Mental Health and Insurance

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TOPIC: General Studies 2

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In News: A year after National Mental Healthcare Act 2017 was passed by the parliament, the Insurance Regulatory Development Authority of India has come out with guidelines asking all insurers to include mental health under their ambit of coverage.

As per the Mental Health Survey of India for 2015-16 which was conducted by National Institute of Mental Health and Neuro Sciences, approximately 15 percent of Indian population suffers from mental health issues which require active intervention. Mental illness requires prolonged medical attention along with continuous care and support from professionals which is often a huge financial burden on families. What makes this problem more complex is the deep rooted stigma around mental health conditions.

The right to mental health

The term “mental health” has become a euphemism for “mental illness”. This is in stark contrast to what it should be, for mental health is the most valued asset we have, the most treasured aspect of our humanity. This is precisely why, when people are asked to compare different health conditions, mental health problems are ranked as the ones they fear the most. This is not surprising, for we rely on the diverse capabilities our mental health underpins to successfully learn and master the skills that make our lives meaningful and worthwhile. So, one would expect that mental health would be the most prioritised of all issues facing the world. Sadly, that is quite far from reality.

Mental ill health is on the rise worldwide, but that this increase is causing massive amount of disability, early deaths and fuelling cycles of poverty. Most people with mental health problems do not receive care, which prolongs suffering and leads to colossal societal and economic losses. Even worse, they are often subjected to human rights abuses and discrimination. Perhaps no other cause of suffering has been so profoundly neglected.

In India, suicide is now the leading cause of death of young people, alcohol use is blatantly promoted by commercial interests and its abuse has been relegated to a moral issue to be addressed by primitive, punitive policies rather than through a public health approach, tens of thousands of people with severe mental health problems languish in horrific conditions in mental hospitals or on the streets and appalling deprivations — from under-nutrition to neglect — that affect the development of the brain in childhood remain unchecked. There are virtually no community-based mental health services in the country.

Mental Health and Insurance

As per the Mental Healthcare Act, mental illness means a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgement, behaviour, and capacity to recognise reality or ability to meet the ordinary demands of life. It also includes mental conditions associated with the abuse of alcohol and drugs, but does not include mental retardation which is a condition of arrested or incomplete development of mind of a person. The Act further states that every person with mental illness will be treated as equal to persons with physical illness when it comes to healthcare, including health insurance.

IRDAI has taken cognisance of the law, and asked insurance companies to implement its provisions. The circular is a step in the right direction as it increases the scope of health insurance coverage for a large number of population. As per the National Mental Health Survey of India for FY16 conducted by the National Institute of Mental Health and Neuro Sciences, nearly 15% of Indian adults are in need of active intervention for one or more mental health issues.

IRDAI, in its circular, said that insurers will have to make provisions to insure mental illness, according to the rules laid down by the Mental Healthcare Act, 2017. According to Section 21(4) of the Act, every insurer needs to make provisions for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness. The circular stated that insurers will need to comply with these provisions with immediate effect.

However, this may still not mean a blanket cover for mental illness and may affect the pricing. Premium will have to be revised and though there was nothing against covering, but companies have always excluded not going the claims that can arise out of it.

Issues that have riddled the mental health industry with obstacles in proper implementation and provision of services

1. There are some differences in the definitions and coverage of mental disorders, and insurance companies will need to draft policies after considering the pros and cons of each system. Moreover, if insuring mental illnesses becomes dependent on the diagnoses – i.e. if claims will necessarily require a diagnosis for reimbursement – there is a chance that the healthcare system may be burdened with over-diagnosis, especially for children.
2. It will be important to identify treatment modalities covered within the insurance plan. For example, depending on the severity of symptoms, psychopharmacological medication, psychotherapy or both may be required for treatment. In other cases, hospitalisation may be recommended. Therefore, insurance agencies will need to identify the scope of coverage for various mental disorders as well as rely on scientific, evidence-based therapy for the same.
3. Third, and a related issue, will be to determine adequate licensing for mental health professionals in the country. Although the Rehabilitation Council of India bears the responsibility of registering clinical psychologists in India, there are several mental health para-professionals, including counselling psychologists and psychotherapists, whose licensure is not currently covered. Ideally, the IRDAI notification will push the sector towards ensuring that appropriate professional identification, regulation and registration of mental health professionals across the country happens.
4. Fourth, it will now be the shared responsibility of insurers and mental health professionals alike to facilitate the acceptance and literacy of mental health conditions across the country. After all, when insurance agencies develop their models of mental health coverage, they will also want to guarantee sufficient buy-in from clients who may already be insured for physical ailments. This pushes the mental health dialogue to new heights, especially in the policy and insurance spaces, furthering the cause of establishing and sustaining mental health infrastructure in an overburdened country.

Conclusion

The growing acceptance of mental health issues among the urban youth is an indicator of demand for coverage. Further, whether only health or medical policies will include mental disorders in their coverage is not immediately clear.

This is a paradigm shift in the Indian mental health space, with the potential to change how our country perceives mental illness. Improper implementation at this juncture could set us back several years. Insurers will hopefully acknowledge this policy as a complex yet important move for the overall wellbeing of their clients.

Must read: Link 1

Connecting the Dots

1. Addressing mental health will influence economic productivity of our nation. Discuss.
2. The Rajya Sabha recently passed the Mental Healthcare Bill. What was the need of having a law relating to people having mental illness? Have the provisions of the law tried to address the pressing issues being raised by various stakeholders? Analyse.