Mental Health Insurance in India

Mental Health Insurance in India

Mental Health Insurance

According to the American Psychological Association (APA), mental health is defined as a state of mind characterized by emotional well-being, good behavioral adjustment, relative freedom from anxiety and disabling symptoms, and a capacity to establish constructive relationships and cope with the ordinary demands and stresses of life.

What is Mental Health?

Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood. It should be noted that mental health is more than just an absence of mental disorders or illness.

Mental health is an integral and inseparable part of health, and one cannot be truly physically healthy without being mentally healthy, and the same is true vice versa. Positive mental health can enable a person to realize their full, and true potential, cope with different kinds of stressors of life, work productively, and add meaning to their lives and to the lives of those around them.

Some new perspectives on the meaning of mental health point out that past definitions focus too much on a generally accepted view of good mental health, and fail to take into consideration cultural and individual differences. Aware of the fact that differences across countries in values, cultures, and social background may hinder the achievement of a general consensus on the concept of mental health, Galderisi, et al. aimed at elaborating an inclusive definition, avoiding as much as possible restrictive and culture-bound statements.

The new Definition

A new, and more researched definition of mental health may look like this: Mental health is a dynamic state of internal equilibrium that enables individuals to use their abilities in harmony with the universal values of society. Basic cognitive and social skills; ability to recognize, express and modulate one’s own emotions, as well as empathize with others; flexibility and ability to cope with adverse life events and function in social roles; and harmonious relationship between body and mind represent important components of mental health which contribute, to varying degrees, to the state of internal equilibrium (Galderisi, et al., 2015).

Mental Health in India

Mental health is a major concern worldwide and India is not far behind in sharing this. The WHO estimates that the burden of mental health problems in India is 2443 disability-adjusted life years (DALYs) per 10,000 population; the age-adjusted suicide rate per 100,000 population is 21.1. The economic loss due to mental health conditions, between 2012-2030, is estimated at USD 1.03 trillion.

It is estimated that 6-7 % of the population suffers from mental disorders. One in four families is likely to have at least one member with a behavioural or mental disorder (WHO 2001). These families not only provide physical and emotional support, but also bear the negative impact of stigma and discrimination, leaving most of the people affected by mental health issues untreated.

The Government of India launched the National Mental Health Program (NMHP) in 1982, with the following objectives:
  • To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population;
  • To encourage the application of mental health knowledge in general healthcare and in social development; and
  • To promote community participation in mental health service development and to stimulate efforts towards self-help in the community.

Under this program comes the District Mental Health Program (DMHP), which focuses on district-level initiatives to improve mental health conditions. The Mental Health Policy, of 2014 upholds a participatory and rights-based approach to quality service provisions.  The Mental Healthcare Act, 2017 provides the main legal framework for providing services to protect, promote and fulfil the rights of people with mental illnesses. The National Mental Health Programme and Health and Wellness Centres are efforts to provide quality care at the primary health care level. Deaddiction centers and rehabilitation services are also available, albeit not as many as really needed to successfully tackle the issue.

Mental Health Epidemic

Despite improvements in various health indicators, India contributes disproportionately to the global burden of disease (Srivastava, et al., 2016). In 2017, the President of India, Ram Nath Kovind asserted that India was “facing a possible mental health epidemic”. A study revealed that in the same year, 14% of India’s population suffered from mental health ailments, including 45.7 million suffering from depressive disorders and 49 million from anxiety disorders. The Covid-19 pandemic has further accentuated this mental health crisis. As of 2021, only a few states included a separate line item in their budgets towards mental health infrastructure. This means that the mental health needs of the country as a whole are not being met at the rate that they need to be.

The causes of this deficit in mental health treatment and facilities can be attributed to poor planning, lack of policies, lack of programs offered by the government, low awareness in Indian societies and communities, stigma, poverty, etc. Lack of employment and income are major contributors to multidimensional poverty for persons with severe mental illness (PSMI) (Trani, et al., 2015). Lack of knowledge about mental illnesses poses a challenge to the mental health care delivery system (Brown, Harris, Russell, 2010). Thankfully, mental health awareness campaigns have yielded positive outcomes. 

The need for mental health insurance

Research has highlighted the role of community-based systems in low-income countries and has also yielded positive results in creating awareness, thereby impacting participation (Trani, et al., 2016). To tackle the mental health concerns of a country with a population as large as India’s, the role of community mental health care cannot be neglected. Research has shown that community-based programs and interventions have an undeniable positive impact. Communities are vital sources of support during crisis, providing collective contexts for shared identity and solidarity that predict supportive, prosocial responses (Bowe, et al., 2021).

With community intervention methods as an asset, focusing on formulating policies as part of community driven programs is not to be overlooked. More specifically, formulating a practical, workable mental health insurance plan can prove to be extremely beneficial to the workingclass members of the country. One of the most effective and important changes that can be brought about using a community psychology approach, is bringing change at an institutional level. In this report, this area is explored based on the assessment of mental health needs of working individuals.

Insights from Surveys and Interviews

A survey related to need for mental health insurance needs was carried out and was answered by thirty working Indians belonging to different regions and demographics. 83.3% of the sample answered that they felt that mental health insurance policies are needed in India, while 80% of them agreed that they would personally benefit from a mental health insurance program. While 63% of the participants stated that they were not aware of any mental health insurance schemes or programs that were available. In another attempt to assess the need for mental health insurance among different demographics, I interviewed 3 persons, each of whom worked different jobs, and belonged to different age groups.

All the persons who were interviewed agreed that they would want to enroll in a mental health insurance plan, provided they knew more about it. AK, 41, who was an interviewee said that she felt that mental health insurance is definitely needed as it would yield better outcomes for people going through mental health problems and provide increased access to treatment. When asked if she felt that she would personally benefit from such insurance, she said that if she were to ever go through any mental illness in the future, an insurance plan would surely be valuable. 

Perspectives from a Rising Academic Specialist

Similarly, SD, 21, who is working as an academic writing specialist, opined that mental health issues are akin to health problems that occur physically and that it can be unexpected. According to her, mental health insurance is a crucial step in providing people the means to financially cope and heal their health, without having to worry about their finances. She said that in the long run, an insurance plan would help her if she ever needed to make use of it. When I asked her about why she thinks India is deficient in mental health insurance options, she said that it was possibly because of stigma.

“This could be the case due to India’s long-held relation with bias and superstition. “This has created an atmosphere where mental health disorders are not considered disorders that are worthy of being treated like a physical illness. The lack of awareness, maintained stigma, narrow-mindedness and plain arrogance despite the availability of knowledge stop the implementation of insurance (policies) such as this”, she said. 

Perspectives from Industry Professionals and Legal Framework

GR, 26, who works as a mechanical design engineer was also an interviewee. Speaking about corporate culture, he said that the pressure that he and his co-workers feel to perform to the best of their abilities results in huge amounts of stress over extended periods of time, hence, an insurance policy would be a great helping hand to keep working individuals mentally healthy, in case they face any serious mental health issues. When asked if he would say that he would personally benefit from a mental health insurance policy, he said that it having one would provide him a sense of comfort like any other health insurance.

Overcoming Stigma and Raising Awareness:

This would allow him to work with more confidence and certainty. Regarding the issue of very less mental health insurance policies in place right now, GR said that this was the case because most people simply were not aware of this subject. There also exists a certain hesitancy to admit one has mental health issues, as it leads to differential treatment of that individual within a society. Unfortunately, being mentally ill is seen as a weakness, and consequently, the common person does not engage in these conversations. 

The responses to the survey and the interview that I conducted indicated that there was a dire need to spread more awareness about the fact that mental health insurance is something one could apply for, and what its benefits could be. Almost all of the participants agreed that such insurance policies should exist and that they would benefit most people. One of the important provisions of the Mental Health Care Act, 2017, in section 21 (4), is the inclusion of “mental illnesses” for health insurance coverage. This is a progressive step toward considering mental illness at par with physical illness, which will, in turn, ensure better access to mental health care (Bijal, et al., 2019).

India’s Insurance Regulations

India’s Mental Health care Act, 2017, states that “every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for [the] treatment of physical illness.” Furthermore, in August of 2018, the Insurance Regulatory and Development Authority of India (IRDAI) directed that all insurance companies comply with the statute and compulsorily make provisions for the coverage of mental health care under their respective insurance policies. Even so, close to zero insurance companies had actually integrated mental healthcare into their insurance schemes. Thus, in response to an RTI filed in February 2019, the IRDAI responded that none of the insurance companies had complied with the law thus far. Subsequently, the Supreme Court also issued a notice to the IRDAI in June 2020, seeking an explanation for the non-compliance of insurance companies to provide cover mental healthcare insurance in their policies.

A Closer Look at Leading Insurance Companies in India

In an attempt to then better understand if the mental health insurance needs of the people are being met, and the scenario that persists in the realm of the insurance sector, reaching out to some leading insurance companies, and enquiring with them about the policies that they offer was the important next step.

Exide Life Insurance is an insurance company owned by Exide Industries. It was founded in 2001 and is one of the pioneers among private life insurance companies in India. It has a presence in over 200 cities across the country and has multiple life insurance, savings, and retirement plans. However, in a telephonic conversation with an agent from Exide, it quickly became clear that the company did not provide any insurance based on mental health issues, and in fact, did not even fully understand what mental health meant.

Insurance Companies in India:

The agent seemed completely unaware of the term mental health or even mental illness and kept mentioning all the life insurance policies that the company offered, focusing on physical health issues. Bajaj Allianz, which was the next company that I contacted, was the only insurer from whom I got a positive response. The agent explained to me that they did have a scheme with mental health care covered which was under their general health insurance plan. The agent further described what the plane looked like, and what it entailed. Another notable insurance company is Kotak Life Insurance.

The company, also founded in 2001, caters to around 15 million customers and has 232 branches in around 167 cities and towns in India with close to 99,275 agents. Under the umbrella, the company offers various protection and health plans, savings and investment plans, child plans, and retirement plans. In a rather short conversation with one of the company’s agents, I was told that they were not aware of any such policies and that if I wanted any further details, I would have to become a customer.

Developing a mental health insurance policy

Evidently, there is a clear need for stricter advocation of the inclusion of mental health care in insurance schemes and more accessible mental health insurance plans. Hence, below is an individual attempt at formulating a broad, general framework policy for mental health, insurance, which is based on experience and information that I have personally obtained throughout the process of making this report, and as a student of community psychology.

Declarations page
  • Mental health insurance coverage: Mental health, as defined by the WHO, and the definition that we go by, is “a state of well-being in which the individual realizes their own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to their community”. Thus, this policy aims to enable to financially empower those individuals who are, in any way, unable to meet any of the specified conditions in the definition of mental health, as long as their condition has persisted for more than 6 months and is then diagnosable.
  • Premium: The amount to be paid by the insured will be in accordance to their annual income. There is no fixed cost for the insurance, the cost will be decided in proportion to the income that the insured or the customer is earning. 
  • Deductibles: No deductible is applicable, as long as the customer’s mental health issue is diagnosed and has been subjected to verification by the insurer.

Insuring Agreement

This is an individual insurance policy that will be available to the customer alone and does not concern the family of the customer. A customer will buy the policy at the price determined in proportion to their income and has to renew the policy every 10 years. The insurer will bear the costs of any financial losses incurred by the customer, if the mental health problem has been diagnosed after its symptoms have persisted for more than 6 months, and a diagnosis was not possible then.

The type of mental illnesses or issues that are covered under this policy will include all severe mental illnesses, which can be diagnosed.

All documents required for verification purposes must be made available to the insurer, by the customer. The customer agrees to all the terms and conditions of this policy by giving their consent. In case the consent of the patient cannot be obtained, their family members or caretakers will be considered.

  • Excluded perils or causes of loss: Any mental illness that is a side-effect of a physical illness, any mental health issue that has not persisted symptomatically for over 6 months, and has not been diagnosed by a psychologist or a psychiatrist.
  • Excluded losses: Any losses incurred due to a mental illness or mental health problem prior to the purchase of the policy.
  • Persistence of mental health issues for over 6 months.
  • Diagnosable mental health issue.
  • Cooperation by the insured during the entire process, including verification, treatment, and documentation.

India stands in dire need of a shift in how we regard mental health issues and the value we place on it. While awareness and education remain at the forefront of improving our situation, making institutional changes simultaneously is truly the need of the hour. Sensitization programs for insurance company employees, policymakers, and the public can help pave a brighter and more successful path towards integrating mental health issues in health regular health insurance policies, thus considering mental health also regular, and accord equal importance to it. A workable, comprehensible, and just insurance policy is needed for better understanding and implementation of mental health insurance programs. In my attempt at developing a mental health insurance policy, by laying out a general policy, I have strived to formulate a policy that is easy to understand and one that is mainly aimed at the betterment of the health of the public.

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