Mental Health, Often Ignored, Gets A Shot In The Arm

There’s some respite at last for those who are affected by mental health concerns. After Parliament passed the National Mental Healthcare Act 2017 last year, the Insurance Regulatory Development Authority of India (IRDAI), the body that regulates the insurance industry in the country, has come out with a fiat asking all insurers to include mental health under their ambit of coverage.

In the circular, a copy of which is available with Swarajya, the IRDAI has said that in accordance with Section 21(4) of the Act, “every insurer must make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness”.

The circular, signed by General Manager (Health) D V Ramesh, directs insurers to comply with the Act “with immediate effect”.

However, when Swarajya spoke to a senior official at New India Assurance for further information on the matter, the official, on the condition of anonymity, said no such concrete schemes have been firmed up as yet because the IRDAI was yet to clarify on what, in mental health, will be covered and what not. The official also said that, as such, health conditions relate to the mind, which is, in principle, intangible, the parameters to measure such “insurable” illness need to be clearly defined.

The official also said insurers were currently clueless about matters relating to costing as the definition of mental illness was in the broad spectrum, as per the extant law.

Chapter 2, Section 3 of the Act says mental illness shall be determined in accordance with such nationally or internationally accepted medical standards (including the latest edition of the International Classification of Disease of the World Health Organization) as may be notified by the central government.

According to the National Mental Health Survey 2015-16, conducted by the National Institute of Mental Health and Neurosciences (NIMHANS), individuals in the age group of 40-49 years are most prone to psychotic, bipolar, neurotic, depressive, and stress-related disorders.

In addition, residents in urban metros seemed to display a higher proclivity towards mental illness, while the prevalence of morbidity among adolescents was 7.3 per cent of those interviewed, with equal distribution among male and female genders.

The study also says the median amount spent on care and treatment varied between disorders – alcohol-use disorder: Rs 2,250; schizophrenia and other psychotic disorders: Rs 1,000; depressive disorder: Rs. 1,500; neurosis: Rs. 1,500; and epilepsy: Rs 1,500.

The big positive outcome of the Mental Health Act, however, is the recognition of suicide, or the “attempt to suicide”, as a genuine problem stemming from personal and social inadequacies, rather than a crime.

The Caregiver’s Story

Shaurya Sethupati (name changed to protect identity), a college student, one of whose parents is afflicted by Schizophrenia, told Swarajya that if insurance firms do come up with options to cover mental health concerns, it will be a landmark development for a country that has so far stigmatised mental illness and failed to acknowledge its pervasive reality. He also said societal nature is such that when people see a person suffering from a physical disability, sympathy is immediately forthcoming. But sadly, those affected by mental illness only receive disparagement in return. This is possibly because of a lack of information and, therefore, lack of understanding, due to the invisible nature of mental health concerns.

He also said mental illness is very broad-spectrum, and hence society must not jump to conclusions about the “uselessness” of such people. On the contrary, some of the most creative brains are “ab-normal”.

He further adds, with a tinge of sarcasm yet hope, that movies such as A Beautiful Mind and recently Hichki serve as periodic reminders that basic notions must be regularly challenged and that those with mental health concerns are also human beings, albeit with abilities that can at times “shock” the “normal”.

When asked whether he felt the current Mental Health Act was comprehensive, he said one area which the government could have focussed on is to address the “fiscal trauma” that families of mentally-ill persons face.

Explaining what he meant by “fiscal trauma”, Sethupati says not all mentally-ill people are jobless or non-earners. Many of them are working professionals contributing to society in meaningful ways, but at great personal cost. However, when it comes to management of money, they can at times take destructive decisions. He said one major complication such families face is when credit card companies offer “free cards” to such people, they, unaware of the implications, lap up these offers. And as a means to cope with their inherent depression, they turn towards consumerism for “solace”. This forces the families into a debt trap, as money-management becomes a serious concern.

Another case is that of Kalaivani (name changed to protect identity), a long-time resident of the United States. When she was diagnosed with severe mental health concerns, her spouse had to live separately along with their children as she was unable to lead a normal life. When she came back to India with whatever money she had accumulated over the years, an overzealous religious organisation, quick to sense her vulnerability, offered her “hope”, but in the process made sure she donated most of her money towards “charity” and “god’s work”. Unfortunately, Kalaivani today lives with her mother in near-penury, finding it tough to meet her medical needs and make ends meet.

The government, it appears, has not addressed such issues in the Act, says Sethupathi, leaving financial predators free to prey on such hapless people.

With a sigh, he says, families should be “insured” against such trauma too, but one wonders how that will ever happen.

Dr H Chandrashekar, secretary, Karnataka State Mental Health Authority, and Head of Department of Psychiatry, Bangalore Medical College and Research Institute, told Swarajya that the fact that mental health will now be covered under insurance is a shot in the arm for patients and caregivers. He said insurers thus far were not very keen on covering mental health owing to reasons they knew best, but with the government now mandating such coverage, those suffering will definitely stand to benefit.

As many mental health illnesses extend beyond several years, patients and caregivers alike brace for long periods of suffering. If insurance cover is denied to them, as has been the case so far, it makes treatment very expensive for them. And with the prospects of stability of income being denied to them, the situation is very bleak. The government move is indeed laudable.

(Efforts to reach the IRDA for comment on matters of definition and for further clarity went in vain.)