Pandemic triggers mental disorders but insurance eludes many

Mumbai: When 66-year-old Pritam P tested positive for Covid late last year, it triggered a far more debilitating illness in his wife—her underlying depression and suicidal tendencies surfaced. Mrs P, a retired bank employee, had to be hospitalised for almost a month under the supervision of a Mumbai psychiatrist. The couple’s next nightmare began after she was discharged. While her bank’s group mediclaim covered a portion of her medical expenses, her own policy continues to reject the Rs 3.5 lakh claim, exposing the confounding absence of clarity and uniformity with regards to mental illness insurance.

The ongoing pandemic has catalyzed a range of mental disorders—from mild anxiety to suicidal behaviour requiring hospitalisation. As independent insurance agent Vickram Thakkar says, “Before lockdown, we used to get six-seven claims for mental illness in a year. Now we are getting seven-eight claims in a month.” Several insurers, though, continue to try and get around the 2017 law which establishes parity between physical and mental illness. Already traumatised, families find themselves confronting both stigma and ignorance when it comes to claims approval.

Because a mental illness is not as tangible as, say, a heart surgery, insurers might question the need for hospitalisation. “But why on earth would I send my child into a psychiatric hospital just to be able to claim insurance?” asks Natasha M, the mother of a 27-year-old with severe obsessive compulsive disorder (OCD), bordering on psychosis. Her son’s compulsions got exacerbated because of the discomfort of being locked in a small apartment, leading to bouts of aggression. He had to be sedated and admitted to a hospital where he gradually stabilised.

When the patient’s or the family’s safety is at stake, hospitalisation is necessary, say psychiatrists. Insurers though counter that several claimants may not have disclosed pre-existing conditions. “Insurance is a business at the end of the day,” says the head of a private insurance company. “And it’s a business that runs on good faith. But we do give an opportunity to the insured individual to tell the full story and work with that.”

Last month, the Delhi high court rapped a national insurance company that refused to honour the claim of a young woman who spent a month in a Gurugram hospital for schizoaffective disorder. In her judgement, Justice Pratibha Singh stated: “The present petition raises issues of grave public importance. In the modern world, mental health is as important as physical health... While physical illnesses are manifested in the human body in some form, mental illnesses do not always have visible physical manifestations. However, mental illnesses can also be debilitating and destructive. The recent pandemic also highlights this beyond any doubt. Circumstances leading to patients requiring isolation, healthy persons being subjected to lockdowns, work from home conditions, loss of employment leading to lack of confidence for long durations have led to several mental problems. Such mental conditions need to be dealt with immediately. Availability of insurance for mental disabilities or conditions is, therefore, not only important but is an essential need.”

“People should know that they can claim, and they should claim,” says Dr Soumitra Pathare, director of Centre for Mental Health Law and Policy in Pune. “This artificial distinction between physical and mental illness needs to go. An illness is an illness. All debates on this are over.”

And yet, mental health advocates point out that you can compare physical and mental illness only up to a point and much needs to change in the way insurance products are designed in the future. “Because the social ramifications on the person as well as the family are so qualitatively different,” says Dr Nirmala Srinivasan, founder of the Families’ Alliance on Mental Illness. “Practitioners like insurers should also understand this. They should not have such a long exemption period for pre-existing conditions.” She suggests they should also cover ongoing treatment, whether it is counselling, therapy or ECT treatments, because sometimes hospitalisation is not required if medication is given early enough.

According to a report published by the ministry of health in December 2019, even before the country got besieged with Covid and its multiple fallouts, one in every seven people in India had a mental disorder, ranging from mild to severe. The most cases were caused by depressive and anxiety disorders—with 45 to 46 million suffering from each—followed by schizophrenia and bipolar disorder. “Their prevalence is increasing across India and is relatively higher in the southern states and in females,” the report stated. Recognising the enormity of the burden of mental disorders, the Mental Health Act of 2017 clearly established parity between physical and mental illness.