Making money work for the mentally ill

As director of policy to former UK deputy prime minister, Nick Clegg, Polly Mackenzie was well versed in campaigns large and small, not to mention the 24/7 rhythm of life at the heart of the British government.

Her current objective, though, is something far more personal. Now heading up a recently-launched policy institute, Money and Mental Health, she is focusing on breaking the link between financial difficulty and mental health problems. It’s an issue which has long held substantial allure.

“Mental health has always been something I’ve been interested in,” she says. “My dad is a psychotherapist, but in politics it’s an issue which Nick Clegg and I worked on for the 10 years we were colleagues. When he became leader of the Liberal Democrats, it was his first question at Prime Minister’s Questions, and in government it transitioned into something that we really tried to push up the agenda. Now, I’m focusing on the fact that people with mental health problems are three times as likely to be in problem debt – but it doesn’t have to be this way.”

Money talks

Money and Mental Health was set up last year. Founded and funded by “Money Saving Expert”, Martin Lewis, it aims to research and identify practical policy solutions to the link between mental illness and money problems, working in partnership both with those providing services and those using them to find what really works.

“We’re looking at legislative, regulatory and product change,” explains Mackenzie. “What is fascinating is how, during periods of poor mental health, people’s cognitive and psychological processes change, making them more challenging to deal with as customers. This is relevant for public services as well, because they have to interact with everybody – especially when you’re dealing with the welfare benefits, some of which are reserved for people with some kind of impairment, otherwise they wouldn’t be eligible.”

The trouble is that systems and processes rarely take into account these types of variables, designing instead a one-size-fits-all approach which fails to achieve the intended outcomes. “We want financial services companies to assess people’s mental capacity, or make it easier to interact with their provider or raise a query with them – and government should be doing this as well,” adds Mackenzie.

“People so often get into difficulties after misunderstanding just a direct debit form – which is a simple page with only four pieces of data you need to enter. Whereas the application form for a benefit for a vulnerable person is often up to 50 pages long – they are designed for people who are neuro-typical, even though the customer group is far from that.”

Rising up the agenda

As a political issue, however, there is no doubt that mental health has become far more prevalent in Westminster discourse and beyond. A good example of its new-found ubiquity is that both David Cameron and his successor as prime minister, Theresa May, chose mental health as the subject of their first New Year announcements, in 2016 and 2017. “The power of mental health as a political issue is that it is about caring for people who are vulnerable and is by no means limited to people who are poor,” Mackenzie points out. “It crosses the political spectrum like few other issues.”

Although the close resemblance of Cameron and May’s two announcements prompted some murmurings, it nonetheless served as further evidence of the issue’s rising profile. But is it just seen as a useful tool for politicians in search of a soundbite? Not so, believes Mackenzie.

“I’m not that cynical about it,” she says. “For Theresa May, her focus on mental health has arisen from her interest in police efficiency when she was serving as home secretary, and the ridiculous situation of the police having to use their cells for people who are really more in need of intensive mental health care. It’s a waste of police resources and is not good for the person or the community.” She believes that Cameron, too, was sincere but that his interest was always competing with the many other issues on his radar.

“Improving mental health services requires investment – and that money has to come from somewhere,” she says. “So it is really a question of prioritisation. You can have a sincere belief, but whether or not it trumps deficit reduction or some of the other spending pressures is down to the individual, and this is where a gap can materialise between the rhetoric and reality.”

Life as a “SPAD”

As Clegg’s director of policy, Mackenzie became a member of Westminster’s battalion of special advisors or SPADs – politically appointed aides to ministers. Unlike their colleagues in the civil service, their tenure is tied directly to the fate of their minister – they rise and fall with them. The more senior the minister, the greater the number of special advisors they are allowed to recruit.

“The job description can be very different and varied,” says Mackenzie. “There are policy special advisors and media special advisors, but the basic part of the role is to act as a link between the politically neutral civil service and the political party of each minister. After all, ministers are politicians and they need to be connected to politics.”

In her role running the Liberal Democrats’ policy shop in government, Mackenzie was an eyewitness to, and participant in, the British policymaking machine. It was an illuminating experience, to put it mildly.

“What you need for a campaign are some good ideas that sound nice, but this is just the skin on the apple in terms of what it actually takes to make something happen,” she says. “As a party, our preparation work before the election extended to working out the cost of our proposals, but only in order to take questions from the press – not in terms of where we were going to find the money from. By contrast, David Cameron’s Conservatives had invested huge amounts of time in preparing for being in government. This meant that I and all our ministers and staff went through a huge crash course about how to get stuff done. It’s fair to say we had lots to learn in those first few months.”

She goes on to say that the structure of the British government made this learning curve steeper. “It doesn’t recognise coalition governments, and so our legitimacy to ask for stuff was often questioned,” she recalls.

“Looking back, I think of things we would do differently given the chance, but also areas of success. The biggest regret was the Health and Social Care Act, a landmark health reform that everyone said was going to be a disaster. We only paused the legislation, but it was clear it was going to be a mistake and it turned into a three-year distraction for a healthcare system which is trying to deliver more with less every day. It just wasn’t worth all that pain. But then there other examples, like the Pupil Premium, which I am intensely proud of and is something that looks like it is here to stay. The real magic is coming up with these types of policies that are impossible to get rid of and are working as intended.”

Coming up with a similar level of policy success at Money and Mental Health is now her overriding objective. But while there are no easy fixes – and the road ahead will doubtless have a few twists and turns – few would bet against her.