Recession, debt and mental health. Rachel Jenkins, Chris Fitch, Malcolm Hurlston, and Frances Walker. Debate on recession and health. Health impact of unemployment Rising food and fuel prices Collapse of savings/pensions Recession cuts to health services But what about debt??.
Rachel Jenkins, Chris Fitch, Malcolm Hurlston, and Frances Walker
Health impact of unemployment
Rising food and fuel prices
Collapse of savings/pensions
Recession cuts to health services
But what about debt??
£1220 billion mortgage debt
£230 billion unsecured consumer credit
Compared to 2007, there had been a 70% increase in the number of households with mortgage arrears of three months or more (Council of Mortgage Lenders, 2009).
1 in 2 people with debt (seriously behind with payment) have MD (compared to 1 in 6 general population)
! In 4 people with MD have debt (compared to 1 in 11 general population)
People can simultaneously be patients, advice clients and bank customers; but advice rarely coordinated
Eg debt collection practices aggravate depression, impacting on productivity and ability to pay
Staff and organisational resistance to joint action
Concerns about information sharing and security
How should people with debt and mental health problems be supported by the respective sectors?
How should such activity be coordinated?
What changes to government policy and practice are needed?
All health and social care professionals should ask about financial difficulties in routine assessments
Where debt is reported, primary care professionals should routinely assess for depression and other CMD
Professionals should receive basic debt first aid training
How to talk with patients about debt
How to refer to and support debt counsellors
RCPsych , Rethink and FSA
produced guide for health and social care professionals on debt and mental health, and working with money advice services
But how many patients will take up debt referral?
Can primary care and debt counselling be more closely integrated?
UK financial sector should
Recognise existence of customers with mental health problems
Improve practice in communication between creditors and customers
Encourage customer disclosure of mental health problems by
Explaining how it will improve creditor decision making
Giving such information a limited shelf life
Placing health information in confidential electronic envelopes only accessible to designated staff
Need to strengthen coordination across health, money advice and creditor sectors
MALG guidelines were only published strategy to address this , but limited profile in health and social care-need to extend and bring in user perspective
Debt care pathways
recognising different needs of different disorders
Coordinating irrrespective of entry point
£13 million extra for provision of psychological therapies to counter credit crunch stress
Encouraged PCTs to use £ 80M to commission complementary services including debt advice
FSA and Treasury piloting a money advice service (with health input) to roll out nationally in 2010
Inadequate consideration of customer mental health , leading to inappropriate/distressing action
Where customers agreed to creditors requesting information from health professionals
Variability in amount and type of info
Delays, refusals or payment requests from professionals
Poor quality and irrelevant information provided
Debt and Mental Health Evidence Form
(Standardised clinical information form) to help health professions, with consent;
delicate balance to give helpful information but protect personal info from being unnecessarily shared
UK public education and financial capability programmes
did not consider mental health and debt
Did not target people with MD who were at high risk of debt
Fill the gaps especially for students (high debt, high MD)
Online debt advice could identify people at risk of debt and MD
CCCS developing on line depression remedy for clients in debt
Dept for Business Enterprise and Regulatory Reform White Paper on consumer credit
Office of Fair Trading developing guidelines on responsible lending
Need longitudinal research to disentangle these relationships
Research needs funding
Joint action needs investment