Abstract
BackgroundJob loss, austerity measures, financial difficulties and house repossession contribute to the risk of self-harm and suicide during recessions. Navigating the benefits system and accessing sources of welfare and debt advice is a difficult experience for vulnerable people, further contributing to their distress. Whilst there is some evidence that advice-type interventions can lead to financial gain, there is mixed evidence for their effectiveness in improving mental health in those experiencing financial difficulties. There have been no interventions targeting those who have self-harmed due to economic hardship.MethodsOur aim was to determine the feasibility and acceptability of a brief psychosocial intervention (the ‘HOPE’ service) for people presenting to hospital emergency departments (ED) following self-harm or in acute distress because of financial, employment or welfare (benefit) difficulties. Nineteen people consented to random allocation to the intervention or control arm on a 2:1 basis. Participants randomised to the intervention arm (n = 13) received up to six sessions of 1:1 support provided by community support staff trained in Motivational Interviewing (MI). Control participants (n = 6) received a one-off session signposting them to relevant support organisations. Fourteen participants were followed up after 3 months. Participants and mental health workers took part in qualitative interviews. The acceptability of outcome measures including the PHQ-9, GAD-7, repeat self-harm, EQ5D-5 L and questions about debt, employment and welfare benefits were explored.ResultsInterviews indicated the main benefits of the service as the resolution of specific financial problems and receiving support when participants were feeling most vulnerable. Randomisation was acceptable to most participants although not always fully understood and control participants could be disappointed. Recruitment was slow (1–2 per month). The outcome measures were acceptable and appeared sensitive to change.DiscussionThe HOPE intervention is feasible and acceptable. There was evidence of need and it is a relatively inexpensive intervention. Refining aspects of the intervention would be straightforward. A full-scale RCT would be feasible, if broadened eligibility criteria led to increased recruitment and improvements were made to staff training and support.Trial registrationISRCTN58531248.
Highlights
Job loss, austerity measures, financial difficulties and house repossession contribute to the risk of selfharm and suicide during recessions
Job loss, financial difficulties and housing problems are associated with an increased risk of depression, self-harm and suicide [1,2,3] People with pre-existing mental health problems are vulnerable to the effects of financial difficulties [4, 5] and such individuals are the most likely to lose their jobs during periods of economic recession [6, 7]
People presenting to the Emergency Department (ED) of a large inner-city hospital in the South West of England following self-harm or with suicidal thoughts, depression and/or in crisis and where financial, employment, welfare benefit or housing problems were cited as contributory factors were identified by the members of the hospital’s liaison psychiatry (LP) team as part of the usual assessment
Summary
Austerity measures, financial difficulties and house repossession contribute to the risk of selfharm and suicide during recessions. Financial difficulties and housing problems are associated with an increased risk of depression, self-harm and suicide [1,2,3] People with pre-existing mental health problems are vulnerable to the effects of financial difficulties [4, 5] and such individuals are the most likely to lose their jobs during periods of economic recession [6, 7]. A review of studies investigating advice-type interventions, delivered in a range of settings, reported that advice services can lead to financial gain, but there is limited evidence of mental health improvements [8] These advice style interventions did not involve psychotherapeutic techniques and were given by a range of people including citizens advice volunteers/ workers welfare rights officers and advice workers and included giving advice in people’s homes, primary care, via telephones, offices or job centres about benefits, debt, employment, housing, legal issues, amongst many others.
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