This research aimed to develop a consistent approach to working with people with mental health problems and financial difficulties through the expert consensus of financial counsellors, financial institution staff, mental health professionals, consumers and carers. Overall, 462 items were endorsed by all five groups as important or essential to be included in the guidelines. The endorsed items were written into a guidelines document that aims to inform policy and practice. There were a number of findings worthy of further discussion.
Clear professional role delineation was a consistent theme evident in the data. For instance, while there was endorsement for the financial counsellor to ask about mental health problems, there was limited endorsement for financial counsellors using therapeutic techniques. Conversely, there was endorsement for mental health professionals to ask about financial difficulties, but limited endorsement for them using financial counselling techniques.
Differentiation of roles within the financial institution staff was also evident in the Round 1 survey results. In Round 1, items referred to financial institution staff as a homogenous group, but many did not reach consensus. Comments provided by panel members indicated that some of the statements may be applicable to some roles within the financial institution and not others. For instance:
“I am concerned about the term "financial institution staff" as that covers so many positions…the extent of "how much" would depend on their position and decision making capacity in their organization.”
“Asking [about] thoughts of suicide…would not be appropriate for some financial institution staff, e.g. bank teller when the queue is out the door and everyone is listening.”
For this reason a number of the items for Round 2 were re-drafted to differentiate between the roles of hardship, collection, branch and contact centre staff. In Australia, hardship staff are trained to provide financial solutions for people experiencing financial difficulties or hardship, collection staff negotiate payment from people with overdue accounts, branch staff work in the local bank branches and contact centre staff work with customers over the phone. Contact centre staff can be located overseas or in Australia. This redrafting of items to differentiate these roles led to a number of items being endorsed for specific roles.
The guidelines also include a section about what a support person should know and do to help the person with mental health problems and financial difficulties. The financial counsellors, in particular had concerns about the support person’s ability to act in the person’s best interest, either due to ignorance around financial issues or more malicious intent. The consumers also rated an item about the support person providing advice to the person lower than the other panels.
Specific actions for financial institution staff
A number of items were included in the survey that addressed specific actions that financial institution staff should take to assist the customer with mental health problems and financial difficulties. Some of these items received agreement from all but the financial institution staff. Such differences are likely to stem from the legal and institutional requirements on financial institution staff, which the other panels may not have been aware of. In response to the statements about specific strategies for financial institutions (e.g. suspending interest), one participant said, “System limitations”, while another said, “Financial institutions cannot record or keep sensitive information.” Another commented, “These questions pose a difficulty for me in terms of privacy and yet responsible bank lending for consumers whose finances are not in great shape.” The financial institution staff also commented on the tension created by the need to follow privacy laws and institutional policies, and what they thought would be best for all parties involved:
“I'm not 100 % sure about mental health disclosure due to privacy laws, but knowing a customer’s health issues helps us so much to look at solutions that will assist their financial situation.”
The use of a standardised form
Panel members were asked to rate a number of items relating to the development and use of a standardised form that the mental health professional could complete to communicate how a person’s mental health problems impact on their ability to manage their financial difficulties. It is envisioned that this form will allow financial counsellors and financial institutions to work collaboratively to find the most appropriate solution to the person’s financial difficulties.
Privacy laws and institutional policies likely influenced the rating of items about the use this form, for instance items relating to recording of information about how the mental health problems affect the person’s ability to manage current financial difficulties received endorsement. However, items asking for detailed information about the diagnosis and treatment of the mental health problem did not.
In addition to the consensus received for the items relating to this form, the researchers also received numerous positive anecdotal comments about the usefulness of such a form. In spite of the consensus and positive feedback, it is expected that the implementation of this form will be complex and difficult given privacy laws and the various institutional policies that govern the management of personal information .
These guidelines compared to other work in Australia and overseas
These guidelines can be compared to other work done in Australia and overseas. In Australia, Good Shepherd Youth and Family Services developed two booklets based on a literature review and interviews with financial counsellors. While the advice in these booklets is generally consistent with the advice in the guidelines, they included a number of pieces of advice that were not endorsed in the current study. Moreover, unlike the current guidelines, these booklets only cover the role of the financial counsellor and mental health professional.
In the UK, the Royal College of Psychiatrists and the Money Advice Trust published a document called Debt Collection and Mental Health: Ten Steps to Improve Recovery. The Australian guidelines diverge from this document in several ways. First, the UK document recommends that financial institution staff ask specific questions about how mental health affects the person’s financial situation and their ability to communicate with creditors. Second, they recommend that financial institution staff refer customers to mental health professionals. Items similar to this did not receive endorsement from the panels in this study. This may be because participants thought the actions depended on the specific situation. Furthermore, privacy laws are different in the UK to Australia, which may have implications for the ability to collect and store private information about mental health problems.
Another notable difference from the UK work relates to the type of information to be collected using a standardised form. The UK form requests details about the diagnosis and treatment of the mental health problems. Similar items were included in our Delphi questionnaire, but as stated earlier, were rejected by all panels. The Australian form focuses on the functional impact of the mental health problems on the ability to manage current financial difficulties. Again financial institution staff may have been cautious in wanting to collect detailed information due to the privacy laws in Australia. However, the remaining panels also thought it was not necessary to collect this amount of detail.
Implementation of the guidelines and potential future work
Until recently, financial counsellors have not had a national framework for training and professional development, which has led to inconsistent training, particularly around working with people with mental health problems . The guidelines for financial counsellors are currently being used to inform mental health training for financial counsellors and financial counselling students. These guidelines are also available as part of a larger suite of mental health first aid guidelines on the Mental Health First Aid Australia website (www.mhfa.com.au). Previous work has shown that people who download these guidelines make practical use of them to help people with mental health problems .
Discussions are ongoing with financial institutions and the mental health sector on how best to implement these guidelines, including tailoring of training according to the person’s role. A set of principles for working with and supporting a person who is experiencing mental health problems and financial difficulties is being developed using the guidelines. The principles are broader than the guidelines and will be for the use of financial counsellors, financial institution staff and mental health professionals.
Once the principles are complete and a standardised form is developed, future work will need to be done to better understand and overcome the earlier noted difficulties anticipated in the implementation of these documents. Further research in this area could include an evaluation of the use of the guidelines, principles and standardised form. Future work could also be done to try to get the guidelines and principles incorporated into the existing financial codes of practice. This current project was limited to developing guidelines for people with mental health problems who are already experiencing financial difficulties. Future work is needed to address prevention of financial difficulties by developing guidelines for financial institution staff who make decisions around lending money and providing credit.
Limitations of this study include being able to apply these guidelines consistently within financial institutions, given the legal and systematic constraints highlighted above. Two other limitations are related to the online Delphi process. The first is the possibility that some panel members were asked to advise on statements that were outside their expertise, possibly leading to a lack of inclusion of items related to best-practice evidence. The second limitation is that while participants are able to provide comments in Round 1 of the survey, they are not able to fully discuss their comments and opinions with other experts. Panel members may have made incorrect assumptions and held biases that remained unchallenged because there was no opportunity for discussion. It is possible that key actions were omitted from the guidelines because of this.