Mind and money matters

How to manage your finances: it is not a subject you are taught at school; you are just supposed to know how to do it. For people with a mental health condition, this can prove a real challenge. Psychologist Janneke Koerts investigates where things go wrong and what can be done about it.

^{Text: Beau Oldenburg / Photos: Henk Veenstra} 

Often, it starts with something small. A bill put to one side. A reminder shoved unopened into a drawer. Until before you know it, there are bin liners full of letters under the bed. ‘That’s how some people file their paperwork,’ says researcher Janneke Koerts. ‘We know because we’ve talked to them. They were simply too overwhelmed to do anything about it.’

Distressing

Koerts has enlisted the help of a small group of PhD students to examine the link between mental health conditions and financial problems. The team regularly comes across distressing situations: people stealing food or toilet paper out of sheer necessity, homes gradually falling into disrepair because the maintenance costs are too high, mounting rent arrears. ‘And this financial hardship comes on top of everything else a person is already struggling with,’ Koerts explains. ‘That makes it even harder.’

And she points out that money is more than just money. ‘If you have no financial wiggle room, you are vulnerable to social exclusion. No gym subscription, no hobbies, fewer social activities. All that has a direct impact on your quality of life.’

Interplay

Koerts explains that the relationship between mental health and money is two-directional. Financial stress can exacerbate mental health issues. Conversely, mental health problems can make it harder to manage your money. ‘Our main focus is on the latter. What impact does, say, ADHD or a psychosis or depression have on your finances and your ability to manage them well?’

Maintaining a good overview

A mental health condition can affect people’s finances in many different ways. For example, a student who fails to complete their studies can consequently struggle to find work. Individuals who reduce their working hours find their income decreasing. Some people are tempted to make unwise impulsive purchases. ‘You often come across impulse buying behaviour among people with ADHD,’ Koerts says. ‘It is generally the case that people with mental health conditions struggle with planning, setting priorities, and maintaining a good overview.’

Largely overlooked

To date, this problem has received relatively little attention. Koerts acknowledges that a lot of good work is already being done, but not as a standard part of the care on offer. ‘Whether or not financial problems are addressed tends to be the luck of the draw: which practitioner you happen to be assigned to and whether they know where to find the right support. Not every healthcare provider is aware of all the available referral options.’

Koerts estimates that approximately eighty percent of all existing research on the interplay between mental health conditions and financial problems focuses on people with dementia. ‘The issue is certainly not unique to one condition. It plays a part in a wide range of conditions, albeit with subtle differences. And yet other groups are being pretty much ignored.’

Taboo

Shame on the part of clients is a major problem. ‘We don’t find it easy to talk about money at the best of times,’ says Koerts, ‘and certainly not if we find ourselves in financial difficulties.’ As a result, financial worries tend to remain under the radar. Another obstacle is that financial problems are not always recognized to be part of a condition, ‘even though there is a definite link between the two.’

Everyday life

What particularly appeals to Koerts about this topic is the everyday nature of it. ‘I’ve always been interested in how mental health conditions impact people’s ability to function on a daily basis,’ she explains. ‘How they cope with money is a concrete example.’ Financial management is part of life, whether we like it or not. ‘We learn nothing about it at school and yet somehow we’re expected to know what to do.’

Surprising findings

Koerts uses a combination of questionnaires, interviews, and tests to map her research findings. ‘For example, we’ve developed a test to measure financial literacy. When you look at an invoice, can you distinguish the important information from the secondary information? Do you understand what is being asked of you?’ Another method she uses is to present people with hypothetical scenarios to see how they go about making financial decisions.

The interviews form an essential part of the work. Not only do they add nuance but sometimes they also yield surprising insights. For example, we found that people with a psychosis do not necessarily experience being placed under financial guardianship as negative. ‘You would think that people would be reluctant to relinquish control,’ says Koerts, ‘but many people indicate that it actually relieves their financial stress and gives them peace of mind.’

Basic needs

One of the other results that has emerged from Koerts’ research is less reassuring. A quarter of the people with a psychosis reported that they are unable to meet their own basic financial needs. ‘That is a significantly higher proportion than in the population as a whole,’ says Koerts. ‘And higher than their siblings’ — an indication that it has to do with more than upbringing. 

Failing system

Individual factors are only part of the story. The system itself plays at least as significant a role. ‘Finances are personal, but you have to manage them within a system,’ explains Koerts. And that system is complex: it comprises a bewildering spider’s web of rules, forms, and service desks. ‘And it is a cruel paradox that the more problems a person has, the more regulations they are faced with.’

Paralyzing

For people who already find it hard to concentrate or to gain an overview, the bureaucratic mountains they are expected to climb can be paralyzing. ‘There comes a point when people just think “It’s all too complicated. Why bother?”’ Their mistrust of the authorities does not help either. ‘Look what happened with the benefits scandal. Something like that really impacts how people view the system.’

Koerts believes that simplification is the answer. ‘We tend to assume that everyone can read and do maths, that they have a computer and know how everything works. But that’s just not true.’ She wants to see a shift towards more trust and less complexity. 

Better cooperation

Koerts plans to start a new project in June, financed by ZonMw, aimed at better integrating financial support into mental healthcare. ‘We’ll be working together with mental healthcare institutions, local authorities, and people with lived experience of mental health issues,’ she explains. Our central question is: how can we spot financial problems sooner and then ensure that people get the right help more quickly?

It is absolutely not the intention that practioners should suddenly take on clients’ finances. ‘They’re already under pressure,’ Koerts says. ‘But we can ensure that the warning signs are picked up sooner and that the lines of communication are made shorter.’

Starting small

‘We’ll start small, just in the provinces of Groningen and Drenthe. But we hope that over time, what is shown to work can be applied on a broader scale.’ She does not think it is realistic to reform the system from the top downwards. ‘But what we can do is to generate more understanding between the different domains and help the different parties to appreciate each other’s standpoints better.’

This is where the people with lived experience come in. They know better than anyone where things go wrong — and what helps. ‘The knowledge they bring to the table is invaluable,’ says Koerts.

International

And the project may not stop at the Dutch border. Plans are afoot to conduct an international comparative study together with colleagues from the United Sates and China. ‘There’s a cultural element to how finance works,’ she says. In the US, everything is done by credit card, whilst in China, the payment system is highly digitized.’ It is the differences that make comparing systems so interesting.

Less impulse shopping

Has Koerts changed her own behaviour as a result of her research findings? She smiles. ‘I’m a control freak by nature, so my financial admin was already in pretty good shape.’ But it has taught her something. ‘I’ve become more aware of impulse purchases. That brief rush of dopamine when you buy something.’ She pauses. ‘I recognize that feeling sooner now and sometimes I decide not to buy whatever it is after all.’

Further information

Janneke Koerts