A man undergoes PET scan, used to diagnose psychiatric conditions. (Carla Gottgens/Bloomberg)

Mental Health Insurance: India Breaks A Taboo But Is That Enough?

For nearly three years, Akash, 17, has had bipolar disorder, a condition that causes extreme, at times violent, mood swings. His mental health is on the mend, but there have been days when he tried to harm his parents and elder sister. Akash even thought of killing himself.

Such episodes ended in long stays in hospital. The family, which has spent Rs 5 lakh on his treatment, could afford private medical care. Yet, sudden hospitalisation left them stretched.

“We were denied insurance because counselling is an out-patient expense,” his mother said. “And hospitalisation for mental disorders is not covered,” she said, seeking to remain anonymous as such conditions in a family can lead to social alienation in India. “We don’t speak about his illness outside home, but it has drained us—financially and emotionally.”

A professional support network to help people like Akash is grossly inadequate in India. The Mental Healthcare Act, 2017, by making it compulsory for insurers to cover such disorders, took the first step to ease the financial stress. The regulator notified the decision on Aug. 16, erasing the line between physical diseases and mental illnesses that are still considered a taboo.

An estimated 15 crore—or more than a tenth of— Indians require mental healthcare at any given time, including acute care and long-term rehabilitation, according to the National Mental Health Survey of India 2015-16. Families spend an average Rs 1,000-1,500 a month on treatment and travel to access care. Other hidden and intangible expenses, paid mostly out of pocket, add to their burden.

Insurance for such ailments needs to evolve and specialise into covering consultation, rehabilitation and therapy costs, Harish Shetty, consultant psychiatrist at Mumbai’s LH Hiranandani Hospital, said. “If insurance can cover a limb fracture, it can also cover the fracture of the mind.”

Mental Health Insurance: India Breaks A Taboo But Is That Enough?

Costlier Health Cover

About 15 percent Indian adults need active intervention for one or more mental health issues, the national survey found. Among teenagers, the prevalence is nearly 7 percent for both genders. The conditions can be categorised into common and severe disorders. The new law defines care as analysis, diagnosis, treatment, care and rehabilitation of the afflicted person.

Still, mental illness is a wide term, Jyoti Punja, chief customer officer at Cigna TTK Health Insurance, said in an email. “Insurance companies are looking at the regulator for a clear definition.”

The first step, according to Jahnavi Kedare, consultant and president of the Bombay Psychiatric Society, could be covering acute psychosis where hospitalisation is required. All diagnostics and psychiatric help, she said, should come under the basic plan.

A hurdle for insurers is lack of data related to mental diseases and treatment costs that could help them assess the risk. Without that, pricing becomes tricky.

“Insurance companies will initially remain cautious and introduce basic hospitalisation plans with adequate controls like a waiting period,” Ashish Mehrotra, managing director and chief executive officer at Max Bupa Health Insurance, told BloombergQuint in an email. Experience, he said, will help them offer covers for comprehensive care.

Punja agreed that a feasible and lasting solution will take time, but till then health insurance could become costlier. “If mental disorders are covered as part of basic health insurance policies, overall premium may increase for everyone.”

But covering hospital expenses will address part of the problem.

Counselling Costs

Sharda decided to seek professional help when her 60-year-old mother-in-law attempted suicide for the second time.

“I was a few months into my job and didn’t have as much money as I do now,” she said. The fee for sessions was a financial burden, Sharda said, adding that such costs should be covered under insurance.

Counselling continues for months, even years, and accounts for a substantial chunk of treatment costs. While government hospitals mostly don’t charge for it, Shetty said a single session with a private psychiatrist costs up to Rs 2,000. Jasmine Khattar, executive and clinical director at the Institute for Exceptional Children, a Mumbai-based non-profit, said some even charge as high as Rs 3,000 an hour.

Moreover, most conditions don’t need hospitalisation. Cases not requiring a hospital stay are 27 times more than when a patient is admitted, according to a report by a panel on mental health constituted by the National Human Rights Commission.

That’s why Kersi Chavda, consultant psychiatrist at Hinduja Hospital, suggests that an ideal mental illness cover should include out-patient expenses.

Mental Health Insurance: India Breaks A Taboo But Is That Enough?

Breaking The Taboo

Still, even insurers agree that the biggest challenge to overcome is the taboo. Families and patients hide conditions, even from their closest kin. Sharda’s mother-in-law is one such example.

“My family refused to even address it as a health concern; they merely sent her to Mumbai for a change,” she said. “I haven’t told them about the counselling sessions. It’s looked down upon in our family.”

Sharda at least sought professional help. About 80 percent of the people suffering from mental disorders don’t do that, according to the national survey, even when the illness lasts for more than a year.

“People are quick to dismiss treatment for mental health problems as its results are not as tangible as for a wound being bandaged,” said Sharda. They, she said, are unwilling to spend on therapy of the mind as they would on a heart problem.

As a result, a robust mental care support system is missing. The ratio of psychiatrists to population in India is worse than Nepal, Pakistan, Iraq and Brazil, according to the World Health Organisation’s 2014 data—the latest available numbers. Expenditure on mental health accounts for just 0.2 percent of the nation’s public health spend.

Mental Health Insurance: India Breaks A Taboo But Is That Enough?

Revamping the existing infrastructure will help strengthen the insurance framework as well, according to Cigna TTK’s Punja. It will improve availability of information, she said, allowing insurers to design better-priced plans, reduce frauds, and standardise mental healthcare.

Akash’s mother saw firsthand how quality care helped her son recover. “We need more such facilities for mentally disturbed people; we need more doctors,” she said. “We need to treat it as an ailment and seek help.”

(BloombergQuint withheld the identity or changed names of patients and family members)

Also read: Health Insurance To Now Cover Mental Illness: IRDAI