This article is about the financial difficulties faced by people living in the United States who are poor and have mental illness, and a pilot programme seeking to help them. Millions of people in the United States cannot afford to meet their basic needs, and levels of unsustainable debt are high, given low incomes and a relatively high cost of living. People with mental illness are disproportionately represented among this group, even those who receive financial assistance from the government. The pilot project focused on helping people understand and make the best use of financial services, and worked with local banks and the government to try to improve locally available financial services. The United States has a great deal to learn from the experience of global microfinance. In addition, the benefits system must be reformed to increase people’s incomes, and reduce disincentives to saving and finding employment.