Send the Debt and Mental Health Evidence Form (DMHEF) to your creditors

This sample letter covers England and Wales

For a version of this sample letter that covers Scotland, please click here.

Use this letter to send the completed Debt and Mental Health Evidence Form (DMHEF) to your creditors.

You can find information about how to use this letter in our Instructions for using the Debt and Mental Health Evidence Form (DMHEF).

Fill in your contact details, account number and any extra information you want to include in the grey shaded areas.
Today’s date will be added automatically.
Sign each letter.

Letter in joint names

You can choose to send a letter in your own name or in joint names. You may have a debt in joint names, or want to write to your creditors together because you have worked out a joint budget.

Change to joint version

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27th July 2024 [today’s date]*

Dear Sir/Madam

Account No:

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I enclose a copy of my completed Debt and Mental Health Evidence Form (DMHEF) and consent form.

As you will see from the DMHEF, my mental health condition is seriously affecting my ability to manage my money and debts. Please consider my circumstances and use your discretion when collecting on any debt that I owe.

I would like you to

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I look forward to hearing from you.

Yours faithfully

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Send the Debt and Mental Health Evidence Form (DMHEF) to your creditors (sole name)

Send the Debt and Mental Health Evidence Form (DMHEF) to your creditors (sole name)

Letter in joint names