Routine enquiry: How asking about money problems could help thousands more people with mental health problems recover each year

Two months ago, we launched our latest report, Breaking the Cycle, where we made the case for integrating support for money advice in mental health services. This report builds on lots of our work over the last seven years, where we’ve heard countless stories from people with mental health problems who have experienced devastating financial difficulties and wished they’d been offered help sooner.

Over the years, we’ve been able to consistently demonstrate that money and mental health problems are intricately linked – and our recent national polling shows how the cost of living crisis is only exacerbating these challenges. We know financial difficulty can hinder recovery from a mental health problem, and with more people needing support, the need for joined-up services has never been so urgent.

That’s why we’re calling for people to be routinely asked if they’re experiencing money worries as part of their initial assessment for NHS Talking Therapies – the flagship programme for treating mild to moderate mental health problems – and be proactively referred for money advice. By combining money advice and NHS Talking Therapies, we could systematically intervene to disrupt this devastating cycle for tens of thousands of people. In fact, we estimate that this could help 27,000 more people recover from mental health problems each year.

We’ve shared this recommendation and the evidence to support it with politicians, leaders in money advice services, NHS England and NHS Talking therapy services. This has been met with a recognition of the need and the gaping hole in service provision – and enthusiasm, encouragement and support for such joined-up services.

But we’ve also received some welcome challenge from critical friends. Specifically, one key pushback about where our recommendation fits within existing service provision. This has been hugely helpful in sharpening our thinking, and we’re enormously grateful for people’s thoughts and time, but they’ve also made us more determined in our cause. Below, we set out how our recommendation goes above and beyond existing support and why it’s desperately needed.

NHS Talking Therapies are rolling out Employment Advisors nationally across their services, providing support on employment issues for clients in and out of work. Employment Advisors are also being trained to deliver Money Guidance to complement this service. This training supports Employment Advisors to confidently talk about money with their clients and provide safe and effective guidance.

This is a fantastic step in the right direction and will likely help thousands of people each year. But our recommendation is distinct in three key ways:

1) More people asked about money worries

Our proposal would see all 1.2 million people referred to NHS Talking Therapies each year proactively asked about money worries. Employment Advisors see around one in six (15%) of people referred to NHS Talking Therapies, and therefore, solely relying on Employment Advisors for this support risks missing the other 85% of people who may need support.

2) Support is proactive

Our proposal would see every person referred to NHS Talking Therapies routinely asked about their finances as part of the initial intake assessment. Whereas Employment Advisors with Money Guider training offers support when financial difficulties naturally arise as part of the conversation. Given the stigma surrounding financial difficulties, relying solely on this route for capturing all those struggling risks missing vast numbers who are experiencing financial difficulties.

Our recommendation would see NHS staff proactively referring people to money advice. In contrast, Employment Advisors with Money Guider training may provide guidance or signposting, but the task of reaching out and asking for support remains with individuals. Given the challenges many people with mental health problems can face in reaching out for support, this risks people falling through the net.

3) Money advice rather than guidance

Money Guiders do vital work, but their support is limited to guidance and signposting rather than specialist-regulated advice, as our model proposes. 

Huge strides have been made in the last few years to support people with problem debts, and as we’ve highlighted, the Money Guider training for Employment Advisors is another crucial step in the right direction.

But it falls short of what we believe is really needed. People struggling with mental health problems require routine enquiry and proactive offers of specialist support. Integrating money advice in NHS Talking Therapies is a small step with huge benefits, improving recovery, saving money and boosting growth in the long run.

If you’re a leader in NHS England or an ICS and want to hear more about integrating money advice in NHS Talking Therapies and other mental health services, please get in touch.  We’re committed to ensuring people get the support they need during the cost of living crisis and beyond and would love your help.