Mental health staff increasingly dealing with 'vicious cycle' of patients’ wider problems during clinical time

8 out of 10 mental health staff said that dealing with a patient’s practical issues left them with less clinical time to treat their mental health issues, Citizens Advice has found.

Over half (57%) reported the proportion of time they are spending on non-health issues has increased compared to last year.

Citizens Advice conducted a survey of 244 mental health practitioners who deliver NHS England’s Talking Therapies programme. These services provide treatment of anxiety disorders and depression in England.

Nearly all (98%) respondents said they had dealt with a patient’s non-health problems during an appointment in the past month.

The most common problems mental health staff are assisting with are debt and money problems, unemployment and work, housing and welfare.

Mental health staff reported these problems had a negative impact on their patients’ ability to manage their mental health, complete a course of treatment and ultimately recover.

More than half of those surveyed reported increased stress as a result of dealing with these non-health problems.

Mental health staff reported they have spent appointment time helping patients with these problems through:

• budgeting or debt management plans

• contacting public services/agencies of the patient’s behalf

• providing supporting letters

• assisting patients complete benefits applications

• contacting creditors on the patient’s behalf

Citizens Advice helped over 100,000 people who reported having a mental health problem in 2017.

Citizens Advice data shows clients with mental health problems are more likely to face  multiple, complex problems compared to the average client. In 2017, clients with mental health problems had an average of 5.3 issues per client, compared to 3.8 problems per client overall.

In the past 2 years, Citizens Advice has seen an increase in the number of clients with mental health problems, including an 11% increase in those who require advice on benefits.   

CItizens Advice is calling for advice services to be integrated in more mental health settings to alleviate the pressure on frontline mental health staff and to better support the needs of people with mental health problems.

Roughly a third (34%) of respondents had access to an integrated advice service within the mental health setting.

Gillian Guy, Chief Executive of Citizens Advice, said:

"If you're living with mental health problems, everyday issues like managing your money, dealing with your landlord, or applying for benefits can be much more difficult to manage. But if these issues aren’t addressed, they can often escalate and make mental health problems worse - creating a vicious cycle that is difficult to break free from.

“Providing people with practical support is essential to make sure these problems don't spiral out of control, but this should not be the job of already stretched mental health professionals. To reduce pressure on frontline NHS staff and better support people with mental health problems, advice services should be available in mental health settings as a matter of course.”

One of the mental health practitioners surveyed by Citizens Advice said:

“There is always a certain amount of [practical problems] in therapy but it has become entirely unmanageable. Very often my entire assessment and subsequent intervention will be related to social or financial issues. That is not our role, can be stressful and is an expensive use of health care practitioners’ time.”

Dr Jed Boardman, Lead for Social Inclusion, Royal College of Psychiatrists, said:

“In order to stay mentally healthy, we all need enough money in our pockets, a decent roof over our heads, some valued work, and a supportive environment.  People with mental health problems need all of these to aid their recovery, as well as engagement with effective therapies.

“The effects of the present lack of advice services available for people with mental health conditions, as highlighted in the report, are exacerbated as mental health professionals try to do their job in the context of increasingly stretched resources. Integrating advice services in mental health settings is one important means of improving the lives of people with mental health conditions and the mental health workforce.”

Simon Crine, Director of the Money and Mental Health Policy Institute said:

“We at Money and Mental Health welcome this important new research from Citizens Advice. As our own research has shown, too often mental health professionals find themselves sorting out debt and money issues at the expense of doing their day job.  Integrating debt advice into mental health services would be a win-win for mental health professionals and people with mental health problems.”

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Notes to editors

1. Citizens Advice conducted an online survey of 244 mental health practitioners from Improving Access to Psychological Therapies (IAPT) services from 10/01/2018 to 06/02/2018. Citizens Advice directly contacted IAPT providers across England to distribute the survey. The providers then shared it directly with practitioners via email and on social media. Citizens Advice also worked with Association of Mental Health Providers, Royal College of Psychiatrists, and The British Psychological Society to design and distribute the survey. 

2. 72 local Citizens Advice have partnered with NHS mental health services to deliver integrated mental health and advice services.
3. The Citizens Advice service comprises a network of local Citizens Advice, all of which are independent charities, the Citizens Advice consumer service and national charity Citizens Advice. Together we help people resolve their money, legal and other problems by providing information and advice and by influencing policymakers. For more see the Citizens Advice website.
4. The advice provided by the Citizens Advice service is free, independent, confidential and impartial, and available to everyone regardless of race, gender, disability, sexual orientation, religion, age or nationality.
5. To get advice online or find your local Citizens Advice in England and Wales, visit citizensadvice.org.uk
6. You can get consumer advice from the Citizens Advice consumer service on 03454 04 05 06 or 03454 04 05 05 for Welsh language speakers.
7. Local Citizens Advice in England and Wales advised 2.5 million clients on 6.2 million problems in 2014/15. For full service statistics see our publication Advice trends.
8. Citizens Advice service staff are supported by more than 21,000 trained volunteers, working at over 2,500 service outlets across England and Wales.