'Money doesn’t talk, it swears'

As we move ever closer to the spending frenzy that is Christmas the Journal of Mental health is looking at money and its association with mental health. Money is key to participating in society. Limited access to finances and the subsequent impact on such participation can have a detrimental effect on mental health. However, links between finances and mental health are complex and can apply at different levels. This paper discusses some of the key issues and highlights important new research that is part of this special edition of the Journal of Mental Health.

The quote is from Bob Dylan in “It’s Alright Ma (I’m Only Bleeding)” back in 1965, and it encapsulates the uneasy relationship we have with money. This issue of the Journal of Mental Health contains papers that take forward the research into the financial aspects of mental health problems. This is a topic approached from different angles by this journal before (Knapp, 2005; Knapp et al., 2007; Mason, Goddard, Myers, & Verzulli, 2011; McDaid, Oliveira, Jurczak, Knapp, & The Mheen Group, 2007; Serowik et al., 2014) but these have mainly been about the funding of mental health care and the hard decisions that need to be made (Gajre, McClelland, & Furnham, 2017). The journal has also been interested in the effects of poor finances and poverty (De Judicibus & McCabe, 2005; Khamis, 2017) on an individual’s mental health and this issue is an extension of that work. The idea for this journal started with the setting up of the Money and Mental Health Policy Unit (https://www.moneyandmentalhealth.org/). This campaigning organisation tries to understand the links between mental health and problematic debt, and then tries to fix the problem. For instance, people with mental health problems admitted to hospital often are discharged with accumulated debt because of them not receiving information or not dealing with bills. Recently they drew attention to the problem of travel insurance, which is often too expensive for people with mental health problems to invest in. Their Head of Research, Katie Evans starts off this issue with a helpful overview of some of the links between financial challenges and mental health problems (Evans, 2018). The links between debt, demographic characteristics and common mental health problems is then investigated in important research by Gunasinghe et al. (2018). Two papers using survey data throw light on how individuals with mental health problems get into a spiral of debt. The first investigates the working practices of debt collectors with respect to mental health problems (Evans, Fitch, Collard, & Henderson, 2018) and the second examined the way in which people with mental health problems can receive appropriate money management assistance (Labrum, 2018). Here, unofficial family money managers help was associated with fewer psychiatric inpatient stays but they were also some negative associations.

The link between mental health and wealth or income may not though be as clear cut as expected. Esposito (2018) for example find quite different relationships for men and women in Mexico. Economic effects of mental health problems are not of course confined to those directly experiencing them. For example, Mahlich, Sruamsiri, and Mori (2018) show substantial impacts on the caregivers of people with schizophrenia in Japan.

We all require time and money to participate in society, and while time is, in principle, equally distributed, the same cannot be said of money. An inability to fully participate in society will, for some, adversely affect their mental well-being and health. Links between finances and mental health are widespread, occur at various levels, and have been investigated over many years. At a macroeconomic level many countries have gone through periods of economic austerity. Longitudinal analyses presented by Barr, Kinderman, and Whitehead (2015) in England show increases in self-reported mental health problems around the same time as the economic downturn in 2009. They also suggest that changing work conditions may also have contributed to the increase in these problems. Loss of work can have a clear negative effect on mental health (Bambra, 2010). While the therapeutic benefits of work exist (Li, 2018), it is recognised that obtaining and keeping employment when experiencing mental health problems is challenging. Unfortunately, when downturns occur, it is likely to be those with mental health problems will lose work first and remain unemployed the longest. Work loss and pressures, such as zero hours contracts, may result in a downward pressure on real wages. Knock-on effects on incomes and debt are again likely to have potential detrimental consequences for mental health (Elliott, 2016). The state of the economy can also make it more challenging to provide appropriate levels of service provision for people with mental health problems (Holloway, 2010). This complex set of interrelationships have often not been considered altogether which would not only help with planning how much of a service will be necessary but also affects the types of support necessary. This sort of policy initiative is at the heart of the Money and Mental Health Policy institute.

Absolute financial deprivation is not the only reason why there is a link between money and mental health. Pickett and Wilkinson (2010) have discussed the growing evidence that income inequality is associated with prevalence of mental health problems and this builds on broader research indicating the negative impact of inequality on society (Wilkinson & Pickett, 2009).

Uncertainty about income and employment may also be related to mental health problems. In an Australian study using panel data methods, Rohde, Tang, Osberg, and Rao (2016) found that a ‘shock’, equivalent to a one standard deviation change in measures of economic security, resulted in increased rates of mental health problems as measured by the SF-36. One interesting potential solution to income insecurity that is gaining traction is to introduce a guaranteed basic income, which may come with health benefits (Painter, 2016). Whether these health benefits do materialise is yet to be proven. However, one cannot watch the Ken Loach film “I, Daniel Blake” without being concerned about the negative impact that negotiating your way around the benefits system may cause. A basic income may not result in increased income but according to one participant of a Finnish trial “I vastly prefer basic income to a benefits system fraught with complicated forms, mandatory courses and pointless obligations” (The Guardian, 7 August 2018).

A number of studies have examined the link between personal debt and mental health. A review conducted by Richardson, Elliott, and Roberts (2013) found very strong relationships between debt and mental health problems generally, depression, psychosis, suicide, and drug and alcohol problems. An acknowledged difficulty though is establishing causation. This can be addressed to some extent by the use of longitudinal analyses (Hojman, Miranda, & Ruiz-Tagle, 2016).

Money, income, debt, employment, and mental health have always been connected and the relationships are complex. What is quite clear is that economies are changing and as such this complexity is more evident. As usual continued research is warranted not just because of our uncertainty but also because it is the moral thing to do.

Disclosure statement

No potential conflict of interest was reported by the authors.