Living with a mental health disability and a substance-use disorder : experiences of individuals in the Maltese context

Abstract

This dissertation addresses a critical gap in local literature by exploring the lived experiences of individuals navigating co-occurring mental health disabilities and substance use disorders, commonly termed dual diagnosis, within Malta’s unique socio-cultural and systemic context. The rationale lies in the public health challenge posed by dual diagnosis and the need to move beyond medicalised interpretations to consider structural factors influencing health outcomes in a small island state. Guided by the social model of disability and the biopsychosocial framework, this inductive qualitative study employed semi-structured interviews with six adult participants in recovery, utilising Reflexive Thematic Analysis to generate nuanced, authentic accounts. Five major themes emerged: "A Self Interrupted," describing identity struggles and maladaptive coping mechanisms alongside existential loneliness; "Societal Shadows," detailing pervasive public and structural stigma amplified by Malta’s closely-knit society; "Familial Echoes," highlighting the family, particularly mothers, as vital sources of emotional stability and motivation; "Service Labyrinths," revealing systemic fragmentation, limited psychoeducation, and failures in essential medication supply; and "Resilient Journeys," illustrating coping strategies based on structured programs, religion, spirituality, and a desire to turn past suffering into guidance for others. Findings suggest participants’ well-being is shaped more by disabling societal barriers, such as employment discrimination and eroded trust from confidentiality breaches, than by individual impairment. Malta’s tight social fabric, cultural expectations and stigma pressure individuals to conceal struggles to protect family reputation, intensifying distress, isolation, and suicide risk. Recovery is undermined by systemic inefficiencies and the dissonance between policy rhetoric and the operational realities of inadequate support structures. The study advocates for urgent policy shifts to dismantle structural stigma, ensure integrated, person-centred care, and reframe dual diagnosis as a pressing social justice and disability concern to promote genuine social inclusion.