There’s a quiet contradiction at the heart of how we talk about mental health in this country.
We have — rightly — made significant progress in reducing the stigma around depression, anxiety, and other mental health conditions. We understand now that these aren’t character flaws. They aren’t the result of bad decisions or weak willpower. They are conditions that deserve compassion, treatment, community, and time.
And yet when it comes to addiction, something shifts.
Our Therapeutic Programme Manager has worked with people in recovery for years, and the observation is one that stays with you:
“In practice, addiction is often still seen as separate from mental health — and that separation is part of the stigma that the people we support face every day.”
A gap that shouldn’t exist
In England, many addiction services are commissioned by local authorities, outside NHS structures, meaning people with addiction are often treated separately from those with other mental health conditions. It sits in a different funding stream, a different referral pathway, and for many people, a different moral category.
That last part matters. When a system treats something differently, it can reinforce the assumptions people already hold. And for many, those assumptions lead them to interpret the difference as a judgment — that addiction reflects a personal failing in a way that depression or anxiety doesn’t.
The Royal College of Psychiatrists has described this as a system where people are “often bounced from one service to another, only being offered support for one condition at a time, as most services lack the specialist skills and resources needed to treat all their illnesses together.” Dame Carol Black’s independent government review put it plainly: addiction must be recognised as a chronic health condition — and treated accordingly.
The evidence is clear: addiction is a mental health issue, shaped by trauma, by biology, by environment, and by the very human need to find relief from pain. The people we support at SCT are not struggling because they made bad choices. They are struggling because they are human, and because the thing that once helped them cope became something that started to hurt them.
That is not a moral failing. That is a mental health condition.
When the system gets it wrong
The official stance is that addiction is a mental health issue. In practice, though, it’s treated separately to other mental health conditions — and that gap in service delivery is where the problem lies. When people experience their care as separate, as different, as lesser, the message they receive is that their condition is too — that addiction reflects a personal failing in a way that depression or anxiety doesn’t.
Shame, as anyone working in this field will tell you, is not a motivator. It is a barrier.
The structural gap in how addiction services are commissioned reinforces that shame. It tells people, in the language of policy and funding, that their condition is different — lesser, more complicated, more their own problem to solve.
What we believe at SCT
Since 1965, we’ve been supporting people in recovery from addiction and homelessness in East London. What we see every day — in our therapeutic programmes, in our recovery communities, in the people who come through our doors — confirms what the research clearly supports.
Our clients are no more to blame for their addictions than a person living with depression or anxiety. They deserve the same compassion, the same access to support, the same community around them, and the same freedom from stigma.
The conversation around mental health has changed significantly in recent years. It’s time for addiction to be part of that conversation — not as a footnote, not as a separate category, but as what it is: a mental health issue, affecting real people, in every community in this country.
This Mental Health Awareness Week, with Action as its theme, we’re taking action by saying this clearly: addiction is a mental health issue, and it’s time our systems, our funding, and our public conversation treated it like one.
Spitalfields Crypt Trust has been supporting people in recovery from addiction and homelessness in East London since 1965. If you or someone you know needs support, you can contact us here.
