Money

It can be difficult to focus on your health when you are coping with the day to day work of meeting core needs, such as making rent or mortgage payments, earning a living wage, or taking care of your family. It is especially difficult if you are facing financial hardship – something that many people struggle with at one time or another, often through no fault of their own. Additionally, financial roadblocks may be even more challenging for a person who lives with a mental health condition like bipolar disorder.

In this section, we will:

  • review what we know about bipolar disorder and finances
  • share strategies you can try that may help you to protect yourself and your family from financial problems
  • discuss how to find assistance and support, and
  • review how poverty can impact quality of life more broadly

Key Messages

What to know about money:

  • Bipolar disorder linked to money problems such as impulsive spending, gambling problems, debt from mood episodes
  • Money problems can be an early warning sign of a mood episode
  • Financial stress can contribute to mood episodes

Why money is important to your quality of life

There is still relatively little research specifically examining financial problems in people with bipolar disorder. Impulsive spending, however, is a fairly frequent occurrence during episodes of hypomania or mania. One Australian study, for example, found that over 70% of patients with bipolar disorder type II report spending large amounts of money when hypomanic1. Consequences of over-spending included financial difficulties (no surprise). But the research participants also described increased interpersonal conflict with family members and partners as a result of overspending, as well as feelings of guilt and remorse. Another small research study looked at the relationship over time between financial difficulties and mental health in people with bipolar disorder.

A middle-aged southeast Asian woman is looking at a shirt for sale in a store.

Study results suggested that the relationship between financial problems and mental health problems may be a two-way street: mental health problems may increase risk of problems like compulsive buying, whereas worries about finances can exacerbate poor mental health2. Other research suggests that financial management skills may be lower in people with bipolar disorder compared to people in the general population, and that this may be related to higher levels of impulsivity3.

In qualitative research (using surveys and focus groups), people with  bipolar disorder talked about over-spending, impulse shopping and being excessively generous with money when in hypomanic or manic episodes. Study participants described sometimes experiencing severe anxiety, depression, suicidal thoughts and guilt afterwards. They described comfort spending and avoiding dealing with their financial situation as a means to cope during times of depression4.

Gambling, spending, and risk-taking

One way in which spending and risk-taking can be combined is through gambling. Commercial forms of gambling contain a built-in ‘house edge’ so that continued gambling is a costly behaviour that can create or exacerbate financial hardships. Gambling Disorder is a recognized form of behavioural addiction, characterized by a loss of control over gambling. ‘Chasing’ losses is an important indicator of gambling problems; for example, returning to a casino in an attempt to recover earlier debts. Recent research has found that a number of behavioural addictions are more common in people with bipolar disorder, including gambling problems as well as compulsive buying . For example, in one study from the U.K., rates of moderate to severe problem gambling were four times higher in people with bipolar disorder than in the general population5. This finding fits with other research studies6,7.

At the same time, people with bipolar disorder might at times benefit financially from the increased risk-taking and creative planning that may go with the condition. Research shows that some individuals with bipolar disorder report that it has increased their abilities to creatively and energetically tackle a wide range of real-world problems8. It’s reasonable to assume that for some people, bipolar disorder delivers improved financial outcomes some of the time9. But it is very important to acknowledge that these cases are uncommon, especially compared to those in which bipolar disorder or another mental health condition is linked with increased financial hardship.

A middle aged-white woman with short dark hair is standing in a dimly lit room holding what looks like it could be a wallet or a coin pouch.

How you can take action

The best time to protect yourself from bipolar disorder-driven financial decisions is when you are feeling stable. When you are exercising good judgment, your mood is fairly stable and your energy level is appropriate for you, you are in a position to plan ahead. It can be helpful to include your family or someone you trust in these plans. Here are some strategies you may want to try.

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Increase your money management abilities.

Managing personal finances is an essential life skill for us all. There are several key aspects of financial management, such as budgeting, managing debt, saving, and retirement planning. In one research study of individuals in psychiatric rehabilitation programs, improving money management skills was identified as one of the most important goals10.

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Limit your risk.

Make arrangements with your bank to protect yourself from risky spending while you’re in a mood episode. This could involve setting limits on your credit card transactions and withdrawals from accounts. Make an appointment to discuss this with a financial advisor or other staff member at your bank. Part of limiting your risk includes:

  1. Make a general financial plan. This could involve tracking your spending using an app, deciding how much of your income will be managed by a family member, or setting priorities for spending. Sometimes healthcare providers or support workers are available to help with this process.
  2.  Make an emergency financial plan. Work out a plan for times of risk. This could include documenting and, if you wish, sharing your personal triggers for impulsive or unwise spending, as well as documenting the ways you have chosen to limit your risk (as in point #2 above).All of these financial protections will need to be discussed in advance with bank representatives and appropriate authorizations will need to be signed in the case that you choose someone you trust to protect your finances if you are unwell.
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Find a trusted helper.

A helper is someone you highly trust who will act to safeguard your financial interests if you aren’t able to make safe decisions. You may decide to give this person power of attorney so that they are able to take control of your savings, credit card and chequing account if you clearly are in a manic or depressive episode such that you cannot trust yourself to make safe money decisions. Only you know who the right person is for you, or if this is an appropriate choice for you.

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Alert healthcare providers.

Sometimes manic or depressive episodes can be made less severe when they are just beginning by increasing or adding medications. Your healthcare provider may be able to quickly step in and prevent bipolar disorder financial crises.

A close-up of someone sitting on the floor, with an arrangement of financials and tax return documents and their phone set to the calculator mode. It's a close-up showing just their arm and legs. They have white skin and are wearing a black leather bracelet, nail polish, and black skinny jeans.

For information about the signs and causes of excessive gambling, the CAMH website is very useful https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/problem-gambling. Support for people experiencing gambling problems varies by country and jurisdiction. For example, in British Columbia there is a dedicated treatment program https://www.bcresponsiblegambling.ca/problem-gambling. Many regions have specialized telephone helplines and options for gamblers to ‘self exclude’ from casino venues or online gambling websites. GamTalk offers online live chat for gambling support https://www.gamtalk.org/. Finally, some banks are beginning to provide tools to enable gambling blocks on debit- or credit- cards; it is important to be aware that gambling on a credit card can incur high interest rates.

Take Action

How you can take action:

  • Improve money management skills
  • When well, take steps to protect against bipolar disorder-driven money problems
  • Identify trusted money-management supporters if needed

Accessing support

Many people who live with chronic health challenges, including mental health conditions, are unable to do paid work to support themselves financially. If you’re unable to do paid work it is possible to seek other forms of support. Many countries offer disability support for people who are unable to work because of serious health conditions. This may be through a public plan (sometimes called a disability pension) or through a private insurance carrier. Note that the process of applying for a public disability pension can be demanding, so you may need support in completing the application process. See your healthcare provider or support worker to discuss where in your area you can find this kind of assistance.

Finally, it bears repeating that it can be challenging to manage a chronic health condition if you are struggling financially. One study described how people with bipolar disorder, even in countries where access to mental healthcare is generally good, still had financial problems accessing sufficient treatment, usually related to monetary constraints or problems with health insurance11. In this way, your financial wellbeing can have a strong impact on other areas of quality of life and your overall health. For example, you may struggle to maintain physical health if you can’t afford healthy food. You could struggle in your home quality of life if you can’t afford rent in your area and are forced to live in unsafe or unsatisfactory housing. Concentrate on meeting your core needs first, such as  accessing supported housing, public assistance or asking a support worker to help you meet  your core needs.

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References

  1. Fletcher, Parker, Paterson, & Synnott, 2013Fletcher, K., Parker, G., Paterson, A., & Synnott, H. (2013). High-risk behaviour in hypomanic states. Journal of Affective Disorders, 150, 50–56. doi:10.1016/j.jad.2013.02.018
  2. Richardson T, Jansen M, Fitch C. Financial difficulties in bipolar disorder part 1: longitudinal relationships with mental health. J Ment Health. 2018;27(6):595-601. doi:10.1080/09638237.2018.1521920
  3. Cheema MK, MacQueen GM, Hassel S. Assessing personal financial management in patients with bipolar disorder and its relation to impulsivity and response inhibition. Cognitive Neuropsychiatry. 2015;20(5):424-437. doi:10.1080/13546805.2015.1076722
  4. Varo C, Murru A, Salagre E, et al. Behavioral addictions in bipolar disorders: A systematic review. Eur Neuropsychopharmacol. 2019;29(1):76-97. doi:10.1016/j.euroneuro.2018.10.012
  5. Jones L, Metcalf A, Gordon-Smith K, et al. Gambling problems in bipolar disorder in the UK: prevalence and distribution. Br J Psychiatry. 2015;207(4):328-333. doi:10.1192/bjp.bp.114.154286
  6. Kennedy, S.H., Welsh, B.R., & Fulton, K. et al. (2010), Frequency and correlates of gambling problems in outpatients with major depressive disorder and bipolar disorder. Canadian Journal of Psychiatry, 55: 568-576. 
  7. McIntyre, R.S., McElroy, S.L., Konarski, J.Z., et al. (2007). Problem gambling in bipolar disorder: Results from the Canadian Community Health Survey. Journal of Affective Disorders, 102: 27-34.
  8. Michalak. E.E., Yatham. L.N., Maxwell. V., Hale S., & Lam R.W. (2007). The impact of bipolar disorder upon work functioning: A qualitative analysis. Bipolar Disorders, 9: 126-143
  9. Lobban. F., Taylor. K., Murray. C., & Jones. S. (2012). Bipolar Disorder is a two edged sword: a qualitative study to understand the positive edge. Journal of Affective Disorders, 141(2): 204-212.
  10. Elbogen. E.B., Wilder. C., Swartz. M.S., & Swanson. J.W. (2008) Caregivers as Money Managers for Adults with Severe Mental Illness: How Treatment Providers Can Help. Academic Psychiatry, 32: 2.
  11. Oedegaard, C.H., Berk, L., Berk, M., ISBD Transcultural Task Force, Youngstrong, E.A., Dilsaver, S.C., Belmaker, R.H., Oedegaard, K.J., Fasmer, O.B., Engebretsen, I.M. (2016) An ISBD perspective on the sociocultural challenges of managing bipolar disorder: A content analysis. Australian & New Zealand Journal of Psychiatry, 50(11), 1096-1103.