Evaluation Scotland Wales

insight

Recovery Space: Minimising financial harm caused by mental health

Evidence type: Insight i

Context:

It is estimated that a quarter of people who are experiencing mental health problems are also in problem debt. This means that in 2017 around 23,000 people in England who were in hospital for mental health problems were struggling with problem debt. This figure rises substantially when taking into account people with mental health problems cared for locally (e.g. by general practitioners, crisis teams, etc).

The study:

The Money and Mental Health Policy Institute (MMHPI) conducted this study in 2018, funded by the Barrow Cadbury Trust. The report uses primary research to focus on the way healthcare services, the Government, the benefits system and essential services can better respond to people in mental health crisis who are also struggling with problem debt.

The study uses both quantitative and qualitative analysis, supported by a brief literature review, to tackle its aims of exploring how people in mental heath crises can be better supported financially. A range of data collection methods were employed:

  • A literature review: the authors conducted a review of the existing literature concerning people’s experiences of a mental health crisis and the impact this may have on their financial wellbeing. 83 articles were reviewed for this part of the study
  • An online survey conducted through the MMHPI’s research community members of 166 people with personal experience of living with a mental health crisis
  • Through the same research community, a similar survey was sent to people with experience of caring for someone with a mental health problem. This elicited 46 responses from people with relevant experiences
  • Survey results from 93 mental health practitioners who work directly with people in mental health crisis were analysed,
  • In-depth interviews: interviews were conducted with 12 people with ‘lived experience’ of mental health crisis, 12 carers, and 11 mental health practitioners.
  • Three focus groups were also used near the end of the project to consolidate the findings from the surveys and the interviews. They were with a mixture of people living with mental health problems, carers, and mental health practitioners.

All fieldwork was conducted in late 2017.

Key findings:

The financial costs of mental health

  • A mental health crisis can lead to numerous changes in circumstances, often resulting in a drop in income and a simultaneous increase in outgoings.
  • This can lead to immediate consequences such as extra financial charges and fees, and longer-term consequences such as a permanent reduction in income and long-term debt.
  • The reaction of health, welfare and financial services to people in mental health crisis can mitigate or exacerbate associated financial problems

Sources of support

  • Carers can support the financial situations of people experiencing mental health crisis. However, there are numerous challenges and access to appropriate help is often only open to certain people
  • Advice services are often over-stretched, and struggle to offer appropriate support.
  • While decision-making can be delegated, this is not suitable for people whose mental capacity to manage their finances fluctuates.

Mental health practitioners

  • While recognising their importance, finances are only one of myriad factors that practitioners must consider when dealing with patients.
  • Practitioners lack legal and practical tools to intervene when a patient clearly lacks mental capacity.

Essential services firms

  • The cognitive effects of a mental health crisis can make it much harder for people with financial problems to deal with essential service providers, meaning payments may be missed and extra charges and penalties accrued. Relatively few tools are available to allow people to ‘self-exclude’ themselves from taking on extra financial commitments during a crisis.

The benefits system

  • Processing claims and making appointments can be extremely hard during a mental health crisis, and benefits agencies often will not liaise with carers.
  • Delays in benefit payments can obviously lead to people incurring extra debts, and being susceptible to exploitation when large back payments are processed.

Recommendations

  • An extension to the Government’s Breathing Space scheme to everyone receiving NHS support for mental health crises.
  • Healthcare services should routinely screen for financial difficulties, and make provisions for this in crisis and care planes.
  • Essential services firms should freeze interest, penalties and enforcement action for a limited time when they are notified that a person is experiencing a mental health crisis.

Points to consider:

Methodological strengths or limitations:

  • While the methodology appears robust (see accompanying document), note that some of the percentages in the report draw on low bases, so caution should be exercised where appropriate.

Relevance:

  • This report is relevant to mental health practitioners, essential services providers and policy makers who are concerned with the prevalence of financial problems among those suffering from a mental health crisis

Key info

Client group
Year of publication
2018
Country/Countries
England
Contact information

Nikki Bond, Rachel Braverman and Tasneem Clarkecontact@moneyandmentalhealth.org