The resignation of Sir Keir Starmer means that the UK could have a new Prime Minister as early as 16 July. As things stand, everything points to that being Andy Burnham.

But whoever takes office in the next weeks will face both big challenges and opportunities in terms of supporting the mental and financial wellbeing of people across the UK.

In recent years referrals to mental health services in England have rocketed. Cost of living pressures are only likely to get worse later this year, which could drag more people into debt. And many people are already facing extremely tough times: 3.6 million people with mental health problems report they have been worried about not having enough money to put food on the table in the past year.

The next Prime Minister and government will also have to deal with ongoing concerns about how poor mental health is contributing to persistently high levels of economic inactivity. And it will need to find solutions to these problems in the context of deeply constricted public finances.

It’s clear then that the new Prime Minister needs to act with real urgency to support people at the sharp end of these trends. They will have to combine ambition with pragmatism in finding cost-effective solutions that are up to the task at hand.

Luckily for them, at Money and Mental Health we’ve put together a readymade package of pragmatic, mostly low cost policy solutions that the next Prime Minister can run with - and that most importantly, will make a big difference in supporting people struggling with their finances and mental health.

Here are our five asks - read on for more detail on each of them:

1. Crack down on bad bailiff behaviour by introducing legislation to regulate the bailiff industry within your first year in office

2. Speed up recovery rates by joining up money advice and mental health support in the new Neighbourhood Health Services

3. Remove barriers to employment for people with mental health problems

4. Help people in vulnerable circumstances by developing a ‘Share Once’ support register

5. Make financial services work for everyone by leading a sector-wide drive to ensure all banks offer a core package of accessibility tools

1. Crack down on bad bailiff behaviour by introducing legislation to regulate the bailiff industry within your first year in office

Aggressive debt collection destroys lives, and the lack of an independent regulator for bailiffs means that they can act with impunity. We have heard horror stories from people who have had bailiffs force their way into homes, or faced other kinds of threatening behaviour. Many people who have a bailiff knock at their door have mental health conditions. For example, our research shows that 73% of people who had a bailiff visit and a council tax debt also had a mental health problem. Nor is this a niche problem - the debt collection enforcement industry is handling close to 8 million cases a year, 64% of which result in bailiff action.

That’s why independent regulation is so vital, and why we and our Chair Martin Lewis have been calling on the government to act. As things stand, bailiff firms can voluntarily sign up to be overseen by the Enforcement Conduct Board (ECB), which has no statutory powers. It therefore can’t sanction non-compliant firms or agents that break the rules, and relies on their membership fees to exist.

In June 2025, the government published a consultation which explicitly recognised the need for “an independent statutory regulator… overseeing the whole bailiff industry, to ensure greater protections for vulnerable people”. However it is yet to publish a response to the consultation, and failed to include bailiff regulation in the recent King’s Speech. We have even heard that government whips stopped a backbench Labour MP taking forward a Private Member’s Bill - another route to deliver this - in June 2026.

There is a real risk that this issue will simply fall by the wayside due to a lack of legislative time. The next Prime Minister should prevent that from happening by introducing legislation in his or her first year in office to regulate the bailiff industry. That means giving the ECB statutory footing; and requiring firms and agents undertaking the ‘Taking Control of Goods’ process (the legal process in England and Wales where a bailiff visits a debtor’s property) to be authorised by the ECB. Failing to do so will leave vulnerable people open to mistreatment and abuse.

2. Speed up recovery rates by joining up money advice and mental health support in the new Neighbourhood Health Services

One of our longstanding goals has been to get money advice joined up with mental health support. Our research has shown that doing so through the NHS Talking Therapies programme could double recovery rates for people struggling with debt and depression, and help an extra 27,000 people recover from mental health problems each year. It would also save the public purse something in the region of £144 million each year.

We were pleased in July 2025 when the government announced ambitious plans to integrate mental health treatment and debt advice in the new Neighbourhood Health Services, as part of the 10 Year Health Plan. The government’s press statement explicitly stated that debt advice would be delivered alongside mental health support and other clinical health services.

But as we’ve written elsewhere, subsequent government and NHS guidance for local commissioners (who will decide how these services are delivered) makes next-to-no-mention of providing debt advice in these services - which raises concerns that this ambition could be downgraded.

It is vital that the next government sends a strong signal to commissioners that money advice should be at the heart of all neighbourhood health services, so that people experiencing mental health problems can get the joined up support they need.

Subscribe now

3. Remove barriers to employment for people with mental health problems

How to tackle the UK’s stubbornly high levels of economic inactivity has been a puzzle for policymakers in recent years and will undoubtedly be a priority for the new Prime Minister.

This is inextricably linked with poor mental health. About four in ten people who are unemployed or inactive have a common mental health condition (based on the Adult Psychiatric Morbidity Survey. Applying that to the total number of working-age people who are unemployed or out of work today, that means over 4 million (our analysis of the Labour Force Survey).

The recent Milburn Review interim report into economic inactivity among young people also highlighted that among disabled young people who are NEET - not in education, employment, or training - the share citing mental health as their primary condition has almost doubled to more than four in ten. The review also highlighted the lack of tailored employment support for young people experiencing mental health problems

The reality is that the vast majority of people with mental health problems want to work. But too many cannot get the support they need to move into employment - or the adjustments they need in the workplace to manage their mental health and thrive. As both the Milburn Review and Sir Charlie Mayfield’s Keep Britain Working review into economic inactivity have indicated, systemic change in training and employer approaches are needed to tackle these problems.

As a starting point, to help more people with mental health problems move into work, the next government should extend the Individual and Placement Support programme.

This programme offers tailored support to people with mental health problems to find the right job and in-work support for both the employee and the employer. It does so by focusing on matching roles to someone’s capabilities, preferences and health needs - rather than pushing people towards any available job - and offering tailored support, proactive employer engagement and ongoing in-work support to help people stay in employment.

These principles should be extended across employment support, so that people with less severe mental health conditions can also benefit from them.

We also want to see a specialist mental health Work Coach in every Jobcentre. Our research has shown that Work Coaches too often fail to understand the impact of people’s mental health on their ability to work. This leads to people being pushed down generic routes to prepare for work or into roles that just aren’t possible to sustain.

The specialist mental health Work Coach would act as a leader across the Jobcentre on understanding mental health issues, as well as working with people who are in need of additional help. This would help more of us who struggle with our mental health to find rewarding, lasting employment.

And to change attitudes and approaches from employers to supporting people with mental health problems to stay in work, the next government should introduce a ‘Healthy Working Lifecycle’ standard for employers. This was one of Sir Charlie Mayfield’s key recommendations as a way to deliver the “fundamental shift” towards employers doing more to support the health and wellbeing of workers, and to remove barriers for people with disabilities.

The idea is that the standard would define expectations for employers on best reducing sickness absence, improving return to work rates and supporting better participation and inclusion of disabled people. From our perspective, we want that to also include a clear focus on embedding more widely the adjustments that can help people with mental health problems to thrive in work, such as offering greater flexibility, security and wellbeing support for employees.

This would also build on the Good Employment Charter introduced by Andy Burnham in Greater Manchester as mayor, which is aimed at ensuring more people can have equal access to quality work that is inclusive, fairly compensated, offers security and flexibility and cultivates an environment where health and wellbeing thrives.

4. Help people in vulnerable circumstances by developing a ‘Share Once’ support register

If you’re experiencing a mental health problem, there is a good chance that it will impact your ability to choose and use essential services like banking, energy, water and telecoms. Our research has shown clearly that common symptoms of poor mental health such as reduced memory or concentration make it more challenging to engage with companies, while services are often poorly designed to meet people’s needs.

The good news is that essential services companies often offer extra support for people experiencing these difficulties, from enabling people to record their condition and communications preferences, or to set up notifications about their account to a trusted third person.

The bad news is that to access this support, people with mental health problems need to disclose their needs to each of the services they use. That can feel like an impossible task when you’re struggling, especially when you have to do it with so many firms. People also tell us that it is often unclear how to make this kind of disclosure. It’s perhaps unsurprising then that only 14% of people with mental health problems have disclosed their mental health condition to their financial services provider, while only 12% have disclosed to their energy provider. These problems are contributing to worse financial outcomes for this group, who pay up to £1,550 more annually for essential services like energy and telecoms. A recent NAO report highlighted the scale of support that’s going unclaimed.

In 2024 the Department of Business and Trade set out plans for a ‘Share Once Support Register’, through which people could disclose their extra support needs and have that information shared across the water, energy and telecoms sectors. If done properly — that is, shaped by people in vulnerable experiences and designed around their needs, concerns and preferences — this could have a big impact in reducing distress and enabling people to get additional support from services providers.

However, those plans stalled under the current government and Ofgem responded by pausing its work on developing the system. DBT recently told the NAO that it remains committed to introducing the system - but our concern is that these plans will get stuck again.

The new government needs to prioritise work with regulators to build a ‘Share Once’ system that covers all essential services sectors (e.g. banking as well as energy, telecoms and water). We want to see meaningful progress in the first year of the new government, and a clear commitment to ensure this is delivered without delay.

5. Make financial services work for everyone by leading a sector-wide drive to ensure all banks offer a core package of accessibility tools

The current government’s financial inclusion strategy - which promised to ‘transform’ financial wellbeing and ‘open up access to financial services’ to everyone - delivered some important measures to improve the outcomes that people with mental health problems face when using financial services.

But we would have liked the strategy to be more ambitious in addressing the barriers that people with poor mental health too often face in using financial services. There is a clear opportunity for the new Government to ramp up its expectation of firms and to hold them to account for delivering genuinely transformative change.

One important way to do that is to ensure sector-wide provision of better tools and products to help people who struggle to access financial services. For example, we know that more than half of people with mental health problems face serious difficulties using the phone to carry out essential admin, and four in ten have severe ‘admin anxiety’ — leaving them unable to effectively use financial services. But banks don’t routinely offer the range of tools and services that would enable people with mental health problems to better stay on top of their finances.

For example, only 7 out of 18 major current providers offer carers cards, which people can give to a trusted person to buy them essentials such as groceries if they are too unwell to leave the house. That leaves people in vulnerable circumstances resorting to sharing PINs and passwords in order to get support from a trusted person to manage their everyday finances.

We want the government to coordinate a voluntary agreement among financial services to offer customers a ‘core package’ of tools to help them use financial services more easily. This could include:

• Tools for carers - like carers cards - which individuals can use to authorise a carer to make purchases on their behalf - or third party account notifications.

• Personalised spending controls - which enable people to block certain types of potentially harmful payments like gambling, or to set spending limits.

• ‘Don’t lend to me’ flags so that people can limit their own access to credit if they are concerned about borrowing in periods of poor mental health.

To make this happen, the next government could take a similar approach to that of the coalition government in 2014, when it coordinated an agreement among current account providers to make basic bank accounts available to people who did not have one.

This ambition is in keeping with the aims set out in the current government’s Financial Inclusion Strategy. But it would also signal a step up in ambition from the next government in terms of tackling the barriers that people in vulnerable circumstances face to using financial services.

I applied to become Head of Research and Policy at Money and Mental Health in late 2019. The pre-interview task was to come up with a research project and how I’d deliver it. My idea was to look at the ‘income gap’ between people with and without mental health problems: how big it is, what drives it and most importantly what we can do about it.

When I started the job the following February, we put that on our list (the team had already been thinking of something along those lines). We were just starting to get going with it… and then Covid hit. We still did the work - which is one of the projects I’m proudest of from my time here - but we prioritised emergency policy ideas to prop up people’s mental health and living standards, rather than getting into detail on the long-term data picture. So seven years on, I wanted to come back and put the finishing touches on that interview task, to see what it can tell us today about possibly the most important question when it comes to money and mental health.

What we know

We did produce an income gap figure back in 2020. That was based on analysis done for us by NatCen, looking at the Adult Psychiatric Morbidity Survey (APMS). That’s a great dataset when it comes to mental health, and has plenty of financial questions. The main downside was that it was quite out of date by then (the fieldwork was done in 2014). We found the annual median income for people with common mental disorders (CMD) like anxiety or depression was a staggering 32% lower than that of people without those conditions, equivalent to a gap of £8,400 in 2020 prices.1

We revisited the question in a 2024 report using another dataset, Understanding Society, which is less strong on mental health but has a much wider range of questions. It’s also been run every year since 2009, letting us dig into differences by how long people have been struggling with their mental health. Our focus in that report was on long-term patterns of money and mental health problems, tracking people over a number of years rather than snapshots. We found a mean (rather than median) monthly income gap of about 6% between those who have not experienced a mental health problem and those who have for one or two years, rising to 9% for people who have three waves of the data or longer. So still a huge difference - in the region of £2k to £3k a year - but much smaller than our original analysis.

There were lots of potential reasons for this smaller figure - different time periods, age ranges, measures, samples - but in my mind the most likely one was what we used to define experiencing a mental health problem. The rest of this section explains more about the different approaches - feel free to skip down to The new analysis if you just want to see the latest figures and our assessment of what’s driving the gap. But the question of how we measure mental health problems is a big one, both from an analytical point of view and a political one.

Who are we talking about when we say “people with mental health problems”?

Over the past couple of years, there’s been lots of chat about the rise in mental health problems and what’s behind it, some high-quality, some less so. A government-commissioned review into this question recently published its interim report. It sets out some of the competing theories, which I’d simplify as “it’s down to a rise in actual psychological distress” or “it’s not about change in actual distress, it’s a rise in the number of people who have either got a diagnosis, self-diagnosed or who feel more comfortable now than in the past in saying they have a mental health problem.” The report unsurprisingly concludes there isn’t a single, simple answer. That is, there have been changes in diagnosis patterns and what we might broadly class as social or cultural explanations, but there’s also been a noticeable increase in the share of people experiencing significant distress.

How does that relate back to the income gap analysis? Well, the APMS takes an approach where it asks you about your symptoms or experiences, and then applies some diagnostic criteria to decide whether an interviewee meets the threshold of having a given condition. Understanding Society takes a similar approach using a set of questions called the GHQ-12 that asks about how you’ve been doing over the past few weeks, touching on feeling depressed or worried but also your ability to concentrate and make decisions. When you say you’re struggling on enough questions, you’re classed as having a mental health problem. Under this definition of “people with a mental health problem”, it’s someone experiencing difficulty lately, even though they might not have had a diagnosis. But within the three most recent years of Understanding (2021-24), there are also decent questions asking people if they’ve been diagnosed with specific conditions. People in this camp could be feeling absolutely fine - lots of conditions are fluctuating or are under control - but would often still identify as someone with a mental health problem.

So when we’re assessing prevalence and change, or outcomes on things we care about like income, there’s a case to be made that no measure of people’s experience of mental health problems gives us the single “correct” picture that we should care about to the exclusion of all others. They tell us something meaningfully different and, depending on how we use that information, useful. More is more, basically.

The new analysis

The top-level headline is pretty similar to what we found in 2024. When we look at Understanding Society’s questionnaire-based definition of experiencing significant psychological distress, the median income gap looking at monthly income varies over time (2009/10-2023/24). It averages out at 10.7% across the period, albeit it’s slightly higher in the most recent data (covering 2023-24) at 11.6%. That 11.6% gap is equivalent to a difference of £213 a month in 2025 prices, which is massive.

The mental health income gap is big and persistent

Source: Money and Mental Health analysis of Understanding Society, Waves 1–15 (2009–2024). CPI data: Office for National Statistics.

Notes: Median individual monthly income gap between people with and without significant psychological distress (GHQ-12 score ≥ 4), expressed in cash terms (left axis) and as a percentage of median income among those without distress (right axis). All figures in 2025 prices, deflated using the ONS CPI figures.

Household finances are more complicated than what an individual in that home has coming in each month.2 But the basic maths of “less money coming in makes it harder to keep on top of bills” seems an obvious factor for why people with mental health problems are overrepresented among those in problem debt and those on the receiving end of harmful debt collection approaches like repeated contacts and bailiffs.

What about if we repeat the analysis but using the questions in Understanding Society about whether you’ve been diagnosed with a condition? The gap for that group is actually very similar - 11.3% in the most recent wave. That similarity is there even though there is less overlap between the two groups than some might expect - about four in ten people experiencing significant distress have a diagnosis, and approaching half of people with a diagnosis are experiencing significant distress. That makes sense based on our other work: mental health conditions fluctuate and lots of people who struggle with their mental health either haven’t had a diagnosis for various reasons or only struggle for a short period.

What’s driving it?

This is supposed to be a short-ish post, so the aim isn’t to provide a super-detailed breakdown of exactly what’s going on. But we can do a quick analysis to see how much of the gap is explained by big demographic or labour market factors.

The first thing I looked at was the difference between men and women with mental health problems, and the results were pretty striking. Using both measures available to us in Understanding Society (the GHQ-12 questionnaire and the self-reported diagnosis version), the gap for men is much larger than for women. Again, it jumps around from year to year but one finding helps illustrate the difference: in some years, the median income of women with mental health problems is higher than that of women without mental health problems, whereas for men the smallest the gap ever gets to is 10% and averages out at 15%, versus an average of 3% for women. As the chart shows though, the gap for women in the latest data is the largest it’s ever been.

The mental health income gap is larger for men than women

Source: Money and Mental Health analysis of Understanding Society, Waves 1–15 (2009–2024).

Notes: Median individual monthly income gap between people with and without significant psychological distress (GHQ-12 score ≥ 4), shown separately for men and women as a percentage of median income among those without distress in each group.

In the most recent data (2023-24) and using the self-reported diagnosis measure, the median income among men with a diagnosis is £368 lower a month than men without a diagnosis (18%), while for women that gap is £58 a month (4%).

I wasn’t shocked that the gap was bigger for men than women - men earn more on average so their income can fall further. The size of the gap, though, was bigger than I expected. Going back to that government report on what’s driving the recent increase, we do see an increase in distress for both men and women, but it’s consistently a higher percentage of women experiencing that distress. The same goes for our diagnosis measure in Understanding Society e.g. in the most recent wave, 25% of women report a diagnosis versus 15% of men.

Unpacking what’s behind that is tricky and raises questions that go well beyond a single Substack post. But one possible theory is that when it comes to diagnoses, men are less likely to either seek one, get one or share it with a survey interviewer. That would mean the men whose income we’re looking at in this analysis are more unwell on average than the women, with worse health having a bigger impact on income.

So to help focus in on one aspect of this complex question and to come back to income, I wanted to see what factors seem to be influencing the gap for men who report have a diagnosis. In our first report on this back in 2020, we pointed to three culprits. People with mental health problems are:

• less likely to be in work in the first place

• more likely to work part-time

• more likely to be in lower-paying occupations.

We’re looking at a different definition of mental health problems here and it’s for a different year, but when we try to break down or decompose the gap among men, we find something similar.

A big chunk of it - something around a half - is due to two of those issues we previously flagged: the combo of being more likely to be out of work and more likely to be in lower-paying jobs when in work. They’re difficult to separate because they tend to go together. Men with mental health diagnoses who are in lower-paying, insecure jobs are also the ones more likely to leave work altogether.

Age might be playing some role too, although among working-age people, men with diagnoses aren’t all in the younger age bracket - they’re relatively evenly spread across the age distribution. That means it’s not a simple story of “younger people are more likely to be diagnosed, younger people are more likely to be low earners, therefore the mental health income gap is really just an age income gap”. Age isn’t irrelevant, though: it influences what occupation we’re in, how much experience we have and how much power we have in the labour market, all of which affects our earnings.

That leaves roughly half of the male income gap that isn’t explained by those factors. There’s lots of things that could be: a sectoral effect (a similar level occupation might be better-paid in one sector than another), discrimination or education could all be a factor. It’s also worth noting in the iterations of this analysis, I initially used a narrower definition of mental health conditions to get things started. There, the unexplained gap was smaller. That might be a helpful reminder that we’re talking about a large and diverse group here and, turning back to what this all means for actual people and policy, there’s not going to be one policy response that works for everyone.3

What can we take away from this? It does tell us that the labour market plays a vital role in the lower incomes experienced by people with mental health problems. That means employment policy, employers, the benefits system, the health system all have a big role to play in helping to close the income gap. That’s why government reviews on those topics led by messrs Mayfield, Milburn and Timms are a great opportunity to get to grips with some of the underlying factors, fill in some of the gaps in our knowledge and, most importantly, get the policies in place to actually start closing this gap.

Subscribe now

The National Suicide Prevention Strategy is at its mid-point and with new leadership entering Number 10, there is the opportunity to take stock and consider what we might do differently. Since it was published in 2023, the policy landscape has changed significantly. We now have a 10 Year Health Plan for England, a cross-government mental health strategy in development, and neighbourhood health centres intended to bring together different forms of support within communities. At the same time, we continue to live through a cost of living crisis that has left many households under sustained pressure, bringing people into problem debt who never would have considered themselves at risk.

That matters because the current strategy made an important shift in how suicide prevention is understood. It explicitly recognised a wider range of suicide risk factors, from financial difficulty to gambling and domestic abuse, and included actions designed to tackle them.

But recognising risk factors is only the first step.

The harder question is whether the actions that follow actually reduce those risks — or whether they mainly use those risks as places to spot people already in crisis.

That distinction matters.

A suicide is a crisis, and people in crisis need rapid, compassionate and effective support. But suicide prevention cannot only mean crisis response. If we only intervene once someone is already suicidal, we leave untouched many of the pressures that help create suicidality in the first place.

Having worked for a decade at the intersection of money and mental health, I’ve seen how often financial difficulty is treated as a backdrop to crisis, something to observe, or at best understand, rather than something policy can change.

Why policy defaults to crisis response

Frontline suicide prevention services remain under intense financial pressure, with many organisations relying on short-term or uncertain funding. The £10m Suicide Prevention Grant Fund that ran from 2023-2025 was not renewed last year. Frontline crisis support organisations are, quite rightly, arguing loudly that the sector is on its knees and without urgent financial help some existing services will reduce or close.

That funding matters enormously. The minister needs to make a confident case for it.

But unless she wins that argument across government, and with local funding allocations not neatly in her control, the minister’s practical tools on suicide prevention are limited if the focus sits primarily on crisis response.

That does not mean crisis services are unimportant. Quite the opposite. A suicide is a crisis, and people in crisis need rapid, compassionate and effective support. And that needs funding.

But if suicide prevention becomes synonymous only with crisis response, the minister is left fighting for a smaller and smaller patch of ground, and the strategy will struggle to have a meaningful impact.

A more ambitious strategy would pair the case for frontline funding with a determined focus on reducing the upstream drivers of risk across government.

The current strategy points in that direction. Its action plan includes a specific section on ‘addressing risk factors’. But while there are 28 actions listed in that section, some are not really about reducing those risk factors at all. Seven of the 28 actions are focused primarily on identifying people at risk of suicide — informed by an understanding of wider risk factors — rather than reducing those risk factors directly.

For example:

“Improve suicide prevention signposting and support to people in contact with primary care services…”

“Include guidance for clinicians and support staff working in alcohol treatment services on identifying and managing immediate risk of suicide or self-harm…”

These are sensible and worthwhile actions. But they are not the same thing as reducing physical illness or reducing substance misuse.

And nowhere is that distinction clearer than in the section on financial difficulty.

How debt is treated differently

Compared with gambling, domestic abuse or loneliness, financial difficulty is treated even less as a problem to reduce and more as a place to spot crises.

Three of the four actions in the section on financial difficulty and economic adversity are primarily about identifying people at risk of suicide who are in touch with the Department for Work and Pensions or government debt collection systems, or strengthening responses when someone discloses suicidal thoughts.

The only action that actually relates to reducing financial difficulty and economic adversity itself is:

“Continue work to improve access and signposting to debt support…”

That may be useful, but it’s also extremely vague.

We now recognise debt as a suicide risk factor. We have not yet learned to treat debt reduction as suicide prevention.

Why this matters

Financial difficulty is not a marginal issue in suicide prevention.

A recent analysis of the 2023/24 Adult Psychiatric Morbidity Survey found that people with problem debt were:

• three times more likely to report having ever attempted suicide (21% vs 7%)

• almost twice as likely to report having ever self-harmed (19% vs 10%)

• 1.7 times more likely to have experienced suicidal thoughts (39% vs 24%)

The relationship is complex and there is rarely ever one single cause of suicide, but it is extremely clear that financial circumstances can play a significant role.

Previous qualitative work to inform our ‘Silent Killer’ report found that finances can shape suicidal thoughts and behaviours in at least two distinct ways:

1. Long-term financial difficulty can undermine resilience — persistent poverty, insecurity and unmanageable debt can exhaust people over time, increasing shame and isolation and straining relationships.

2. Sudden financial shocks can trigger acute distress — unexpected income loss, aggressive debt collection practices, rapid accumulation of fees or charges, or the sense that a situation is spiralling beyond control can leave people feeling trapped or hopeless.

That clearly points to a role for policy interventions that do more than spot people in crisis. It points to the need for interventions that:

• increase financial resilience

• improve income security

• help people resolve debts early

• ensure fair and proportionate collection practices

• make support easier to access before crisis point.

What addressing root causes could look like

New political leadership brings a moment of reflection, and with that an opportunity for a more ambitious set of actions on financial difficulty.

That could include reducing the psychological harm of debt collection by ensuring that the pace of escalation, the frequency and tone of contact and the severity of penalties are proportionate and reasonable in every sector — from energy to council tax to consumer credit.

It could include progressing the Government’s, as yet unmet, commitment to an independent regulator for the bailiff industry, tackling some of the most aggressive forms of debt collection that we see driving crises — for example in the highly publicised, yet too quickly forgotten, case of 19 year old Jerome Rogers.

And it could include improving access to debt advice and income maximisation support, unlocking some of the £24bn a year of unclaimed benefits and getting those struggling in debt to help before things spiral out of control.

That final point is broad — and my critique of the current strategy is partly that its own recommendation on debt support is too vague to drive meaningful change. So let’s get specific about where the minister may have more practical levers than it first appears.

Building suicide prevention into existing DHSC frameworks

Neighbourhood health services were rightly celebrated for the possibility of integrating debt advice and wider support for the social determinants of health into community health settings. But the subsequent Neighbourhood Health Framework and Neighbourhood health centres: design and performance specification have had remarkably little to say about delivering practical help with debt, homelessness, gambling or other socio-economic problems that can drive poor mental health and increase suicide risk.

That is a missed opportunity.

While local areas may well be best placed to shape the details of delivery, the idea that money and debt help should be integrated is a core foundational principle — not something that might be needed in Bradford but not in Brighton.

A refreshed suicide prevention strategy is another opportunity to make that case, set out what good looks like, and explain why it matters not only for wider health outcomes but for suicide prevention specifically.

In a similar vein, the upcoming Modern Service Framework for Severe Mental Illness should be a gift to the suicide prevention team. It will identify the types of support most needed by people with severe mental illness, including wider community support services like debt advice, and set expectations for how these should be put in place.

This, and all frameworks coming from the Department, should emphasise their role in tackling the risk factors for suicide.

Similarly, the new cross-government mental health strategy is a big opportunity. Many of the policies that help prevent mental health problems, or support people to live well with them, will also help reduce suicide risk.

Influencing policy across government can be difficult, with competing priorities, personalities and processes. But there are also plenty of untapped opportunities much closer to home, within the Department’s own frameworks and priorities, where you would hope the task is not quite so challenging.

It’s all just a work in progress

So, if suicide prevention is the work of so many government departments, strategies and policies — do we even need a specific suicide prevention strategy? And won’t it inevitably fall short if the breadth of its ambition is so huge?

Yes, and yes. But that’s ok.

Yes, we need one. The strategy is the only place that focuses on the important downstream work of suicide prevention in moments of crisis, and that work is vital and should not be forgotten.

It also does essential work demonstrating the impact on suicide rates of other policies, strengthening the case for things like investment in gambling treatment, domestic violence services and maternal mental health support.

And it exposes the huge opportunities that lie in increasing proactive identification of those at risk in settings informed by those risk factors for suicide — places like banks, DWP, energy providers or health settings. That’s before we even get into its role in tackling methods of suicide and on bereavement support.

All of that really matters.

But yes, the strategy will inevitably fall short. Being fully honest about the role of wider risk factors in driving suicidality — and the potential for policy to mitigate them — opens up a hundred possible avenues for action, without the time or resource to fully do all of them justice.

But I see policy as the art of incremental improvement. There are no silver bullets. All there is is good ideas, some of which we can make happen, and the hope that any new iteration of the strategy takes the strengths of the last one and builds yet further.

For me, that means ratcheting up the practical ambition of the actions on financial difficulty. Recognising that debt is a circumstance that policy can change, not a characteristic that must be accommodated. And that the combination of its status as one of the major risk factors for suicide, and the number of active opportunities in government policy (and in financial services), means this is the right moment to make financial difficulty a major focus in suicide prevention.

And if we do that, and throw some weight behind it, some of the most important suicide prevention interventions in the next five years might actually be made in debt collection rules, welfare systems, neighbourhood health models, and suicide prevention work so far upstream that the word ‘suicide’ barely features at all.