Addressing the Unique Financial Service Needs of People with Serious Mental Illness

People with serious mental illness (SMI) face profound financial precarity: most rely on public benefits that leave them well below the federal poverty level, and many struggle with financial management and self-determination. The association between SMI and limited income is well-documented, with clear implications for employment and public benefits policy reform—yet financial well-being extends beyond income amount alone. Equally consequential, and far less examined, is how people with SMI receive, store, spend, save, and borrow funds: their ‘financial access’ – or use of the financial services infrastructure of daily financial life. Evidence-based financial education and counseling interventions for this population, including guidance about financial services, remain scarce. Meanwhile, research with overlapping marginalized populations—people experiencing homelessness, substance use, and incarceration, many of whom also have SMI—documents both early promise and growing peril in the expanding fintech landscape. Some fintech apps initially provided accessible, low-cost alternatives to traditional banking, critical for a largely un- and underbanked population. However, recent qualitative findings reveal troubling debt cycles driven by earned-wage access or cash advance products, surfacing urgent concerns about predatory issues, particularly concerning for populations with financial vulnerabilities including limited income, executive functioning challenges, and heightened susceptibility to financial exploitation.

This roundtable will open a dialogue on improving the financial health and empowerment of people and families living with SMI through financial education and counseling that addresses financial services use, and policy reform to improve financial services options and regulation. Aligned with the conference theme of advancing rigorous inquiry for the common good, our panelists draw on theory, intervention research, and over a decade of community-based qualitative work to illuminate a critical and underserved intersection of mental and financial health. The first presenter will introduce a theoretical framework situating financial health—encompassing financial precarity, efficacy, and well-being—within the context of SMI, grounding the audience in the conceptual landscape. The second presenter will share findings from a feasibility study for a psychiatric hospital-based financial empowerment curriculum, with results suggesting that targeted financial skills training may improve discharge preparedness and support longer-term community reintegration. The third presenter will describe how financial access shapes available user options. The fourth presenter will draw on a decade of qualitative and mixed-methods research with people experiencing SMI, homelessness, substance use, and incarceration, documenting changes in financial access over time, and how fintech apps—initially experienced as accessible, affordable, and dignified alternatives to traditional banking—have increasingly become predatory in nature, with participants describing debt cycles precipitating housing loss and relapse.

The facilitated discussion will explore implications for: (1) research, including developing valid measures of financial health in behavioral health populations, evaluating financial empowerment interventions, and examining fintech’s role in financial precarity; (2) policy, including regulation of fintech targeting vulnerable consumers and expansion of public and basic banking options; and (3) practice, including embedding financial education and counseling into behavioral health services. Our goal is to catalyze a research agenda that treats the financial needs of people with SMI as inseparable from recovery, equity, and democratic participation.