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Treating financial difficulty – the missing link in mental health care?

Money, finances and debt are the most common source of anxiety (Mental Health Foundation, 2014), and are frequently linked to the development or aggravation of mental health conditions. About half of people (45%) in problem debt (self-identified as being “seriously behind” on payments for a range of bills and credit obligations including energy bills, rent or mortgage payments and credit agreements like credit cards, catalogue shopping or personal loans) have a mental health problem (Jenkins et al., 2009). People in problem debt are twice as likely to think about suicide as those not in financial difficulty, even after controlling for other socioeconomic and demographic factors (Meltzer et al., 2011). People with mental health problems are also more likely to be in problem debt than the rest of the population. While fewer than one in ten (8%) people without mental health problems are in problem debt, this rises to nearly one in four (24%) for people experiencing depression or anxiety, and one in three (33%) for people experiencing psychosis (Jenkins et al., 2008). This is partially due to the fact that people with mental health problems are significantly less likely to be in employment than the rest of the population, and that those people with mental health conditions who are in work are significantly more likely to be in low-paid, high-turnover, part-time or temporary work (Independent Mental Health Taskforce, 2016). Mental health problems can also affect a person’s problem solving and planning ability, memory or ability to communicate, which can make managing money difficult (Holkar, 2017). People report, for example, that they spend more than usual, put off paying bills, avoid dealing with creditors or take out loans when they would not usually do so. While these behaviours are already recognised in the diagnostic criteria for bipolar disorder, recent research suggests that these problems are widespread across a range of mental health problems and causality is bidirectional (Mackenzie & Holkar, 2016).