Mental Health Insurance Cover in India Is a Welcome, but Unplanned, Move
An
IRDAI notice to all insurers acknowledging that mental and physical
illnesses are no different will do wonders to destigmatise the illnesses
and to improve mental health literacy.
On August 16, the Insurance Regulatory and Development Authority of India (IRDAI) issued a notice
addressed to all insurers, with the subject “The Mental Healthcare Act,
2017.” It directed all insurance companies to provide health insurance
for mental illnesses in line with the law passed last year with
immediate effect.
This is a wonderful and welcome step, as acknowledging that mental
and physical illnesses are no different will eventually do wonders to
destigmatise the illnesses as well as to improve mental health literacy.
However, the move also seems unplanned, with no guidelines for how
insurance companies can adhere to the official instruction. Further,
insurance companies seemed unprepared when the Mental Healthcare Act was
passed and seem equally unprepared when it’s time to include mental disorders within coverage.
In an earlier piece describing how mental health insurance can
revolutionise the industry in India, Some of the implications of
providing mental health insurance have already been outlined. For
example, “acknowledging that some mental disorders have a biological
basis helps determine the actuarial risk of such illnesses and educate
relevant stakeholders” (source).
The IRDAI’s step brings to the fore several issues that have riddled
the mental health industry with obstacles in proper implementation and
provision of services. This is because insurance companies will now
become shared stakeholders in the country’s mental health dialogue.
Insurance agencies will need to be wary of several aspects when
implementing this instruction. Companies and actuarial scientists
working in the sector could start by familiarising themselves with the
diagnostic categories of mental disorders. Here, they may decide to
adhere to the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5), as published by the American Psychiatric Association, or follow the categories outlined in (chapter 5 of) the International Classification of Diseases (ICD-10) on mental and behavioural disorders.
There are some differences in the definitions and coverage of mental
disorders across both classifications, and insurance companies will need
to draft policies after considering the pros and cons of each system.
Moreover, if insuring mental illnesses becomes dependent on the
diagnoses – i.e. if claims will necessarily require a diagnosis for
reimbursement – there is a chance that the healthcare system may be
burdened with over-diagnosis, especially for children.
Second, it will be important to identify treatment modalities covered
within the insurance plan. For example, depending on the severity of
symptoms, psychopharmacological medication, psychotherapy or both may be
required for treatment. In other cases, hospitalisation may be
recommended. Therefore, insurance agencies will need to identify the
scope of coverage for various mental disorders as well as rely on
scientific, evidence-based therapy for the same. For instance, there
exist highly structured and effective therapeutic interventions, like cognitive behaviour therapy
for depression, that operate with a fixed plan of eight to twelve
sessions to address symptoms. Insurers will need to become aware of such
practices that their future clients can avail of.
Third, and a related issue, will be to determine adequate licensing
for mental health professionals in the country. Although the Rehabilitation Council of India
bears the responsibility of registering clinical psychologists in
India, there are several mental health para-professionals, including
counselling psychologists and psychotherapists, whose licensure is not
currently covered. Ideally, the IRDAI notification will push the sector
towards ensuring that appropriate professional identification,
regulation and registration of mental health professionals across the
country happens.
Fourth, it will now be the shared responsibility of insurers and
mental health professionals alike to facilitate the acceptance and
literacy of mental health conditions across the country. After all, when
insurance agencies develop their models of mental health coverage, they
will also want to guarantee sufficient buy-in from clients who may
already be insured for physical ailments. This pushes the mental health
dialogue to new heights, especially in the policy and insurance spaces,
furthering the cause of establishing and sustaining mental health
infrastructure in an overburdened country.
Although these are a few issues insurance companies should keep an
eye out for, there are also several unobservables that are yet to be
estimated, especially once policy turns into action. The growing
acceptance of mental health issues among the urban youth is an indicator
of demand for coverage. Further, whether only health or medical
policies will include mental disorders in their coverage is not
immediately clear.
This is a paradigm shift in the Indian mental health space, with the
potential to change how our country perceives mental illness. Improper
implementation at this juncture could set us back several years.
Insurers will hopefully acknowledge this policy as a complex yet
important move for the overall wellbeing of their clients.
Source : https://thewire.in/health/mental-health-insurance-irdai-dsm5-clinical-psychology