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Health, Financial Stress & Advice

Health, Financial Stress & Advice. Paul Sweeting, Brighton and Hove Advice Strategy Project. Lucy Evans, Brighton and Hove Citzens Advice Bureau Becky Woodiwiss, NHS Sussex. ‘Advice’, Health and Wellbeing. ‘Advice’ means help with ‘Social Welfare’ or ‘Civil Justice’ problems including:

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Health, Financial Stress & Advice

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  1. Health, Financial Stress & Advice Paul Sweeting, Brighton and Hove Advice Strategy Project.Lucy Evans, Brighton and Hove Citzens Advice BureauBecky Woodiwiss, NHS Sussex

  2. ‘Advice’, Health and Wellbeing • ‘Advice’ means help with ‘Social Welfare’ or ‘Civil Justice’ problems including: • Problems with debt • Problems with Benefits and Tax Credits • Problems with Housing • These problems, if unresolved, lead to further problems: • Overall 27% lead to stress related illness and16% lead to physical ill health • 61% of housing related debt problems lead to stress related ill health • 53% obtain medical help as a result: (with Over 90% obtaining help from their GP) (Source: ‘Civil Law, Social Problems and Mental Health’ LSRC 2009 ‘Causes of Action: Civil Law and Social Justice (2nd Edition 2006) Pleasence et al)

  3. The context: increasing demand • Brighton and Hove Advice Partnership anticipates an exponential increase in demand for advice related to welfare reform: • Overall reductions in payments towards housing costs • People on low income facing new liabilities (e.g. Council Tax) • Transition to Universal Credit • Changes to disability and incapacity related benefits • People on the lowest incomes will have less to live on

  4. The challenge: ensuring advice services meet need ADVICE AGENCY

  5. Background to the Project • Brighton and Hove pilot funded through 2010 Advice Partnership / B&HCC ‘Benefits take up’ programme • Continuation funding from PCT in 2011 • Public Health funded expansion for 2012

  6. The health of individuals and populations is determined by genetic makeup lifestyle factors environmental exposures socioeconomic factors; - Income Social status Education Social support Housing Employment and working conditions Public Health Perspective

  7. Health seeking behaviour has a longer term focus. People are unlikely to seek healthier lifestyles until their basic needs have been met. - Maslow’s hierarchy of needs. Independent inquiry into inequalities in health (the Acheson Report) Dept Health 1998 & Fair Society, Healthy Lives, the Marmot review DH 2010 - Concerns over widening inequalities. Links to healthy living services to support clients too. Public Health Perspective

  8. University of Liverpool longitudinal study (SF-36 survey) clients before/after advice improved in 2 of the 8 health domains; mental health and vitality. Still true at 6 &12 months. (Abbott and Hobby, 2002). 1:3 of those in debt have mental health problems Psychological impacts; loss of self-esteem and personal identity feelings of isolation stress and anxiety insomnia stigma and shame severe depression suicidal thoughts. Cause and consequence - which comes first ? Mental health

  9. Brighton and Hove CAB GP Surgery • Over 200 residents assisted across 6 GP surgeries: • St Peters • Park Crescent Health Centre • Mile Oak Medical Centre • Goodwood Court medical Centre/Eaton Centre • The Practice / Wellsbourne Centre • Broadway Surgery Wellsbourne Centre • And also: • Lung Cancer ‘health and wellbeing’ clinic RSCUH

  10. Service provided • 1. Initial face to face interview • 2. Confirmation of advice letter • 3. Follow up work as required

  11. Outcomes achieved: Financial • Initial estimated increase in annual income for clients: • Clients referred via the Lung cancer clinic over 9 months: £206,887pa • Clients referred via St Peters Surgery over 8 months: £194,869 pa

  12. Outcomes achieved: Financial • Clients said they spent the additional income on: • Travel • Heating and care • Food • Health products • Clothing, leisure, holidays

  13. Outcomes achieved: Health and Wellbeing • Of the clients referred via the Lung cancer clinic: • 75% said mental health very or fairly positively improved • 50% said physical health very or fairly positively improved • 65% said that if advice not available in clinic they definitely or probably would not have approached another agency for advice • 54% not used CAB before

  14. Outcomes achieved: Health and Wellbeing • Of the clients referred via the GP surgeries: • 68% said health very or positively improved as a result of advice • 68% said that if advice not available in surgery they definitely or probably would not have approached another agency for advice

  15. Client feedback • ‘I didn’t panic about having to go to an unfamiliar place’ • ‘probably would have been too unstable to seek help elsewhere’ • ‘it was easy and accessible whereas other services are hard to get hold of and not welcoming’ • ‘I had given up and lost hope…I am not a person to push things’

  16. Discussion • What are the barriers to people accessing the advice they need? • What practical steps can we take, with the resources we have, to make services more accessible?

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