The clinical scenario here is at the interface between general practice and the Citizens’ Advice Bureau (CAB). It is important gently to probe patients who present with symptoms of anxiety or depression to ascertain the root cause of their troubles. The GP should avoid prescribing in a ‘one size fits all’ manner. Antidepressants can certainly take the edge off psychological symptoms but if the underlying problem is not treated, the symptoms are likely to recur once the medicine has stopped.

In a history you should be looking to cover areas such as work, relationship issues, bereavement, financial pressures and any recent or past events that may be contributing to the current psychological symptoms. Initially, patients may be reluctant to disclose such personal information. They may even have difficulty recalling some facts. Sometimes it will only be on reflection at home that they realise the answers to your questions.

This lady is very anxious and you have identified her debt as a serious contributor to her state of mind. Do you send her off to the CAB? Do you offer her some pearls of wisdom from Proverbs? Or do you take some time to help her over the long term to solve her problems?

Debt is a huge problem in our society. Less than 5% of the UK population save money for the future and there are over 35 million credit cards in circulation; those facts alone show the potential to trap people in debt. She is not alone. But in the same way that debt creeps up on you, getting out of debt has to be done step by step. There is no quick fix. I think it would be wise therefore for GPs to have thought out a strategy for helping patients caught in the debt trap. I would suggest a four-point model, which could be converted into an advice sheet to share with patients in her situation.

The size of the debt

First the debtor needs to be clear in their own mind of their actual financial circumstances. Some are victims of unemployment; many more are stuck in the ‘spending slightly more than they earn’ trap, hoping for the next pay rise to bale them out. One in five people say they regularly avoid checking their bank balance because they are too scared to find out how little money they have, according to Lloyds TSB (see www.creditaction.org.uk/debtstats.htm for more statistics).  Debtors should make an itemised list of all the money they owe and to whom. This may be quite frightening but the facts must be clear.

Income and expenditure

Then a table should be constructed itemising each area of monthly expenditure, for example mortgage/rent, utility bills, car expenses, food bills, clothing and luxury items. A similar table should be filled in for household income, including salaries, benefits and one off payments. Then compare the monthly income and expenditure. The resulting sum may be negative. It is important that this process is completed or true belt tightening will not be possible. This should be done with her husband/partner (if she has one) as the solution will require both of them to be on board. Honesty is an essential ingredient.

Future planning

Now they need to agree a financial plan. In the case of someone in financial crisis due to low income then the CAB will be a good source of advice regarding financial benefits. This will solve some debt problems. For many more it will be necessary to identify areas of luxury expenditure that need to be cut back. Once this has been agreed they can work how much debt they can afford to clear each month.  They should contact creditors and let them know what they can afford. They will be more reasonable if debtors communicate with them rather than throw each red bill in the bin.

Keeping control

Regular (which may mean weekly) reviews of the situation will be necessary to monitor the situation and ensure things remain on track. Keep a cashbook with a record of daily spending and tot it up at the end of each week.  The temptation may be to stop monitoring once things are settling. Beware, as complacency may mean heading back to serious debt. Credit cards lead to a detachment from the real value of money. Many wise people have counselled that these tempters should be cut up and cash used in their place.

One could argue that none of this is real medicine and is thus a waste of doctor time. I would reply that this is whole-person medicine. Long-term worry can cause psychological illness including anxiety and depression. It can also contribute to ischaemic heart disease, gastritis and irritable bowel syndrome. By taking the time with people who are in distress from worldly worries, they will see that you love them and support them despite their mistakes. Above all, I pray that they will know some of the Father’s love for them.

There are many wise Bible verses to reflect on for the Christian. Proverbs is full of them (Pr 21:17,20; 27:23,24). Hebrews 13:5 says, ‘Keep your lives free from the love of money and be content with what you have, because God has said, “Never will I leave you; never will I forsake you.”’