The other one in four
People in financial difficulty are falling through the gaps in mental health services.
Disclaimer: All identifying personal details have been changed.
Trigger Warning: Mention of suicidality, homelessness, relationship breakdown and benefits eligibility assessments.
Alongside my work for Money and Mental Health, I am a social worker in a crisis team. In that alternative life there are times when the importance of the work Money and Mental Health is doing stands out particularly starkly. Like on one day last month, when I spoke with three separate people who were all feeling suicidal for reasons related to their finances.
Malika was found by the police, about to attempt suicide after her shopping addiction had led to relationship breakdown and homelessness. There was nothing I could do about the homelessness apart from point her towards the right department, but I managed to kindle some hope that with the right support, the addiction and relationship difficulties could be addressed.
Christina was so anxious about her upcoming benefits assessment that her problem drinking increased and she planned an overdose. Again, although there was nothing I could do about the possibility she would lose the benefits she relies on, I could at least ensure that she had support to attend the assessment.
Adam had already made a very serious suicide attempt after losing his taxi driving business due to a back injury. This impacted on the whole family’s finances and on his own sense of self-worth. There was nothing I could do about his back pain, but pointing him to debt advice and referring for some counselling felt like it might help.
A day like that gets you thinking. It is well known that financial problems can both cause and result from mental health problems, and significantly slow recovery. We also know that people experiencing a mental health problem are likely to struggle to seek help with financial difficulties. For example, they may be terrified of leaving the house, or lack the concentration and motivation to wait for distant appointments. So why for people like Malika, Christina and Adam does it take an attempt on their lives before someone helps them address these very real financial problems?
Our new research reveals that healthcare providers and commissioners have a limited awareness of the link between mental health problems and financial difficulty. Providers are more likely to recognise the link than commissioners, as are those in the devolved nations, where joint commissioning has progressed further. Around half of Clinical Commissioning Groups and NHS Trusts in England either commission or work with an external organisation, like the local Citizens Advice, to provide a specialist service for people experiencing both mental health problems and financial difficulty. By contrast, every Welsh Local Hospital Board has some form of specialist provision, as do 91% of Scottish NHS Trusts and three quarters of Northern Irish Health and Social Care Trusts.
“No one asked, so I didn’t say”
But even then, there is often no routine process to ask service users about financial difficulty, meaning that available help still may not reach the people who need it. Four in ten people experiencing problems do not tell their mental health workers about their financial difficulties, and our research shows that many healthcare providers aren’t bringing it up either. Just over half (57%) of NHS Trusts in England routinely ask about financial difficulties, compared with close to three quarters in Northern Ireland (75%), Wales (71%) and Scotland (73%). Routine screening in primary care, where the vast majority of people get help with mental health problems, is likely to be even less frequent, with only 17% of CCGs telling us they make sure providers ask service users about their financial situation.
Leading from the top?
Worryingly, extremely few services systematically recognise and respond to the link between financial difficulty and mental health at all stages of the process from assessing need to providing and evaluating a service. Only 4% of Clinical Commissioning Groups (CCGs), 10% of Scottish NHS Trusts and 33% of Northern Irish Health and Social Care Trusts did so. No Welsh Local Hospital Boards were found to be systematically addressing the link. This means that in most of the country, we are either relying on individual practitioners to have the initiative and know-how to address the issue, or simply leaving service users to struggle on alone.
The right support with money problems can transform lives and reduce pressure on overburdened mental health services. But with financial problems on the rise, a systematic response is urgently needed to make sure that appropriate help is consistently available, rather than waiting until it reaches crisis point. We are calling for those responsible for our health system to take action and fill the gaps that people like Malika, Christina and Adam will otherwise continue to fall through.
Read the full report here to find out more and see what the services in your area are like.
Please do also get in touch if you know of an excellent service addressing this issue: our next step is to establish what really works to tackle this problem and better support the efforts of individual practitioners.