1. © WHO Collaborating Centre Recession, debt and mental health Rachel Jenkins, Chris Fitch, Malcolm Hurlston, and Frances Walker

2. © WHO Collaborating Centre 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??

3. © WHO Collaborating Centre 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

4. © WHO Collaborating Centre 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

5. © WHO Collaborating Centre 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?

6. © WHO Collaborating Centre 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

7. © WHO Collaborating Centre 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?

8. © WHO Collaborating Centre 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

9. © WHO Collaborating Centre 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

10. © WHO Collaborating Centre 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

11. © WHO Collaborating Centre 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

12. © WHO Collaborating Centre 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

13. © WHO Collaborating Centre 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

14. © WHO Collaborating Centre Forsight Recommendations Fill the gaps especially for students (high debt, high MD) Online debt advice could identify people at risk of debt and MD

15. © WHO Collaborating Centre Action on consumer interventions CCCS developing on line depression remedy for clients in debt

16. © WHO Collaborating Centre Government policy Dept for Business Enterprise and Regulatory Reform White Paper on consumer credit Office of Fair Trading developing guidelines on responsible lending

17. © WHO Collaborating CentreResearch Need longitudinal research to disentangle these relationships Research needs funding Joint action needs investment