© who collaborating centre recession, debt and mental health rachel jenkins, chris fitch, malcolm...
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© WHO Collaborating Centre
Recession, debt and Recession, debt and mental health mental health
Rachel Jenkins, Chris Fitch, Rachel Jenkins, Chris Fitch, Malcolm Hurlston, and Frances Malcolm Hurlston, and Frances
WalkerWalker
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Debate on recession and healthDebate 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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Scale of UK debt 2008Scale 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
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Mental health and debtMental 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
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Foresight I Health and Social CareForesight 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?
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Foresight Health Foresight Health RecommendationsRecommendations
• 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
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Action on health and social careAction 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?
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Forsight Financial Forsight Financial Recommendations 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
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Foresight Financial Foresight Financial RecommendationsRecommendations
• 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
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Action on Financial Action on Financial RecommendationsRecommendations
• £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
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Foresight I Organisations Foresight I Organisations recovering debtrecovering 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
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Action on organisations recovering Action on organisations recovering debtdebt
• 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
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Forsight I Consumer InterventionsForsight 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
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Forsight RecommendationsForsight Recommendations
• Fill the gaps especially for students (high debt, high MD)
• Online debt advice could identify people at risk of debt and MD
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Action on consumer interventionsAction on consumer interventions
• CCCS developing on line depression remedy for clients in debt
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Government policyGovernment policy
• Dept for Business Enterprise and Regulatory Reform White Paper on consumer credit
• Office of Fair Trading developing guidelines on responsible lending
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ResearchResearch
• Need longitudinal research to disentangle these relationships
• Research needs funding
• Joint action needs investment