Poor no more?
Patients are often very distressed or distracted about money problems. For some people, money problems may be the original source of stress and a key contributing factor in their illness; for others, their illness may make them more likely to worry about finances. The current (2012) prospect of savage cuts to disability benefits is causing widespread anxiety, anger and protest among service users, carers and staff. Patients may worry about salaries or wages and sick pay, benefits, insurance, money management and debt. These can also be major concerns for families if a relative with mental health problems is not coping.
Debt is a huge issue for many people, including those with mental health problems. A few statistics (from Final Demand) paint a very clear picture:
1 in 4 adults has a mental health problem
1 in 2 adults with debts has a mental health problem
1 in 4 adults with a mental health problem is also in debt
If someone has got into a tangle with money – which can include having lost track of income and outgoings altogether – listening to them and helping them find support is critical. Some people may need broad advice and/or reassurance, while others need very specific help and support – for instance with filling in forms, finding out about what benefits they may be entitled to, coping with interviews about financial issues and working out how to deal with debt.
Staff don’t need to be experts in money matters – being able to help patients access the support they need is invaluable. These are the sorts of things that ward staff do which patients find very helpful:
- Listening to patients and encouraging them to talk about their concerns
- Putting them in touch with an expert who can help them (see Resources)
- Supporting them through the process of seeking expert help
- Knowing your limits – if you’re not a financial expert, be clear that while you can offer support, you can’t actually act as a money advisor
- Asking whether it would help them to put together a financial plan for when they leave hospital and in case they are admitted to hospital again in the future
- Establishing what other sources of support are available to a patient, for example their social worker, CPN, carers, friends and family.
- A regular ward clerk that assists patients with information and enquires about sick notes and benefits.
- Ward administrators are knowledgeable about benefits etc.
- One of the patients earns spending money watering the plants everyday and there are other jobs through which patients can earn some money if they don’t qualify for benefits.
- In partnership with the Job Centre but paid for by the Trust, an employment officer liaises with employers eg about sick notes and also helps with benefits.
- Two members of staff employed specifically to help patients with benefits
- A Rethink advocacy volunteer helps with benefits fortnightly.
- The Involvement Centre offer leaflets and information on financial advice and support services and hold regular drop-in clinics.
- An In-Reach team come to the ward to spend time with patients who are referred to them with issues like accommodation, benefits, paying bills, debt etc.
- Patients have the option of having their benefits paid into either a hospital or community bank account and are supported in managing their money.
- Patients are provided with a rehabilitation money on a weekly basis to purchase ingredients for individual cooking sessions.
- The Hospital has two members of staff who have been trained in assisting patients in accessing their appropriate benefits and this is also supported by the Advocate.
- It is very frustrating not being able to just pop out to the bank or go and pay your council tax. I found that I had to be very creative in coming up with solutions to these issues.
- While on the ward I took the opportunity to learn more about how to manage money and payments. There was lots of helpful leaflets and staff to talk to for advice.
- I used my time in hospital to seek advice about my finances. I was helped to apply for benefits – it was a great weight off my mind.
- I went on weekend leave and paid my electricity bill. This was me taking charge again and it was a wonderful feeling.
- Our ward seems to have links with so many different services from PALS to gardening services to sports groups, they even rang my bank when I was having issues there….there really is something for everyone!
- I got help with the practical life stuff, then everything else fell into place.
- Like a lot of patients with my condition I had a drawer full of unopened letters and bills. I couldn’t face them for a long time. So during my admission my CPN took me home to gradually go through them and I felt much better for it.
- Getting help from the In-reach team and my CPN was really helpful when it came to my money.
- I find managing my money very therapeutic. I used online banking when on the ward and took great pride in at least one area of my life being under control.
- I couldn’t even start to focus on the emotional aspects of my reason for admission until the mundane tasks (such as arranging for my mortgage payments to continue) were completed and stable.
- Getting the practical things sorted out is like the foundation, then you can get on with living again.
- I felt like there was one long list of things that would fall apart if I was in hospital and it made me extremely resentful until I sat down and came up with a plan for managing each part of my ‘home life’.
- It is important to me not to lose sight of the practical matters like paying bills when I come into hospital because they underpin my life and once they start to slip it just adds to my difficulties.
- I like to have order in my life because I get scared there will be a point of disorganised – no – return. I switched my telephone banking and the staff helped me with my paperwork for all my other bills as a priority in the first few weeks.
- I was so worried that I wouldn’t be able to pay my rent whilst I was on the ward but the staff helped show me about internet banking and now I can pay all my bills even when I’m not well
- I go to a Money Matters group on the ward once a week to help sort out my finances and it gives me one less thing to worry about
- When I was admitted to the hospital I was up to my eyeballs in debt. I used to be plagued by nightmares about it. We found ways of not only dealing with the problem but ways of dealing with the stress caused by it.
- I’m currently in a lot of debt. The staff have made arrangements for me to see a financial advice service and even escort me to my appointments; they didn’t have to because I’m informal but it felt supportive them being there with me.
CAREing on the ward
The Royal College of Psychiatrists, along with Rethink Mental Illness and a range of other organisations, has produced a really useful free booklet called Final Demand – debt and mental health, which is packed with information and guidance about ways you can help. This includes how to spot the signs that someone may be at risk of or experiencing money worries and how to broach the subject with them. For a link to download it, see Resources.
A key message in the booklet is that even when you don’t know about financial issues, there are four steps you can take to help:
- Consider debt as a possible underlying cause in any stress-related illness
- Ask simple questions about any money worries a patient may have
- Refer them to appropriate support, whether this is by phone, online or face to face
- Engage with and support the advisor, as well as following up the patient to see how they are coping.
What the Mental Capacity Act covers
The Mental Capacity Act covers major decisions about someone’s property and financial affairs, health and welfare and where they live.
It also covers everyday decisions about personal care (such as what the person eats), when the person can’t make those decisions for themselves.
This means if you are unable to make some decisions, the Mental Capacity Act says:
- you should have as much help as possible to make your own decisions
- people should assess if you can make a particular decision
- even if you cannot make a complicated decision for yourself, this does not mean that you cannot make more straightforward decisions
- even if someone has to make a decision on your behalf you must still be involved in this as much as possible
- anyone making a decision on your behalf must do so in your best interests
- How to decide if a person lacks mental capacity
The main values of the Mental Capacity Act
The Mental Capacity Act sets out five principles – the values that are the basis of the legal requirements in the act.
Every adult has the right to make his or her own decisions and it must be assumed they can unless it is proved otherwise. Also, a person must be given all reasonable help before anyone treats them as though they are unable to make their own decisions.
Just because someone makes what might be seen as a poor decision, it should not be assumed that they are unable to make any decisions.
Any decision made for a person who is unable to so for themselves must be done in their best interests. Any decisions made for someone else should not restrict their basic rights and freedoms.
Organisations that protect vulnerable people
The Mental Capacity Act 2005 provides protection and support for people who lack capacity to make their own decisions. This is done through three main organisations:
- the Court of Protection
- the Public Guardian
- the Independent Mental Capacity Advocate
The Court of Protection
The Court of Protection has the power to make decisions about whether someone lacks mental capacity. It can also appoint deputies to act and make decisions on behalf of someone who is unable to do so on their own.
The Public Guardian
The Public Guardian is an individual whose role it is to protect people who lack mental capacity from abuse. The Public Guardian has several duties:
- registering Lasting Powers of Attorneys
- registering Enduring Powers of Attorney
- supervising deputies appointed by the Court of Protection
Independent Mental Capacity Advocates
An Independent Mental Capacity Advocate is someone appointed to support a person who lacks capacity and has no one to speak for them. Independent Mental Capacity Advocates only become involved when certain decisions need to be made involving serious medical treatment. Independent Mental Capacity Advocates are also involved in a change in the person’s accommodation where it is provided by the NHS or a local authority.
Resources and references
The Alzheimer’s society has lots of information about dementia, and also has a section about financial and legal affairs, which covers mental capacity and appointing someone to manage money on an individual’s behalf, should they not be able to do this themselves.
The Citizens Advice site has a comprehensive section on money management that includes banking, savings, pensions and insurance as well as money problems, such as debt.
This website covers all public services in England and Wales and has information on all aspects of money, tax and benefits.
Money Advice Liaison Group (MALG)
This group is made up of advice agencies, creditors and health organisations. It has overseen the publication of recommendations about mental health and debt and the site has a list of links to documents about good practice in this field.
This site, which has information and advice on all things financial, has produced a clear, comprehensive booklet called The MoneySavingExpert.com Guide to Mental Health & Debt and is free to download:
0808 808 4000
This site is run by the Money Advice Trust, which is a registered charity and offers free confidential advice. You can also email them or use their online money advice tool.
Rethink Mental Illness
Their website has lots of useful information about money, including debt, benefits, allowances, looking after someone’s finances if you’re a relative or carer and how someone’s capability to work is assessed. You can find their advice about money, along with useful links.
This charity offers free advice and about all aspects of tax, including tax debts, and has useful links and tips. There is a specific section about tax debts and mental health problems.
The Royal College of Psychiatrists
The Royal College of Psychiatrists’ website has a section with information about mental health and debt. They’ve put together a useful booklet, Final Demand: Debt and Mental Health, which looks at how health and social care workers can support people with mental health problems who are facing debt: www.rcpsych.ac.uk/pdf/FinalDemandcf.pdf
Final Demand – debt and mental health. Rethink and Royal College of Psychiatrists