Views of services users and staff on a combined money advice and psychological therapy service within IAPT

Figures & data

Table 1. Service user participant demographics.

	Service Users (n = 16)
Gender
Female	10 (62.5%)
Male	5 (31.25%)
Prefer not to say	1 (6.25%)
Gender same as birth
Yes	13 (81. 25%)
No	3 (18.75%)
Ethnicity
White British/other	14 (87.5%)
Asian Indian	1 (6.25%)
Mixed White/Black African	1 (6.25%)
Last accessed IAPT
Currently	1 (6.3%)
Less than 6 months	6 (37.5%)
6 months − 1 year	3 (18.7%)
1 − 2 years	3 (18.7%)
2 − 3 years	2 (12.5%)
More than 3 years	1 (6.3%)
Last accessed debt advice
Currently	1 (6.3%)
Less than 6 months	2 (12.5%)
6 months − 1 year	3 (18.7%)
2 − 3 years	1 (6.3%)
More than 3 years	3 (18.7%)
Not sure/haven’t use	6 (37.5%)
Living arrangements
Owns own home	7 (43.75%)
Renting	7 (43.75%)
Other	2 (12.5%)

Table 2. Staff participant demographics.

	All Staff	IAPT Therapists	CA Advisors
N	20	14	6
Gender
Female	100%	100%	100%
Mean Age (SD)	40.16 (12.17)	40.07 (11.88)	40.40 (12.94)
Ethnicity
White British/Other	11 (55%)	8 (57.14%)	3 (50%)
Black African	3 (15%)	1 (7.14%)	2 (33.33%)
Black British	2 (10%)	2 (14.29%)	–
Chinese	1 (5%)	1 (7.14%)	–
Indian British	1 (5%)	1 (7.14%)	–
Bangladeshi British	1 (5%)	1 (7.14%)	–
Prefer not to say	1 (5%)	–	1 (16.67%)

Figure 1. Diagram of overlapping subthemes within the thematic framework.

Table 3. Example quotes from interviews with service user participants.

Framework category	Themes	Illustrative quotes
Impact of money worries and mental health problems	Less able to manage money	“I made a lot of bad decisions with my money” (SU10)
	Activities more limited	““I was doing the CBT at the time, that almost cost me maybe £5 for a week in travel expenses and there was no help for that sort of thing” (SU11)
	Problems accessing benefits	“a big thing was getting the confidence to keep calling like people like Universal Credit” (SU14)
	Unable to act on advice	““if I’m really anxious I won’t want to pick up the phone and stuff or leave the house” (SU01)
	Difficulties asking for help	“I was too embarrassed to talk to family about it” (SU10)
	Fears over the future	““You know so it’s like something major happens and you haven’t got the money to sort it out” (SU05)
Benefits of a combined money advice and mental health intervention	Would offer practical/expert advice	“you absolutely need Somebody that has a certain degree of knowledge” (SU11)
	Would offer holistic care	“just a bit more linking it into the mental health side really” (SU04)
Components of money advice	Provide practical support	“thinking back to the last time with PIP and things like that I was just really struggling to manage it myself, and so they acted as my third party” (SU07)
	Psychoeducation	“obviously for me there is a emotional or psychological reason and ways to maybe sort of look into how I could sort of change that.” (SU01)
	Content being tailored to the individual	“definitely something that’s a bit more tailored” (SU04)
Introducing money advice into IAPT	Therapists should introduce the money advice to their clients	“it isn’t something people are proud of if they are in debt, so perhaps mentioning it in the first session.” (SU09)
	Advertise the money advice service widely	“it would be really helpful to have good publicity and it [be] publicised in a way that is well received or people know about it” (SU06)
Format and delivery preferences for money advice	Money advice should be weekly/fortnightly	“perhaps weekly or fortnightly to start with” (SU7)
	Longer first session with shorter follow-ups	“I would probably say like half an hour on average.” (SU12)”
	Short to medium term money advice	“I would say the first one and then say into two or three weeks and then another one in perhaps the same sort of time again another 2-3 weeks.” (SU08)
	Telephone/online acceptable for money advice	““For me I like to go for a combination of online cause I don’t do very well phone calls, or in person” (SU12)
	Ensure any format is accessible	“what’s the easiest you know? What’s the easiest for the individual?” (SU02)
	Sessions should be flexible and tailored to the individual	“what’s the easiest you know? What’s the easiest for the individual?” (SU02)
Timing of the money advice	Provide both services in parallel	““there are benefits to doing it because you’re working on both at the same time” (SU07)
	Flexibility in the timing of money advice	““I think it depends on every person” (SU12)
Sharing information and collaboration between services	Only ‘need-to-know’ information being shared	“I guess the minimum necessary to get the help, you know not going into huge amounts of detail” (SU07, service user)

Table 4. Short example quotes from interviews with CA advisors and IAPT therapists.

Framework category	Themes	Illustrative quotes
Impact of money worries and mental health problems	Money worries worsens mental health	“they don’t have a future from their point of view and it’s quite depressing.” (ST16, IAPT staff)
	Employment affects both money and mental health	“She’s quite anxious all the time, she’s really worried about what will happen if she loses this job.” (ST20, IAPT staff)
Benefits of a combined money advice and mental health intervention	Money advice will improve mental health	“if they are getting the support to deal with their debt and automatically the anxiety level will go down” (ST16, IAPT staff)
	A combined intervention will be helpful and feasible	“I really really think it will work” (ST12, CA money advisor)
	Provide an easier referral process with follow-up	“something that we can ensure that they go to, something that we can follow up and see if they’ve attended” (ST19, IAPT staff)
	Enable mutual agency support between services	“Just to take out that like middle part of like emailing, reaching, waiting” (ST13, IAPT staff)
	Clients would feel more listened to	“I think they feel quite listened too” (ST13, IAPT staff)
	Better protection of therapeutic time	“I guess in having that specialist support you can have that more focussed time thinking about the intervention” (ST09, IAPT staff)
Components of money advice	Tools, strategies, and information giving	“a basic understanding of the different sorts of debts I think, is extremely important” (ST06, CA money advisor)
	Training for therapists and advisors	“I think [training] would be really helpful” (ST10, IAPT staff)
Introducing money advice into IAPT	Ask standard question about money at triage	“I think getting them to that service as soon as possible, even at the telephone assessment um when you come into the service” (ST15, IAPT staff)
	Wait for clients to bring up money worries	“Well I mean I don’t necessarily ask them directly about money issues, but I will be listening out for um sort of any clues” (ST14, IAPT staff)
	Introduce money advice sensitively	“I tend to avoid the word debt in itself, it’s just because somehow it seems to bring anxiety.” (ST04, CA money advisor)
Format and delivery preferences for money advice	Money advice should be given one-to-one	“I guess my preference if I was looking to get support like that I would want one to one” (ST13, IAPT staff)
	Money advice workshops would be useful	“maybe seeing that other people are also struggling with debt or trying to come out of debt might be quite a booster as well I think.” (ST19, IAPT staff)
	Face-to-face preferred for money advice	“face to face you know your whole being you’re fully present for the person, and there is a lot non verbal um communication between the therapist and the client” (ST15, IAPT staff)
	Written plans of verbal communications are needed	““I think written [plans] will be a very good idea” (ST16, IAPT staff)
Timing of the money advice	Start money advice before therapy	“I just generally think if somebody really is in debt or have real debt issues, then to resolve that first to get that out of the way” (ST19, IAPT staff)
	Start the therapy before money advice	“maybe towards the end if they’re beginning to feel better, if they’ve been in a very bad place, might be a good time” (ST07, CA money advisor)
	Continue money advice after therapy	“if that was something that was negotiated and there was still ongoing debt difficulties then absolutely, I think that just that there was that understanding that actually therapy was stopping here but the advice was carrying on I think” (ST05, IAPT staff)
Sharing information and collaboration between services	Communication between both services would be useful	“I think those would be the anchor of collaboration, I think it would be most helpful” (ST08, IAPT staff)
	Integrate money advice with therapy	“then maybe within the second session then alongside the person giving talking therapy, then um er a debt advisor would kind of come in alongside of that” (ST02, CA money advisor)
	Client consent/confidentiality is required	“we have to be mindful of how much information the client wants shared” (ST20, IAPT staff)

Data availability statement

The data are not publicly available due to [restrictions e.g. their containing information that could compromise the privacy of research participants].