Nikki Bond, Senior Research Officer, Money and Mental Health
3 ways the Mental Health Act can be changed to better tackle money and mental health problems
22 April 2021
23,000 people in England alone were struggling with problem debt while in hospital for their mental health in 2017. In the same year, over 100,000 people in problem debt attempted suicide. The links between mental health crisis and financial difficulties are well established; but on admission to hospital, many people still find their finances go awry, causing huge devastation and impacting recovery.
Despite the high prevalence of financial problems at the time of mental health crises, service users’ treatment plans, which set out how patients care needs will be met – largely neglect these matters. Our research found that eight out of ten (81%) respondents reported their crisis or relapse prevention plan did not mention finances. As long as finances go unacknowledged, there is a risk that people will be discharged from hospital and return to the same financial environment that contributed to their crisis in the first instance.
The Mental Health Act is the legislative framework that determines the care and treatment people receive when detained in hospital. The Act, which is currently being reformed, emphasises increasing choice and autonomy and treating people as an individual. This reform provides a once in a generation opportunity to legislate that people’s holistic needs, including finances, are considered during an inpatient stay. In our consultation response to the Reform of the Mental Health Act, we propose three small changes which would make a huge difference to support people in mental health crisis with their finances.
1. Include planning for financial matters in Advanced Choice Documents (ACDs)
ACDs will be a legal requirement which practitioners are required to develop with service users to enable them to set out in advance their choices around care and treatment if they are detained under the Act. The document can include preferences around consent to certain treatments, the gender of care staff, behaviours indicative of relapse and crisis planning arrangements. The ACD provides an opportunity for people to protect themselves from financial harm by putting in place support and planning for when they are unwell.
People who have experienced mental health crises want to be protected from the consequences of being financially disinhibited when they are unwell. People know that deteriorations in their mental health can lead to financial problems, so obtaining their preferences around preventative action is crucial.
2. Include explicit financial prompts to encourage people to stipulate their preferences
Simply including financial matters within the standard format of an ACD may be insufficiently explicit to support people to consider their preferences for advanced care and treatment around their finances. Therefore, we propose the document details the following prompts, which clinicians can use when supporting service users to record their preferences:
- Changes in financial behaviour that may indicate early signs of relapse – such as; disengagement with finances or unusual or excessive spending
- Planning arrangements for financial support in a crisis – including preferences around how priority bills will be paid, access to credit, or identifying a third party to deal with financial matters on their behalf.
3. Incorporate addressing financial matters as an integral part of Care and Treatment Plans
Addressing finances is only one of the many factors that mental health practitioners must consider in their assessment and care planning, and service capacity may mean it is not adequately addressed. Making finances an explicit legal requirement to consider in Care and Treatment Plans would bolster practitioners’ opportunities to safeguard patients from financial harm.
Ensuring the reformed Mental Health Act makes provision for increasing people’s choice and autonomy to protect themselves from financial harm is essential to breaking the toxic link between mental health crises and financial difficulties.