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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??.

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Recession debt and mental health

Recession, debt and mental health

Rachel Jenkins, Chris Fitch, Malcolm Hurlston, and Frances Walker

Debate on recession and health
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??

Scale of uk debt 2008
Scale of UK debt 2008

£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).

Rising unemployment

Mental health and debt
Mental health and debt

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

Foresight i health and social care
Foresight I Health and Social Care

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?

Foresight health recommendations
Foresight Health Recommendations

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

Action on health and social care
Action on health and social care

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?

Forsight financial recommendations
Forsight Financial Recommendations

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

Foresight financial recommendations
Foresight Financial Recommendations

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

Action on financial recommendations
Action on Financial Recommendations

£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

Foresight i organisations recovering debt
Foresight I Organisations recovering debt

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

Ambiguous/unrealistic instructions

Delays, refusals or payment requests from professionals

Poor quality and irrelevant information provided

Action on organisations recovering debt
Action on organisations recovering debt

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

Forsight i consumer interventions
Forsight I Consumer Interventions

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

Forsight recommendations
Forsight Recommendations

Fill the gaps especially for students (high debt, high MD)

Online debt advice could identify people at risk of debt and MD

Action on consumer interventions
Action on consumer interventions

CCCS developing on line depression remedy for clients in debt

Government policy
Government policy

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