Debt support scheme for people in mental health crisis reaching just 3% of forecast number

Just 786 people started breathing space programme - for which AMHPs play key role - in first 10 months, prompting calls for action to widen access

Couple struggling with debt
Photo: Stock

Just 3% of the expected number of people have accessed a scheme to help people in mental health crisis manage their debts.

The government had forecast that 27,500 people would access the mental health breathing space programme in 2021-22. The scheme gives people a moratorium on certain debts for the duration of their treatment plus 30 days.

However, just 786 people were registered for the scheme in its first 10 months, from its launch in May 2021 to February 2022, equivalent to 3% of the anticipated number.

To access mental health breathing space, a person needs an approved mental health professional’s (AMHP) certification that they are accessing mental health crisis care. This  encompasses being detained in hospital under the Mental Health Act 1983, being removed to a place of safety by the police or receiving any other crisis, emergency or acute service from a specialist team in relation to a serious mental disorder.

The purpose of breathing space is to give the person the opportunity to tackle their debts by preventing creditors from contacting them or taking enforcement action for the duration of the scheme, and providing them with debt advice.

AMHP leads’ concerns

The AMHP Leads Network, which represents AMHP managers, said the figures confirmed what they had been seeing in practice, and that action was required to widen awareness of the scheme to other mental health professionals.

“Prior to implementation we had expressed concerns that limiting the certification role to AMHPs may overly restrict access to the scheme – as many people in mental health crisis do not encounter AMHP services,” said the network.

“AMHPs and AMHP services are well aware of and ready for referrals to the scheme and most have taken steps to promote this locally. However we are not confident that the broader range of mental health services supporting people in crisis are aware of and promoting the scheme and this may be limiting referrals.

“Wider publication of the scheme to the full range of community and inpatient mental health teams may be required in order to improve the uptake of what is a welcome and much needed intervention to people experiencing mental health crisis.”

More on your role under breathing space

Community Care Inform Adults users can find out more in our guide to breathing space by Tim Spencer-Lane.

The Money and Mental Health Policy Institute gave a similar message in a recent report on tackling financial difficulties among people receiving specialist mental health care.

It said the low take-up of the scheme was not indicative of need but implementation challenges. It urged the Treasury, which oversees breathing space, to consider promoting its use among mental health practitioners other than AMHPs, such as social workers, nurses and healthcare assistants.

Problem debt ‘can exacerbate mental health problems’

More significantly, it said the scheme should be offered automatically to all people detained under longer-term sections of the MHA, such as section 3 (detention for treatment in hospital). The institute said this would reflect the wider recognition of the “links between mental health problems and financial difficulties and how problem debt can exacerbate mental health problems”.

To enable this, professionals should conduct a systematic enquiry of people’s financial circumstances within 14 days of their detention starting, before referring them to an AMHP for certification if appropriate.

“This would also ensure opportunities to support people through formal debt advice after discharge are not missed, and people will be supported to resolve financial difficulties and help to prevent financial worries from hindering recovery,” the report said.

The government’s view is that take-up levels reflect much lower demand for debt advice during the pandemic, and debt advice providers and mental health crisis care providers taking time to adapt their ways of working to breathing space.


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17 Responses to Debt support scheme for people in mental health crisis reaching just 3% of forecast number

  1. Trev April 11, 2022 at 3:11 pm #

    Rather than blame other professionals for their supposed ignorance the AMHP Leads Network might find it more illuminating to reflect on what an AMHP told me when I asked to discuss this “AMHP’s don’t have the time to do basic social work.”

    • Lou April 13, 2022 at 9:26 pm #

      I am pleased to say Trev that I don’t know any AMHPs in my neck of the woods that would have that attitude. I am sorry you came across someone who would say that.
      I do think that the mental health crisis breathing space is like many other benefits / schemes supposedly provided to help people in crisis. Too narrow in remit, badly publicised and too complicated. Makes you wonder if the government really wants people to take these things up….I think the idea of screening patients on longer sections to see if they need financial assistance or advocacy would be a great idea. We know that poverty and complex social disadvantages are bringing people into mental health services. It can only get worse in the current climate.
      As an AMHP I can only say that I want to do more, not less in terms of work and interventions that can address the wider challenges that many patients face.

    • Megan May 10, 2022 at 6:55 am #

      Exactly and what about those in mental health crisis not having mha assessments?

      Possibly at point of mha assessment people aren’t able to identify debt and organise this rather this should be available before

  2. Ellie April 14, 2022 at 9:09 am #

    Interesting quote there Trev. Not sure if it means that AMHP’s believe what they do is more ‘complex’ than mere social work and their skills transcends social work so this task is beneath them or that they would like to do basic social work but are too busy to do so?

    • R April 15, 2022 at 10:12 am #

      Surely it means that the AMHP role & their interaction with a person at a MHAA is extremely limited, including time limited. The AMHP is likely to receive referral, risk assess & apply for warrant, attend MHAA & that’s about it… no ongoing involvement with the person as the MHAA will have been conducted by the AMHP available on duty & not by someone who knows the person. In my experience anyway. Plus only meeting someone at a MHAA gives very little opportunity to get to know a person or gain any trust (no one present when someone is removed at hospital, often against their will, is likely to remain very popular with them for some time…), and they may well be too distressed/unwell/psychotic to engage in discussions about their finances. This referral should be able to be made by any mental health professional (& responsibility of whoever is care coordinating in community or key working on the ward). Though again IME ward staff are not keen to even ask any questions about social situation… OTs excepted!

      • Hutton April 15, 2022 at 11:15 am #

        But AMHP’s get offended if you regard them solely for “sectioning” don’t they? I’ve been at no end of many a tirede by evangelising AMHP’s keen to tell us what a complex role they have and how adept they are at establishing relationships under the most challenging situations with complexity unimagined by the likes of non-AMPH’s. Are you saying that they only see people for a MHAA and then dump them to the tender care of doctors and nurses and whoever else is passing along the way? Curious.

        • R April 17, 2022 at 5:36 pm #

          It depends on the setup in your area I guess. AMHPs are often social workers on a rota who work in different teams, so when they attend a MHAA for someone not under their service they aren’t likely to have further involvement.

      • Tahin April 15, 2022 at 9:01 pm #

        It really is a tired trope now this “ward staff” not having any regard for the social circumstances of people. Any social worker who sets foot onto a ward without preconceived notions and humility will know that nurses and treating doctors are very keen indeed to know about the social situation. If for no other reason that they can’t discharge without knowing and they can’t do a mental state holistically without knowing. If what you mean is that they require social workers to inform them too, well that’s our job isn’t it? It doesn’t mean we and the token OT have special magical powers that nurses and doctors don’t have. Actually, we are the magpies of care professions. We really should stop pretending that we don’t borrow and steal from others better trained and better equipped than us. Good as I think I am at my job, I see nothing unique in my training. Compared to the highly specialised and nuanced skills of nurses, doctors and indeed OT’s, what do we bring that they don’t already posess? I am proud to be a social worker but I am not proud of the self given entitlement that some of us covet to rubbish our colleagues. The RCN and the BMA and indeed the RCP stand for something tangible and credible. What does SWE stand for?

  3. Dan April 15, 2022 at 8:11 am #

    Maybe advertise this scheme to social workers. Please un my team would use it. I stumbled across it by accident a few months ago.
    Don’t blame social workers for not using something that they don’t k ow exists.

  4. Peter April 16, 2022 at 8:18 am #

    I thought we had PSW’s precisely so we didn’t have to rely on publicity to inform us on changes to legislation and “schemes”? Aren’t they meant to be the ones keeping up and ensuring we catch up? I think it’s time we stopped blaming everyone else for our deficits. And haven’t heard the dreaded Tories pumped in a bit of loose change for AMHP’s get this going? Here’s a novel idea: local AMHP Leads could spare an hour from their busy schedules and lay on a briefing session to all social workers. Their PSW chums could ensure that our team leaders give us the time to attend/zoom in. It’s not that outrageous to expect social workers to teach social workers how to do social work is it?

  5. Chris April 16, 2022 at 10:27 am #

    My manager is in no end of meetings with providers and health professionals so am intrigued why the AMHP Leads Network isn’t encouraging their cohort to publicise and promote this to the wider mental health services. They have the responsibility to make it work so why the shifting of the low take up on to others? In the last 2 months I’ve been asked to gen up on MCA and Court of Protection rules so I can brief colleagues including doctors and inpatient managers. If a mere CMHT social worker can have that responsibility why not AHMP managers? Unless ofcourse “basic social work” really is too menial a function for AMHP’s? In contrast to Lou, my experience is that AMHP’s seem to be more interested in impressing lawyers and psychiatrists than being social workers. Just this week I was told in no uncertain terms that having admitted “your patient” I needed to be aware that he was likely to appeal and I should get started with the “tribunal report”. Not sure which part of that is common social work language.

  6. Esme April 24, 2022 at 4:22 pm #

    So they are just “experts” in conducting a mental health act assessments then? Which means they aren’t practicing social work given that other professionals are AMHP’s too?

    • Hamish April 25, 2022 at 3:14 pm #

      If this is the case than what is the oft assorted claim that they bring in a “unique” social work perspective? Surely organising and conducting a MHA so it complies with legislation is following ‘technical’ rules that anyone from any background can do? No disrespect intended as I am sure the AMHP role is as complex and as stressful as claimed but that must be the same for an AMHP who is a nurses or an OT? Building relationships and maintaining them is the minimum of social work tasks surely?

  7. AMHP April 26, 2022 at 9:56 pm #

    I appreciate that social workers find us AHMPs a bit of a challenge but the level of misinformed comments here are astonishingly off the mark. Actually what we do is social work at its purest. Intervening in lives when the person is at their most vulnerable and in their most distressed moments, consulting with relatives/families/partners when they are at their most bewildered state. We preserve their dignity and we ensure they are all treated in the most appropriate way. Without us civil liberties would be ignored and prejudice prevail. Ofcourse we talk the language of doctors and lawyers, they are our most immediate peers and at times our adversaries. We understand the law and we understand psychiatry. No apologies for that. Can the same be claimed by other social workers I wonder. We see people, we get them treated and we move on. That’s our role. It’s yours to follow up, engage and not walk away because you have a “heavy” caseload. I do on average 4 MHA in a week and have at least another 6 to triage and follow up. That’s my lot what’s yours If? If you think we are slackers and we can’t do basic social work you are misguided. That we may not do what you think is social work is a conundrum for you. Frankly we are highly qualified experts in psychiatry and that is more than enough. We don’t need to justify our skills here, our validation is embedded in law and in the respect and admiration we get from lawyers, medics and others who understand mental illness. Frankly, if the AMHP Leads did their jobs better I wouldn’t have to write this.

  8. Abigail April 27, 2022 at 8:30 am #

    Given that nobody seems to know what social work is these days the person walking past me in the street saying hello is probably also doing social work so I’ll just park that here. It took 9 weeks for the “AMHP Service” to respond to my mum contacting them about a family member she was worried about. She was told to contact her GP first. It took our family member being brought to a police station before an AMHP spoke to her again on phone. Our family member was apparently safe as they had “good family support” and we knew how to contact services in an emergency so they were told to return home. My mum was not given any details of what happened when the AMHP saw our relative in custody nor what alternative services they could access. It took my declaring I was a social worker before an explanation that our “concerns” and my relatives “presentation” did not meet “the threshold” was offered. Some 14 weeks later when by now my mum was worn out and after our relative was again arrested for an AMHP to actually speak with her face to face. She was told that perhaps she could ask our relative to move out and that perhaps “your daughter being a social worker” might be making it difficult for our relative to “relax”. No further action was taken by the AMHP and no alternative support was suggested. My relative was once again arrested, this time trying to get on railway tracks and taken directly to hospital by the police. Two days after this an AMHP saw our relative in hospital and he was admitted subject to S3. The AMHP recorded that our relative was living with a “perhaps over protected family” and that my relationship was more one of “social worker than sister”. That’s right we were contacting them about a son and brother. AMHP’s are no doubt busy and rightly should weigh up the merit of referrals. In my professional and personal dealings the first response has always been to bat away the referrer though. It’s good that my colleague here gets their validation from the law and is respected and admired by lawyers and medics and others who “understand mental illness”. But guess what, so do relatives and friends of someone in distress. “Highly qualified experts” saying go somewhere else as their first response is not really a something that should be “more than enough”.

  9. Sandra April 27, 2022 at 12:27 pm #

    AMHP is right, us bog standard social workers always do find it a challenge to speak to one.

  10. Ian April 27, 2022 at 6:23 pm #

    I am saddened by some of the experiences spoken about here and while I also understand why my AMHP colleague has responded in the way they have, I have to accept that the way we AMHP’s are utilized isn’t always positive for people and families going through a mental health crisis. It’s a disappointment that the AMHP Network has not really tackled this. We are all social workers and AMHP or not we all grapple with complex lives. We should be honest and supportive of each other. Nothing positives comes of defensive responses. I am truly sorry that Abigail and her mum had this experience and although I don’t know the case details, I would hope that most of us would be a bit more empathetic.