Tasneem Clarke, Research Officer, Money and Mental Health

Providing debt advice in mental health services - whose job is it anyway?

Our latest research, out today, shows how mental health practitioners are going above and beyond in a bid to support people through financial difficulty that would otherwise impede their recovery.

“I’ve worked with people who have literally come to sessions starving because they haven’t got any money for food… it becomes so hard to make any steps forward from a psychological therapy point of view when those basic needs aren’t met.” – Psychologist

At each stage of their attempts to help, professionals come up against barriers which we argue could be removed by those in charge of designing and running services.

Spotting the issue

One in four people with a mental health problem is in financial difficulty – possibly more amongst those with more complex needs. However, identifying when finances are an issue is easier said than done when people don’t speak up as they are fearful of being judged, or don’t recognise finances as being relevant to their mental health. As well as service users being reluctant to share their financial difficulty, our research found that practitioners can be wary of raising the question for fear of losing rapport, yet this fear is usually unfounded.

“I had to bring the subject up first, which I did eventually but found crippling. I think I would have preferred them to raise the matter quite early on, almost as a standard health check.” – Research Community Member

Negotiating the practicalities

Once the issue is identified, practitioners usually try to signpost towards money advice services, which provide specialist, effective advice. But for someone experiencing a mental health problem, it can be impossible to tolerate a long wait, visiting a public place, or having to speak over the phone to access mainstream services:

“I was so ill I was very limited cognitively. I couldn’t even add up, or find info that other agencies needed to help me. I couldn’t deal with the phone, or writing… I could not do the most simple tasks needed to gain access to help.” – Research Community Member

Stepping into the breach

In this case, practitioners sometimes step in to directly contact creditors or benefits agencies on someone’s behalf, especially if they face an urgent threat such as bailiffs or benefits sanctions. In attempting this, practitioners know they lack the necessary training and resources that advice services have, but feel compelled to try and help, despite the bureaucratic barriers of inaccessible helplines, or overzealous interpretation of data protection rules.

“It’s not what I’ve chosen to do nursing to do, but at the same time it’s going to have a massive impact on their mental well-being. Therefore if you don’t address it, it’s still going to be there.” – Mental health nurse

A shared problem

Practitioners suggest that when mainstream advice is inaccessible, extra support is required. In the absence of such specialised services professionals are left attempting to fill the gaps, but uncertain about whether they should be doing so, especially when they don’t feel they have the support of managers or commissioners who don’t prioritise this aspect of mental health. As our previous research showed, only 22% of CCGs in England explore financial difficulty in their needs assessment.

What we'd rather see

Once urgent practicalities are being resolved, mental health practitioners can use their unique skills to help people confront their own situation and prevent recurrences. Examples include using Cognitive Behavioural Therapy to address avoidance of bills, or mindfulness to tackle impulsive spending. However we found few such examples, perhaps because many people’s finances remain at the ‘fire-fighting’ stage due to a lack of appropriate support, or because practitioners don’t have the resources for such in depth work.

Without a service that can properly handle this issue, professionals are left frustrated, and individuals stranded in the mire of spiralling mental health and financial problems.

“If the team could help people with their money issues that would be… very important. It would be another thing off the list of stress or horrible stuff they’ve got to deal with. Money is a massive issue and I feel bad that we can’t do more about it.” – Psychiatrist

To support practitioners in their complex and crucial role, we recommend:

  • Joint commissioning between health, public health and social care of services that enable people with more severe mental health conditions to access financial advice, whether that’s making it easier to access mainstream advice services, improving advice services’ ability to respond to people with more complex needs; or, through specialised advice services for people with the most severe needs;
  • Training for mental health practitioners and service managers that raises awareness of financial difficulty and how best to support people with it;
  • Better information-sharing procedures from businesses and agencies dealing with finances, to make communication during an emergency easier.