Advances in Psychiatric Treatment (2007) 13: 194-202. doi: 10.1192/apt.bp.106.002527
© 2007 The Royal College of Psychiatrists
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Debt and mental health: the role of psychiatrists

Chris Fitch, Robert Chaplin, Colin Trend and Sharon Collard

Chris Fitch is a research fellow at the Royal College of Psychiatrists’ Research and Training Unit (CRTU). He is a sociologist with an interest in finance and mental health, and the challenges of living with a mental health problem in the community. Robert Chaplin is a research fellow at the CRTU and a consultant in general adult psychiatry for Oxfordshire Mental Healthcare NHS Trust. He has interests in audit, the therapeutic alliance and mental capacity. Colin Trend is project manager at Money Advice Plymouth, and provides advice and guidance to people in debt, including those with mental health problems. Sharon Collard is a research fellow at the Personal Finance Research Centre at the University of Bristol. She has research interests in the use of credit and other financial services by low-income consumers, and is a member of the Department for Trade and Industry advisory group on over-indebtedness.

One in four people with mental health problems in Britain report debt or arrears, which is nearly three times the rate among individuals without similar conditions. Although health professionals commonly encounter debt among patients, some report that they lack basic knowledge to effectively intervene and that patient debt is often not acted on until a crisis emerges. Our aim in this article is to improve psychiatrists’ knowledge and confidence in dealing with patient debt. We provide basic definitions of debt and problem debt; outline the impact that debt can have on patients’ health, social and financial well-being; identify the stages and signs that a patient may be accruing problem debt; describe how psychiatrists should respond; and review the instruments available to assess patients’ mental capacity to make financial decisions. We do not expect psychiatrists to become ‘debt experts’, but provide working knowledge for engaging more effectively with this problem.