Thursday, November 19, 2015

The case for Mental Health Insurance

This article was first published in the IIB Bulletin, Vol 2, Issue 2, pp17-18

https://iib.gov.in/IIB/Articles/IIB%20Bulletin%20Q2%202015-16.pdf

As per the World Health Organization (WHO), Mental health refers to a broad array of activities directly or indirectly related to the mental well-being components included in the WHO's definition of health: "A state of complete physical, mental and social well-being, and not merely the absence of disease". It is related to the promotion of well-being, the prevention of mental disorders, and the treatment and rehabilitation of people affected by mental disorders.

Common forms of mental illnesses include Depression, Anxiety/ Phobias, Eating Disorder and Stress, among others. Some of the severe forms of Mental Illness are Schizophrenia, Bipolar disorder (Manic depression), Clinical depression, Suicidal tendency, and Personality disorder.

According to National Institute of Mental Health and National Alliance on Mental Illnesses, in the US, 1 in every 4 persons suffers from some form of Mental Illness or the other, while this statistic is 1 in 6 persons in India. The impact is that people with mental illness die 25 years earlier than other Americans and more than 90 percent of suicide cases are found to have one or more mental disorders.

In a study done by BeyondCore, Inc. on people insured between the ages of 18-35, in the USA, it was found that Mental Illness has a compounding effect on claims (cost of treatment). For example, the annual cost for young adults with heart failure was $42,000, for people taking antidepressants was $7,700, but people who had both heart failure and were taking antidepressants had an annual cost of $70,000 (see Figure 1). 

Figure 1: Compounding effect of Mental Illness



To the economy, the loss of earnings due to mental illness amounts to US$193 billion per annum. Globally, depression alone affects 400 million persons and was estimated to cost at least US$800 billion in 2010 in lost economic output, by WHO, a sum expected to more than double by 2030. While such statistics are not available for India, it will be reasonable to assume that the impact would be significant.

In fact, the situation in India may be worse as acknowledging suffering from some form of Mental Illness is culturally a taboo in India. On top of that, the availability of help in terms of psychiatrists, psychiatric beds, clinical psychologists, etc. is much below the required numbers. For example, there are approximately 3000 psychiatrists in India vis-à-vis a requirement of 150000.  

Health Insurance policies also exclude Mental Illness specifically. Extracts from the policy documents of a few health insurance products read as follows:
  • “the following fall under permanent exclusions: Any expense incurred on treatment of mental Illness, stress, psychiatric or psychological disorders”
  •  “this policy excludes: Psychiatric, mental disorders (including mental health treatments)”

Insurance plays a key role in Healthcare financing. Insurance is based on law of large numbers and there is no denying the large number of people suffering from mental illness. The trouble of course is that Insurance contracts are based on utmost faith and the policyholder must disclose complete known information about his physical and mental health at the time of buying the policy. The fear of inadequate disclosure by the customer may deter the Insurers from offering policies on Mental Health insurance.

Assessing the risks may remain a challenge for the underwriters till adequate data becomes available. Collating the data from various institutions like National Institute of Mental Health and Neurosciences and the Institute of Mental Health and Hospital, Agra may help the Insurance companies design appropriate products.

Use of innovative techniques may come in handy to some extent. For example, social media analytics of an individual may reveal suicidal tendencies or enquiries about specific problems like depression, anxiety, etc. Sentiment analysis can help find people at risk. These can then be verified with the customer and specific undertaking may be taken from the customer if he does not agree with the findings.


Mental illness is also a major cause for the high number of suicides in India. Intervention at the right time, access to healthcare, along with health financing will play a major role in talking the problem of suicides related to mental illness as well as prevention of the illness getting aggravated. It is a serious issue and the Insurers can play a major role to make a difference!
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