Rose Acton, Policy and Research Officer, Money and Mental Health

The missing link

How tackling financial difficulty can boost recovery rates in IAPT


blog12A quarter of people with common mental health problems are in financial difficulty, and our research shows that this is holding back their recovery. Our new analysis of the main NHS talking therapies programme (IAPT) found that the recovery rate for people with both depression and problem debt is likely to be just 22%, less than half that of those who have depression but no financial difficulties (55%). For those with anxiety and debt, the recovery rate is likely to be just 38%, compared to 52% for those with just anxiety.


“The stress from my financial position is making my illness worse, making recovery unlikely.”


“The additional worry of how I’m going to pay the debts back is holding me back from recovery.”


What’s happening now
It is not surprising that the stress, anxiety and worry of being in financial difficulty slows down recovery from a mental health problem. Yet the IAPT programme does not formally recognise this damaging link, and is therefore not identifying people in financial difficulty or referring them on to specialist help.

We spoke to 435 people with lived experience of the IAPT programme – just 6% of those experiencing financial difficulty were referred on to specialist help and 54% suffered in silence by not talking to their healthcare professional about their financial difficulty at all.


“I wasn’t asked, and it didn’t seem relevant, and I felt ashamed and guilty.”


“[I was] scared, didn’t want to admit there was a problem even though there was.”


“I felt too embarrassed to talk about my financial difficulties.”


Closing the recovery-gap
We are calling on the IAPT programme to systematically tackle financial difficulty, by introducing guidance for healthcare professionals, and properly identifying those in financial difficulty and referring them on to help.

Our analysis predicts that tackling financial difficulty would significantly improve recovery rates, and would lift IAPT over its 50% recovery rate target – a target which has not yet been met since the programme’s inception in 2008.

The impact of this change is particularly striking for an individual with depression and financial difficulty, where we predict that receiving debt advice boosts the likelihood of recovery from 22% to 48%. For an individual with anxiety and financial difficulty, the likelihood increases from 38% to 50%.

Overall across the programme, we find that offering people with financial difficulties debt advice through IAPT would raise the recovery rate for depression to 53% and for anxiety to 52% – exceeding the 50% target.


The difference this could make
But this is not just about targets. For the person themselves, lifting the psychological burden of problem debt at the same time as recovering from a mental health problem would provide hope, agency and opportunity.

Help with financial difficulties would allow people to participate in the activities of daily living, including those which promote good mental health and wellbeing – such as taking a break or reducing hours at work, joining a gym or social club. Reducing stress could help people sleep better, concentrate on their goals and perform better work. For those out of work, it would help reduce the worry that getting a new job would simply mean higher repayment demands and increased contact from creditors.

Proactively asking about finances would enable the IAPT programme to deliver therapy that truly responds to a person’s individual needs and circumstances, while at the same time breaking down the stigma, shame, and fear people feel when disclosing they are in financial difficulty.

Tackling financial difficulty is therefore a vital next step for IAPT as a programme, and for the quarter of IAPT service users who are in financial difficulty, the impact of not doing so is great.


Read the full report here