Mental Health Act reform could prevent financial difficulty for people with severe mental illness

When you’re in hospital for your mental health and possibly too unwell to keep yourself safe, your finances are often the last thing on your mind. But that doesn’t stop your income from dropping, due to not being able to work, or benefit losses due to difficulties keeping up with requirements to maintain your claim. Despite these income drops and being acutely unwell, rent and council tax still need to be paid, electricity and gas standing charges continue to add up, and credit card debts need to be dealt with. 

During periods of acute mental ill-health, treatment is often provided through secondary mental health services, such as Community Mental Health Teams or psychiatric hospitals. The support these services provide is vital and saves countless lives. Yet, against the backdrop of income reductions and difficulties keeping up with payments, it baffles me that there are no widespread systems in health services to routinely ask about people’s finances and link people up with existing and established sources of welfare rights and money advice support. 

Seven in ten people we surveyed experienced an income drop while under the care of secondary mental health services. Sadly, these income drops come at a time when the cognitive and psychological effects of our mental health problems mean we can least manage disruptions to our finances. Consequently, more than eight in ten survey respondents experienced financial harm while under the care of secondary mental health services – such as missing a payment for an essential bill or incurring bank charges for going overdrawn.

Despite the clear links between mental health problems and financial difficulties, nearly six in ten (58%) survey respondents were not offered any support with their finances while under the care of secondary mental health services. And eight out of ten (81%) respondents said their crisis or relapse prevention plan did not mention finances.

There are some amazing staff working in secondary mental health services who go above and beyond and ask about people’s broader financial circumstances. There are also examples of good practices where local money advice services provide outreach support in secondary mental health services. But the provision of joined-up money and mental health services is patchy. Relying on exceptional staff and pockets of engaged voluntary services is insufficient.  This is an issue that should be addressed systematically by the government and NHS services. 

The government is progressing with its plans for integrating health and social care. But efforts to integrate money advice into secondary mental services health remain largely forgotten. Despite the evidence on the links between money and mental health, and the adverse impact on recovery, the Department for Health and Social Care and NHS England have yet to systematically build a process for identifying people in their care who require support with their financial needs.

The one exception is the Treasury’s introduction last year of the Mental Health Breathing Space mechanism. A statutory instrument that can protect people in mental health crises from escalating debts and arrears. But without a system in place to inquire about people’s finances in the first instance, thousands of people who would benefit from the support this tool can offer may miss out, simply, because they don’t know it exists, and nobody asks. 

However, a vital opportunity to embed routine screening for financial difficulties among people in secondary mental health services is currently in progress, with the ongoing reform of the Mental Health Act. Two key changes would address the often predictable financial needs of people in secondary mental health services. 

• Include a financial difficulty prompt in statutory Care and Treatment Plans -As part of the ongoing Mental Health Act reform, the template for Care and treatment plans (the document that healthcare professionals complete with services users outlining people’s care and support needs) – are being reviewed. The government should take the lead from practice in Wales, where a ‘finance and money’ prompt is included in Care and Treatment Plan documents and include a financial section in the new template document.  

• Include a financial planning prompt in Advance Choice Documents – Advanced Choice Documents, which will be a statutory requirement under the reform of the Mental Health Act, are primarily intended to enable people to express their care and treatment preferences in advance of admission to hospital. Current plans propose to include prompts around the care of children or pets in these documents. In a similar spirit of personalisation and prevention, plans should also include preferences for any help you might anticipate needing with managing your finances. 

Without such intervention, there is a risk that we will miss this once-in-a-generation opportunity to embed screening for financial difficulties in secondary mental health services. As the cost of living crisis continues, and people with mental health problems are among those at the brunt of the crisis – it’s more important than ever that the government makes good on its commitment to support people with mental health problems through the crisis and beyond. 

To find out more, you can read our full report, Not a secondary issue, here.