Debt and Mental Disorder

1. Debt and Mental Disorder Rachel Jenkins, Howard Meltzer, and colleagues

2. Mr Micawber Annual income twenty pounds, annual expenditure nineteen nineteen six result happiness. Annual income twenty pounds, annual expenditure twenty pounds ought and six result misery.

3. Causes of mental disorder Acute stress-life events eg bereavement, redundancy Chronic stress eg poverty, caring for ill person Lack of social supports and networks Inner vulnerability eg previous abuse, bullying, genetic

4. Income and Mental Disorder Long standing appreciation of links between mental disorder and low income Relative income disparity rather than absolute Income is an indicator of many other parts of life Income can buy one out of a lot of trouble

5. Paper 1. Examined prevalence of low income and debt in people with different kinds of mental disorder Tested hypothesis that relationship between low income and mental disorder is mediated by debt

6. Paper 2 Examined prevalence of mental disorder in people in debt With disconnected utilities Who have cut down on utilities

7. Methods GB national survey of mental disorders 12792 households ,chosen randomly, one person per household 66% response rate-8450 completed interviews

8. Interviews Sociodemographic Income Debt Mental disorders

9. Income questions Could you look at this card and tell me which group represents your household gross income per week from all sources Less than £100 £100-199 £200-299 £300-399 £400-499 £500+

10. People on low incomes much more likely to have a mental disorder See paper 1, table 1. Eg Men on £100 a week are 2.7x more likely to have depression or anxiety and 35x more likely to have psychosis

11. Debt questions Have there been times in the past year when you were severely behind in paying within the time allowed for any of these items? Have you ever been disconnected because you couldn’t afford it? Have you ever used less than you needed in relation to water, gas, electricity, phone because you couldn’t afford to pay?

12. Categories of debt Gas Electricity Water Phone TV licence Hire purchase Mail order payments Credit card payments Rent Mortgage Council tax Road tax DSS social fund loan Child maintenance Other loans

13. People with mental disorder are more likely to be in debt A quarter of people with mental disorder are in debt 24% of people with depression/anxiety are in debt 33% of people with psychosis 25% of people with alcohol abuse 24% of people with drug abuse 8% of people with no disorder

14. People in debt are more likely to have a mental disorder 40% of people in debt have depression/anxiety (14% general population) 1.6% have psychosis (0.4% general population) 15% have alcohol abuse (6% general population) 12%have drug abuse (3% general population)

17. The bottom line A quarter of people with mental disorder are in debt Implications for health care teams? Half of those in debt have a mental disorder Implications for finance teams? Implications for utility companies? Implications for national debt governance?

18. Questions for today Can we Enhance awareness of mental health concomitants of debt Consider how debt/utility arrears be handled, given that high proportion have mental disorder Assist people in debt to access mental health (prevention and treatment) Assist people with mental disorders to access debt counselling services Prevent debt in people with mental disorder Strengthen financial literacy and financial inclusion of people on low incomes Strengthen financial literacy in health and social care professionals ? Have debt counsellors in primary care