By Vandita Morarka
An India Spend report highlights that 60 million Indians suffer from mental disorders, this is about 6.5% of the country’s population.
The World Health Organisation also estimates that around 57 million Indians suffer from depression. A recent survey by the National Institute of Mental Health and Neuro Sciences (NIMHANS) states that 13.7 % of the adult population in India suffers from some form of mental illness. And yet, India spends only about 0.04% of its health budget on mental healthcare.
Mental health and healthcare in India come with a set of taboos and stigmas, which is perhaps why mental healthcare insurance has never been a priority for providers.
The new Mental Healthcare Act, 2017, under the right to equality and non discrimination, S. 21 (4), 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.”
This provision effectively makes it mandatory for all providers of insurance in India to have certain policies and provisions in place that also account for mental illnesses. It also imposes that such provisions must be at par to those for physical illnesses. Considering the placement of this clause, non adherence to it would amount to discrimination.
India currently does not have any distinct insurance coverage for mental health disorders. Several policies may cover mental health illnesses briefly or as under other aspects.
Why is there a need for mental healthcare insurance?
Mental healthcare insurance at the very onset provides for expenses coverage for related treatment and care, which can often be crippling and the reason behind reduced access to such services. For e.g., a single consultation with a leading therapist can be around 1,500-2,500 Rs. in major cities. Consultations with psychiatrists can be even more expensive, additional costs of medication also raises monthly expenditure on mental healthcare drastically.
Alongside, it also helps fight the stigma surrounding mental health by normalising the existence of mental health needs and disorders, as seen with physical health. Having such insurance schemes also provides for an effective channel for information dissemination relating to mental healthcare and related regulations in general to a large audience and reduce ignorance.
Also Read: The Law and You: Mental Health and Minors
India is also extremely short on the number of mental health professionals in reference to its estimated needs, especially those that are well trained and verified. According to the Ministry of Health and Family Welfare, there were 3,800 psychiatrists, 898 clinical psychologists, 850 psychiatric social workers and 1,500 psychiatric nurses nationwide, as of December 2015. (Source: IndiaSpend)
Having efficient insurance policies in place by leading providers will make mental healthcare more accessible for many and will drive a market drive shift towards more and better trained mental healthcare professionals and education/training programs. The attached regulatory measures with such policies will help weed out quacks as well.
Dr Avinash De Sousa from the De Sousa Foundation says that the main problems that insurance providers state makes them reticent about providing mental healthcare coverage under insurance policies are:
Long term treatments
Varying costs of treatments
Diagnostic dilemmas with many psychiatric problems
The lifelong course of many psychiatric disorders
He also says that the cost of psychological treatments like psychotherapy and other psychological treatment show a high variation and the medical cost per month is quite high in case of psychiatric disorders. However, he says that the same is true for other medical problems as well, which are covered by health insurance.
Crucially, more people would get the help they need.
Dr. D’souza feels that covering mental healthcare under insurance would lead to more people seeking help for psychiatric problems, more patients seeking inpatient rehabilitation programs, and that this could also help break the stigma against psychiatric help.
Mental healthcare should be treated on par with general medical health care.
As Dr De Sousa points out, we need to have uniform tiers of costs of treatments so that mental health care can come under the ambit of insurance. None of the insurance providers The Health Collective reached out was willing to comment officially on the subject. On condition of anonymity, one representative did tells us that there is apprehension about including mental healthcare in insurance packages, because of a lack of understanding of how mental health diagnostics and costing works. (This post will be updated if we get an official statement from an insurance provider.)
What are some international best practices?
International best practices differ in terms of coverage, extent of coverage and implementation and implementing body.
Canadian healthcare is largely funded by the federal government and thus the provinces and territories are mandated to provide medical facilities for its citizens. While Canadian healthcare systems function well, in terms of mental healthcare, they lack coverage of therapy and majorly psychiatric treatment is covered by insurance. With waiting lists at psychiatrists for patients being extremely long, several patients are unable to get timely help. Several of these patients would benefit greatly from therapy as well, but that isn’t covered by the medicare policies.
In the USA, the parity law or the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, 2008 (hereinafter MHPAEA), states that insurers are to treat mental health cover at par with general medical health cover. The introduction of the Patient Protection and Affordable Care Act, 2010, also known as the Affordable Care Act (hereinafter ACA), 2010, further led to an amendment in the MHPAEA which extended the provisions of the MHPAEA to individual health coverage, it helped improve the penetration of insurance but treatment received by adults suffering with mental illnesses in America still remains low. Due to varying State laws and implementation, these measures do not always achieve full effect.
The UK offers quite a comprehensive coverage system in relation to mental health illnesses, including medical, surgical, psychological and psychiatric services, through the National Health Service. Discrimination on the basis of mental health issues while providing insurance services is punishable.
Many countries, like Indonesia, may have systems where while the public insurance would cover physical and mental illnesses, private insurance providers would mostly not cover mental illnesses.
What most countries, including India, need is a comprehensive insurance policy that accounts for mental health across spectrum as they do for physical illnesses and for governments to build systemic alternate plans for individuals to access good quality affordable mental healthcare.