","year":"2015"},{"issue":"9","key":"pone.0334524.ref016","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1007\/s00127-013-0740-9","article-title":"Treatment seeking and barriers to treatment for alcohol use in persons with alcohol use disorders and comorbid mood or anxiety disorders","volume":"49","author":"CN Kaufmann","year":"2014","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"issue":"2","key":"pone.0334524.ref017","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.jsat.2013.07.012","article-title":"Comparing barriers to mental health treatment and substance use disorder treatment among individuals with comorbid major depression and substance use disorders","volume":"46","author":"R Mojtabai","year":"2014","journal-title":"J Subst Abuse Treat"},{"issue":"4","key":"pone.0334524.ref018","doi-asserted-by":"crossref","first-page":"23","DOI":"10.5334\/ijic.6004","article-title":"Workforce Development in Integrated Care: A Scoping Review","volume":"21","author":"F Barraclough","year":"2021","journal-title":"Int J Integr Care"},{"issue":"9","key":"pone.0334524.ref019","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1016\/j.nedt.2012.10.011","article-title":"Alcohol education and training in pre-registration nursing: a national survey to determine curriculum content in the United Kingdom (UK)","volume":"33","author":"AS Holloway","year":"2013","journal-title":"Nurse Educ Today"},{"key":"pone.0334524.ref020","volume-title":"Delivering quality care for drug and alcohol users: the roles and competencies of doctors: a guide for commissioners, providers and clinicians. CR173","author":"RCP, RCGP","year":"2012"},{"issue":"1","key":"pone.0334524.ref021","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s13012-020-01073-0","article-title":"Factors influencing the implementation of screening and brief interventions for alcohol use in primary care practices: a systematic review using the COM-B system and Theoretical Domains Framework","volume":"16","author":"F Ros\u00e1rio","year":"2021","journal-title":"Implement Sci"},{"issue":"1","key":"pone.0334524.ref022","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1111\/add.14778","article-title":"Impact of the introduction and withdrawal of financial incentives on the delivery of alcohol screening and brief advice in English primary health care: an interrupted time-series analysis","volume":"115","author":"A O\u2019Donnell","year":"2020","journal-title":"Addiction"},{"issue":"3","key":"pone.0334524.ref023","article-title":"Drug therapy for alcohol dependence in primary care in the UK: A Clinical Practice Research Datalink study","volume":"12","author":"A Thompson","year":"2017","journal-title":"PLoS One"},{"key":"pone.0334524.ref024","doi-asserted-by":"crossref","DOI":"10.21307\/eb-2013-005","article-title":"Managing Madness: Mental Health and Complexity in Public Policy","volume":"2013","author":"S Rosenberg","year":"2013","journal-title":"EB"},{"issue":"1","key":"pone.0334524.ref025","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.beth.2016.09.004","article-title":"Current Definitions of \u201cTransdiagnostic\u201d in Treatment Development: A Search for Consensus","volume":"48","author":"S Sauer-Zavala","year":"2017","journal-title":"Behav Ther"},{"issue":"2","key":"pone.0334524.ref026","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1108\/ADD-11-2017-0021","article-title":"Challenges in working with patients with dual diagnosis","volume":"11","author":"P Pinderup","year":"2018","journal-title":"Advances in Dual Diagnosis"},{"issue":"1","key":"pone.0334524.ref027","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1186\/s12888-021-03188-0","article-title":"Scope, quality and inclusivity of international clinical guidelines on mental health and substance abuse in relation to dual diagnosis, social and community outcomes: a systematic review","volume":"21","author":"R Alsuhaibani","year":"2021","journal-title":"BMC Psychiatry"},{"key":"pone.0334524.ref028","author":"Department of Health","year":"2002"},{"issue":"8","key":"pone.0334524.ref029","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1176\/appi.ajp.2012.11111616","article-title":"Comparative effectiveness of collaborative chronic care models for mental health conditions across primary, specialty, and behavioral health care settings: systematic review and meta-analysis","volume":"169","author":"E Woltmann","year":"2012","journal-title":"Am J Psychiatry"},{"key":"pone.0334524.ref030","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1007\/s10488-018-0887-5","article-title":"Complex systems approaches to understand drivers of mental health and inform mental health policy: a systematic review","volume":"46","author":"BA Langellier","year":"2019","journal-title":"Administration and Policy in Mental Health and Mental Health Services Research"},{"issue":"2","key":"pone.0334524.ref031","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/add.16350","article-title":"Understanding people\u2019s experiences of the formal health and social care system for co-occurring heavy alcohol use and depression through the lens of relational autonomy: A qualitative study","volume":"119","author":"K Jackson","year":"2024","journal-title":"Addiction"},{"key":"pone.0334524.ref032","doi-asserted-by":"crossref","DOI":"10.5334\/ijic.982","article-title":"Barriers and facilitators to integrating care: experiences from the English Integrated Care Pilots","volume":"12","author":"T Ling","year":"2012","journal-title":"Int J Integr Care"},{"issue":"1","key":"pone.0334524.ref033","doi-asserted-by":"crossref","first-page":"5","DOI":"10.5334\/ijic.3068","article-title":"Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review","volume":"18","author":"C Auschra","year":"2018","journal-title":"Int J Integr Care"},{"key":"pone.0334524.ref034","volume-title":"Final report: The recovery partnership review of alcohol treatment services","author":"M Ward","year":"2018"},{"key":"pone.0334524.ref035","doi-asserted-by":"crossref","DOI":"10.1097\/00129234-200609000-00001","volume-title":"Handoffs and transitions of care: where is the Lone Ranger\u2019s silver bullet?","author":"SK Powell","year":"2006"},{"key":"pone.0334524.ref036","doi-asserted-by":"crossref","first-page":"75S","DOI":"10.1177\/1077558708327945","article-title":"Navigating Poorly Charted Territory","volume":"66","author":"S Sofaer","year":"2009","journal-title":"Medical Care Research and Review"},{"key":"pone.0334524.ref037","volume-title":"Better care for people with co-occurring mental health and alcohol\/drug use conditions","author":"PHE","year":"2017"},{"key":"pone.0334524.ref038","doi-asserted-by":"crossref","DOI":"10.1097\/01.NNR.0000280631.48407.9b","article-title":"Theory and knowledge translation: setting some coordinates","volume":"56","author":"J Rycroft-Malone","year":"2007","journal-title":"Nurs Res"},{"issue":"7313","key":"pone.0334524.ref039","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1136\/bmj.323.7313.625","article-title":"Complexity science: The challenge of complexity in health care","volume":"323","author":"PE Plsek","year":"2001","journal-title":"BMJ"},{"key":"pone.0334524.ref040","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s13033-017-0150-6","article-title":"Mental health services conceptualised as complex adaptive systems: what can be learned?","volume":"11","author":"LA Ellis","year":"2017","journal-title":"Int J Ment Health Syst"},{"issue":"3","key":"pone.0334524.ref041","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1001\/jama.2012.7551","article-title":"Understanding health care as a complex system: the foundation for unintended consequences","volume":"308","author":"LA Lipsitz","year":"2012","journal-title":"JAMA"},{"issue":"1","key":"pone.0334524.ref042","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1177\/1356389018803219","article-title":"From complex social interventions to interventions in complex social systems: Future directions and unresolved questions for intervention development and evaluation","volume":"25","author":"GF Moore","year":"2019","journal-title":"Evaluation (Lond)"},{"key":"pone.0334524.ref043","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.h1258","article-title":"Process evaluation of complex interventions: Medical Research Council guidance","volume":"350","author":"GF Moore","year":"2015","journal-title":"BMJ"},{"issue":"1","key":"pone.0334524.ref044","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1186\/s12913-018-2994-0","article-title":"Embracing uncertainty, managing complexity: applying complexity thinking principles to transformation efforts in healthcare systems","volume":"18","author":"S Khan","year":"2018","journal-title":"BMC Health Serv Res"},{"issue":"10","key":"pone.0334524.ref045","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1016\/j.socscimed.2010.01.034","article-title":"Schools as social complex adaptive systems: a new way to understand the challenges of introducing the health promoting schools concept","volume":"70","author":"N Keshavarz","year":"2010","journal-title":"Soc Sci Med"},{"key":"pone.0334524.ref046","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1186\/s12913-016-1343-4","article-title":"Scoping review of complexity theory in health services research","volume":"16","author":"DS Thompson","year":"2016","journal-title":"BMC Health Serv Res"},{"issue":"2","key":"pone.0334524.ref047","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1111\/jan.12815","article-title":"Application of simplified Complexity Theory concepts for healthcare social systems to explain the implementation of evidence into practice","volume":"72","author":"J Chandler","year":"2016","journal-title":"J Adv Nurs"},{"key":"pone.0334524.ref048","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/S1474-8231(01)02021-3","volume-title":"Complexity science and health care management. Advances in health care management. 2","author":"RR McDaniel","year":"2001"},{"issue":"1","key":"pone.0334524.ref049","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1186\/s12916-018-1087-6","article-title":"Being pragmatic about healthcare complexity: our experiences applying complexity theory and pragmatism to health services research","volume":"16","author":"KM Long","year":"2018","journal-title":"BMC Med"},{"issue":"1","key":"pone.0334524.ref050","doi-asserted-by":"crossref","DOI":"10.1177\/1609406918782557","article-title":"Advancing Complexity Theory as a Qualitative Research Methodology","volume":"17","author":"C Gear","year":"2018","journal-title":"International Journal of Qualitative Methods"},{"issue":"1","key":"pone.0334524.ref051","first-page":"180","article-title":"Contracting public health and social services: insights from complexity theory for Aotearoa New Zealand","volume":"16","author":"J Oakden","year":"2020","journal-title":"K\u014dtuitui: New Zealand Journal of Social Sciences Online"},{"issue":"2","key":"pone.0334524.ref052","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1108\/ADD-12-2021-0019","article-title":"Understanding women\u2019s help-seeking for problematic and unhealthy alcohol use through the lens of complexity theory","volume":"15","author":"TC Cane","year":"2022","journal-title":"Advances in Dual Diagnosis"},{"key":"pone.0334524.ref053","unstructured":"NIHR. ADEPT: Using complexity science and digital technology to improve co-morbid Alcohol use disorder and DEpression Prevention and Treatment: National Institute of Health and Care Research 2020. https:\/\/fundingawards.nihr.ac.uk\/award\/NIHR300616"},{"issue":"6","key":"pone.0334524.ref054","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"A Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"issue":"1","key":"pone.0334524.ref055","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1192\/bja.2019.78","article-title":"Why care about integrated care? Part I. Demographics, finances and workforce: immovable objects facing mental health services","volume":"29","author":"DK Tracy","year":"2020","journal-title":"BJPsych advances"},{"key":"pone.0334524.ref056","volume-title":"The NHS long term plan","author":"NHS England","year":"2019"},{"key":"pone.0334524.ref057","unstructured":"NHS England. What are integrated care systems? NHS England; 2022 [cited Oct. 2024].https:\/\/www.england.nhs.uk\/integratedcare\/what-is-integrated-care\/"},{"issue":"1","key":"pone.0334524.ref058","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1192\/bja.2022.78","article-title":"Integrated care systems: can they deliver?","volume":"29","author":"R Rao","year":"2022","journal-title":"BJPsych advances"},{"issue":"1","key":"pone.0334524.ref059","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1192\/bja.2020.3","article-title":"Why care about integrated care? Part 2. Integrated care systems: an irresistible force changing mental health services","volume":"29","author":"DK Tracy","year":"2020","journal-title":"BJPsych advances"},{"key":"pone.0334524.ref060","unstructured":"North East North Cumbria ICS. North East and North Cumbria Organisational Chart Organogram v1: NENC ICS; 2022 [cited 2024 1st August]. https:\/\/northeastnorthcumbria.nhs.uk\/media\/wwkjtlnk\/nhs-north-east-and-north-cumbria-organisational-chart-organogram-v1-as-at-1-dec-2022"},{"key":"pone.0334524.ref061","unstructured":"North East and North Cumbria Integrated Care System. Alcohol support services. [cited 2024 6th September]. https:\/\/northeastnorthcumbria.nhs.uk\/our-work\/workstreams\/health-and-prevention\/alcohol-programme\/alcohol-support-services\/2024"},{"issue":"3","key":"pone.0334524.ref062","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1080\/14780887.2020.1769238","article-title":"One size fits all? What counts as quality practice in (reflexive) thematic analysis?","volume":"18","author":"V Braun","year":"2020","journal-title":"Qualitative Research in Psychology"},{"key":"pone.0334524.ref063","first-page":"19","volume-title":"Doing reflexive thematic analysis. Supporting research in counselling and psychotherapy: Qualitative, quantitative, and mixed methods research","author":"V Braun","year":"2023"},{"issue":"2","key":"pone.0334524.ref064","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1080\/2159676X.2019.1704846","article-title":"To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales","volume":"13","author":"V Braun","year":"2019","journal-title":"Qualitative Research in Sport, Exercise and Health"},{"key":"pone.0334524.ref065","doi-asserted-by":"crossref","DOI":"10.1177\/16094069211070936","article-title":"If we can imagine it, we can build it: Developing Complexity Theory-Informed Methodologies","volume":"21","author":"C Gear","year":"2022","journal-title":"International Journal of Qualitative Methods"},{"issue":"8","key":"pone.0334524.ref066","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001079","article-title":"Building the field of health policy and systems research: social science matters","volume":"8","author":"L Gilson","year":"2011","journal-title":"PLoS Med"},{"issue":"9","key":"pone.0334524.ref067","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1016\/S2215-0366(19)30296-2","article-title":"Novel insights into patients\u2019 life-worlds: the value of qualitative research","volume":"6","author":"V Braun","year":"2019","journal-title":"Lancet Psychiatry"},{"issue":"8","key":"pone.0334524.ref068","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/S2215-0366(23)00104-9","article-title":"Achieving integrated treatment: a realist synthesis of service models and systems for co-existing serious mental health and substance use conditions","volume":"10","author":"J Harris","year":"2023","journal-title":"Lancet Psychiatry"},{"key":"pone.0334524.ref069","volume-title":"Alcohol and Mental Health: Policy and practice in England","author":"IAS","year":"2018"},{"issue":"5","key":"pone.0334524.ref070","doi-asserted-by":"crossref","DOI":"10.1192\/bjo.2020.80","article-title":"Access to specialist community alcohol treatment in England, and the relationship with alcohol-related hospital admissions: qualitative study of service users, service providers and service commissioners","volume":"6","author":"E Roberts","year":"2020","journal-title":"BJPsych Open"},{"issue":"6","key":"pone.0334524.ref071","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.3390\/ijerph15061145","article-title":"The Impact of Austerity on Mental Health Service Provision: A UK Perspective","volume":"15","author":"I Cummins","year":"2018","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0334524.ref072","doi-asserted-by":"crossref","DOI":"10.1057\/s41599-018-0091-y","article-title":"Moral narratives and mental health: rethinking understandings of distress and healthcare support in contexts of austerity and welfare reform","volume":"4","author":"F Thomas","year":"2018","journal-title":"Palgrave Commun"},{"issue":"1","key":"pone.0334524.ref073","doi-asserted-by":"crossref","first-page":"2140","DOI":"10.1186\/s12889-021-12219-0","article-title":"The impact of disinvestment on alcohol and drug treatment delivery and outcomes: a systematic review","volume":"21","author":"S Roscoe","year":"2021","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0334524.ref074","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1186\/s12939-024-02334-w","article-title":"\u201cThey pulled that funding away and we\u2019re not recovering. it\u2019s getting worse\u201d: deaths of despair in post-austerity north east England","volume":"23","author":"T Price","year":"2024","journal-title":"Int J Equity Health"},{"issue":"3","key":"pone.0334524.ref075","doi-asserted-by":"crossref","first-page":"4","DOI":"10.5334\/ijic.7738","article-title":"Floundering or Flourishing? Early Insights from the Inception of Integrated Care Systems in England","volume":"24","author":"B Page","year":"2024","journal-title":"Int J Integr Care"},{"issue":"4","key":"pone.0334524.ref076","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1111\/inm.12063","article-title":"Clinical responsibility, accountability, and risk aversion in mental health nursing: a descriptive, qualitative study","volume":"23","author":"J Manuel","year":"2014","journal-title":"Int J Ment Health Nurs"},{"issue":"1","key":"pone.0334524.ref077","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1186\/s12913-022-08282-x","article-title":"Shared understanding of resilient practices in the context of inpatient suicide prevention: a narrative synthesis","volume":"22","author":"SH Berg","year":"2022","journal-title":"BMC Health Serv Res"},{"issue":"4","key":"pone.0334524.ref078","doi-asserted-by":"crossref","DOI":"10.1111\/nin.12199","article-title":"Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice","volume":"24","author":"A Slemon","year":"2017","journal-title":"Nurs Inq"},{"issue":"2","key":"pone.0334524.ref079","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1111\/j.1365-2834.2009.00994.x","article-title":"Theories of risk and safety: what is their relevance to nursing?","volume":"17","author":"H Cooke","year":"2009","journal-title":"J Nurs Manag"},{"issue":"1","key":"pone.0334524.ref080","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/1468-2230.00188","article-title":"Risk and Responsibility","volume":"62","author":"A Giddens","year":"1999","journal-title":"Modern Law Review"},{"key":"pone.0334524.ref081","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/1471-244X-12-62","article-title":"The development and psychometric properties of a new scale to measure mental illness related stigma by health care providers: the Opening Minds Scale for Health Care Providers (OMS-HC)","volume":"12","author":"A Kassam","year":"2012","journal-title":"BMC Psychiatry"},{"key":"pone.0334524.ref082","volume-title":"Structural stigma in health-care contexts for people with mental health and substance use issues","author":"JD Livingston","year":"2020"},{"issue":"1","key":"pone.0334524.ref083","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1186\/s12913-024-11232-4","article-title":"Understanding the challenges of identifying, supporting, and signposting patients with alcohol use disorder in secondary care hospitals, post COVID-19: a qualitative analysis from the North East and North Cumbria, England","volume":"24","author":"K Jackson","year":"2024","journal-title":"BMC Health Serv Res"},{"issue":"2","key":"pone.0334524.ref084","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1177\/00380261221150080","article-title":"Framing stigma as an avoidable social harm that widens inequality","volume":"71","author":"M Addison","year":"2023","journal-title":"Sociol Rev"},{"issue":"1","key":"pone.0334524.ref085","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1186\/s12889-022-12873-y","article-title":"The impact of COVID-19 on access to harm reduction, substance use treatment and recovery services in Scotland: a qualitative study","volume":"22","author":"J Schofield","year":"2022","journal-title":"BMC Public Health"},{"issue":"5","key":"pone.0334524.ref086","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1192\/bjp.2024.11","article-title":"The impact of reduced routine community mental healthcare on people from minority ethnic groups during the COVID-19 pandemic: qualitative study of stakeholder perspectives","volume":"224","author":"C Winsper","year":"2024","journal-title":"Br J Psychiatry"},{"issue":"3","key":"pone.0334524.ref087","article-title":"Inequities in Health Care Services Caused by the Adoption of Digital Health Technologies: Scoping Review","volume":"24","author":"R Yao","year":"2022","journal-title":"J Med Internet Res"},{"issue":"1","key":"pone.0334524.ref088","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1186\/s12913-022-07584-4","article-title":"Towards digital health equity - a qualitative study of the challenges experienced by vulnerable groups in using digital health services in the COVID-19 era","volume":"22","author":"A-M Kaihlanen","year":"2022","journal-title":"BMC Health Serv Res"},{"issue":"4","key":"pone.0334524.ref089","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1177\/00258172241252223","article-title":"Digital-first primary care: An ambivalent legacy of Covid-19?","volume":"92","author":"KA Choong","year":"2024","journal-title":"Med Leg J"},{"issue":"3","key":"pone.0334524.ref090","doi-asserted-by":"crossref","DOI":"10.2196\/24387","article-title":"Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions: Systematic Review","volume":"23","author":"J Borghouts","year":"2021","journal-title":"J Med Internet Res"},{"issue":"2","key":"pone.0334524.ref091","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1111\/add.12408","article-title":"Reporting quantitative information in qualitative research: guidance for authors and reviewers","volume":"109","author":"J Neale","year":"2014","journal-title":"Addiction"},{"issue":"6","key":"pone.0334524.ref092","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1016\/j.jbi.2011.06.006","article-title":"Considering complexity in healthcare systems","volume":"44","author":"TG Kannampallil","year":"2011","journal-title":"J Biomed Inform"},{"issue":"6","key":"pone.0334524.ref093","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1080\/13645579.2021.1946118","article-title":"Combining complexity-framed research methods for social research","volume":"25","author":"P Barbrook-Johnson","year":"2021","journal-title":"International Journal of Social Research Methodology"},{"issue":"2","key":"pone.0334524.ref094","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.ijnurstu.2010.09.012","article-title":"Complexity theory as an approach to explanation in healthcare: a critical discussion","volume":"48","author":"J Paley","year":"2011","journal-title":"Int J Nurs Stud"},{"key":"pone.0334524.ref095","volume-title":"Commissioning quality standard: alcohol and drug treatment and recovery guidance","author":"Office for Health Improvement and Disparities","year":"2022"},{"key":"pone.0334524.ref096","unstructured":"Addiction Mission [Internet]. : HM Government; 2024.https:\/\/www.gov.uk\/government\/publications\/life-sciences-vision-missions\/addiction-mission"},{"key":"pone.0334524.ref097","doi-asserted-by":"crossref","DOI":"10.1192\/bjo.2021.736","article-title":"Falling through the cracks\u2019 \u2013 the role of assertive alcohol outreach teams in treating comorbid mental health problems in people with addictions","volume":"7","author":"E Naomi Smith","year":"2021","journal-title":"BJPsych open"},{"key":"pone.0334524.ref098","unstructured":"Helping on the way to recovery [Internet]. NENC ICB; 2023.https:\/\/northeastnorthcumbria.nhs.uk\/news\/posts\/alcohol-recovery-navigators-helping-on-the-way-to-recovery\/:"},{"key":"pone.0334524.ref099","volume-title":"NHS Mental Health Implementation Plan 2019\/20 \u2013 2023\/24","author":"National Health Service","year":"2019"},{"key":"pone.0334524.ref100","unstructured":"Wong G, Westhrop G, Pawson R, Greenhalgh T. Realist synthesis: Rameses training materials. 2013."},{"key":"pone.0334524.ref101","volume-title":"It\u2019s broken: Doctors\u2019 experiences on the frontline of a failing mental healthcare system","author":"BMA","year":"2024"},{"key":"pone.0334524.ref102","volume-title":"Progress in improving mental health services in England. Department of Health & Social Care","author":"National Audit Office","year":"2023"},{"key":"pone.0334524.ref103","volume-title":"Alcohol-specific deaths in the UK: registered in 2022","author":"Office for National Statistics","year":"2024"},{"key":"pone.0334524.ref104","volume-title":"Alcohol Profiles for England: short statistical commentary, May 2024","author":"Statistics OfN","year":"2024"},{"key":"pone.0334524.ref105","volume-title":"From harm to hope: a 10-year drugs plan to cut crime and save lives. Updated 29 April 2022","author":"UK Government","year":"2022"},{"issue":"1","key":"pone.0334524.ref106","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1111\/dar.13307","article-title":"Is disinvestment from alcohol and drug treatment services associated with treatment access, completions and related harm? An analysis of English expenditure and outcomes data","volume":"41","author":"S Roscoe","year":"2022","journal-title":"Drug Alcohol Rev"},{"key":"pone.0334524.ref107","unstructured":"NHS England. Working together in 2025\/26 to lay the foundations for reform. In: Care DfHaS, editor. : NHS; 2025.https:\/\/www.england.nhs.uk\/long-read\/working-together-in-2025-26-to-lay-the-foundations-for-reform\/"},{"key":"pone.0334524.ref108","unstructured":"Smith MA. The Liberated Method: Rethinking Public Service. : Department for Levelling Up, Housing and Communities, 2023.https:\/\/irp.cdn-website.com\/ce4d5348\/files\/uploaded\/Smith-%20M.A.%20(2023)%20The-Liberated-Method-Rethinking-Public-Service.pdf"},{"key":"pone.0334524.ref109","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.jpsychires.2016.09.021","article-title":"Peer-based health interventions for people with serious mental illness: A systematic literature review","volume":"84","author":"LJ Cabassa","year":"2017","journal-title":"J Psychiatr Res"},{"issue":"4","key":"pone.0334524.ref110","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1192\/apt.bp.113.011940","article-title":"Peer workers in mental health services: literature overview","volume":"20","author":"S Gillard","year":"2014","journal-title":"Adv Psychiatr Treat"},{"key":"pone.0334524.ref111","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.3389\/fpsyg.2019.01052","article-title":"Lived Experience in New Models of Care for Substance Use Disorder: A Systematic Review of Peer Recovery Support Services and Recovery Coaching","volume":"10","author":"D Eddie","year":"2019","journal-title":"Front Psychol"},{"key":"pone.0334524.ref112","doi-asserted-by":"crossref","DOI":"10.1016\/j.amepre.2018.02.019","article-title":"Emerging Roles for Peer Providers in Mental Health and Substance Use Disorders","volume":"54","author":"SA Chapman","year":"2018","journal-title":"Am J Prev Med"},{"issue":"3","key":"pone.0334524.ref113","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1080\/09638237.2016.1244715","article-title":"The stigma of identifying as having a lived experience runs before me: challenges for lived experience roles","volume":"28","author":"L Byrne","year":"2019","journal-title":"J Ment Health"},{"issue":"4","key":"pone.0334524.ref114","doi-asserted-by":"crossref","first-page":"337","DOI":"10.2975\/35.4.2012.337.340","article-title":"Challenges faced by mental health peer support workers: peer support from the peer supporter\u2019s point of view","volume":"35","author":"V Kemp","year":"2012","journal-title":"Psychiatr Rehabil J"},{"issue":"1","key":"pone.0334524.ref115","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1186\/s12888-020-02688-9","article-title":"Workplace experiences of mental health consumer peer workers in New South Wales, Australia: a survey study exploring job satisfaction, burnout and turnover intention","volume":"20","author":"JN Scanlan","year":"2020","journal-title":"BMC Psychiatry"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0334524","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T17:33:54Z","timestamp":1760549634000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0334524"}},"subtitle":[],"editor":[{"given":"Elizabeth","family":"McGill","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,15]]},"references-count":115,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0334524","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,15]]}}}