Should Providers Ask, “How’s Your Financial Health?

Money may not be the root of all evil but it can be the root of a lot of problems, including mental health problems. But for clinicians, talking about it is taboo.

The amount of money we have and the way we manage it can greatly affect psychological wellbeing, with devastating consequences too frequently associated with financial stress. Between 2008 and 2010, more than 10,000 suicides across the U.S., Canada, and Europe were directly attributed to the global economic crisis.

Despite these numbers, therapists and physicians rarely ask their patients any questions about their financial status. It’s a taboo topic. In fact, and perhaps ironically, most clinicians will inquire about their patients’ sexual practices far more readily than about their financial practices.

The taboo about discussing finances makes this area of our patients’ lives—one too frequently fraught with worry—inaccessible to help from behavioral health and other clinicians. By not paying attention to our patients’ personal finances, we miss a key opportunity to link them to helpful services.

How money affects mental health
In many ways, the world revolves around money. When facing financial insecurity, every aspect of life becomes more difficult. You can’t eat well if you’re broke; medication may be out of reach; paying the rent or mortgage can be a struggle — and not being able to meet these basic needs creates enormous stress.

And if you’re already stressed by financial issues, work performance is likely to suffer. You may have difficulty concentrating and focusing, thus placing your job (and income) at greater risk and further raising your anxiety. It can become a vicious cycle and a negative spiral. Consider recent graduates who’ve taken on a heavy burden of student loans. Many are reeling from the debt, which may affect their ability to look for work, hold down a job, or move forward with their lives in other important ways.

Income and work status also directly affect health care access. Even those who have health insurance may find copays and deductibles impossibly expensive.

Money has a huge impact on almost every aspect of health.

These problems aren’t limited to patients
The fact that some therapists have money issues of their own can add to their reticence about asking their patients questions about personal finance.

During presentations, I’ll routinely ask behavioral health clinicians if they’re discussing money with their patients. They almost always answer with a resounding “no.” Then, I’ll ask about the state of their own personal finances: are they tracking their income and expenses, saving for an emergency fund, perhaps, if their incomes allow, investing in a retirement account? Generally, many will laugh nervously and say something like, “We’re social workers. We don’t make any money and neither do our clients.”

Like all human issues, paying attention to money concerns is the first step toward resolving them to the best extent possible—for both patients and therapists.

Expanding the paradigm
Our health and wellness depends upon an array of factors; money is one of many. And while financial issues tend to have a particularly powerful influence on mental health, there are many other variables involved.

To help patients live their best lives, clinicians of all disciplines can questions that address the whole person. Not just, “Are you depressed?” But, “How are you sleeping? How are your relationships? What does your diet look like? How are you tending to your spirituality? What’s your financial situation?”

In addition, behavioral health providers can familiarize themselves with resources that may be available in the community or the workplace. Many large companies offer financial wellness programs, having recognized financial stress as one of the biggest issues for their employees.

Moving beyond money
Financial troubles often intersect with other issues. Overspending can be a symptom of a serious mental health condition such as bipolar disorder. And many people simply live beyond their means as an attempt to cope with other problems or fill an inner emptiness.

In addition, we live in a culture that promotes consumption. Many people—even high earners—find themselves one or two paychecks away from financial disaster because they’re buying things they don’t need.

Mental health professionals can help by talking to our patients about the difference between wants and needs. We can share strategies for organizing life in a way less driven by unnecessary spending. This may be relatively new territory in the world of therapy, but it’s undeniably important.

Speak up and speak out
At Prudential Health and Wellness, we acknowledge five dimensions of health: physical, emotional, social, spiritual, and financial. Financial issues—as well as these other aspects of health—need to become a normal part of clinician-patient conversations. The more we inquire about money matters as a routine part of assessment, the more we will be able to help our patients get the comprehensive assistance they deserve.

Your Turn

• In what ways has money – or the lack thereof – affected your mental health?
• How would you react if your provider asked you about your financial situation?
• What pitfalls do you see to providers asking about finances? What benefits?