Inclusion of mental healthcare treatment costs in medical health insurance / Graphic by Pixabay

‘Mental health’ is a buzzword but not ‘mental health insurance’

As the importance of seeking medical help to treat mental health issues gain more popularity in the country, there is little discussion over mental health insurance. This can lead to disparity in the accessibility of the treatment.

The impact of lockdown on mental health, the importance of work-life balance and its effects on mental health, lifestyle changes that improve mental health, tips to manage mental health issues, and celebrities talking about their mental health status are most popular topics that the Indian media focuses. While all these issues are essential to remove the stigma attached to mental health and raise awareness among the public, the question about the affordability of the treatment and the implementation of mental health insurance finds negligible space in the media.

The National Mental Health Programme (NMHP) estimates that around 6% - 7% of the Indian population suffers from mental disorders. Treatment for most mental health issues, like depression and anxiety, can be managed with therapy or psychiatric counselling sessions, and they do not require hospitalisation until the conditions deteriorate. Mental health professionals believe that therapy and treatment can prevent hospitalisation for certain mental health issues and can also refrain people from doing self-harm.

Related link: National Mental Heath Programme (NMHP)

Affordability and accessibility

The mental healthcare facilities in the private establishments, especially in the urban area, are more equipped with resources than the public ones. In India, an-hour long therapy can cost between Rs.1000 – Rs.3000 in private hospitals. But some mental illnesses require hospitalisation and daycare services. In addition, there is the cost of medications and travelling expenses to avail better medical services involved.

For those who cannot afford treatment in private hospitals, public healthcare facilities and non-profits are the only suitable options. In a country that is already struggling with the financial crunch induced by the pandemic, out-of-pocket expenditure for mental healthcare treatment increases the financial burden on the families.

Health insurance scenario

Section 21 (4) of The Mental Health Care Act, 2017, states that “Every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness.” In August 2018, the Insurance Regulatory and Development Authority of India (IRDAI) had directed the insurance companies to comply with the clause “with immediate effect”. While this is a landmark legislation, there are multiple discriminatory instances from the ground that can easily question the effective implementation of the mental health insurance.

The insurers often reject the claim of the policyholders citing their reason in jargon that are difficult to understand for a layperson. The question here, then, one needs to ask is what purpose does a mental health insurance serve.

Over the four years, several insurance companies have started to cover mental health treatment for hospitalisation with an added premium. However, only a few of the insurance policies have coverage for out-patient (OPD) costs, which also includes a limit on the claim that the policyholder can make.

In addition, there are policy regulations like the waiting period of two to four years for pre-existing mental health conditions and a requirement for hospitalisation of more than 24 hours to claim the costs of treatment. Also, the policies exclude mental retardation and mental illness that develop as a result of alcohol or drug abuse. This results in policyholders not being able to claim the insurance when they need it the most.

Mental health treatment, unlike physical ailment, does not have a specific recovery time and it varies from individual to individual. Also, there might be a requirement for prolonged or repetitive hospitalisation. Moreover, the severity of most mental illnesses cannot be determined through laboratory tests; thus, making the insurers hesitant to provide the coverage for the treatment. This results in exorbitant costs for the treatment. For instance, the condition of a patient suffering from dementia can deteriorate rapidly after its sudden detection. The cost of which can vary between Rs. 30,000 and Rs. 1 lakh per month, depending on the severity of the disease and the healthcare facility.

Sanjay Pinto, an advocate of the Madras High Court, newspaper columnist and author says, “Other than government interventions, legal intervention and judicial activism can play a major role.” He further explains that the necessary changes can be made through suitable amendments and court directives to ensure that there is access to medical treatment for patients suffering from mental illness.

Further, the insurers must provide transparent services and they must look at their work beyond a business perspective. There is a greater need for insurance companies to incorporate ethical practices for better physical and mental healthcare.