Mental Healthcare Act 2017

A market for mental health insurance?

The Mental Healthcare Act mandates insurance providers to cover mental illnesses. This will boost mental health literacy and fight stigmatization

 

Mental health is a subject often not spoken about voluntarily, except by professionals in the field. Mental health insurance is even further from the discussion. There is a shortage of service providers as well as services. Several barriers deter the progression of mental health services in low- to middle-income countries like India, including inadequate funding, concentration of services in urbanized centres, lack of integration with primary care services, and lack of experience and training among mental health professionals.

The new Mental Healthcare Act 2017 includes the following clause under the right to equality and non-discrimination: “21 (4) Every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness.”

The health insurance industry in India offers individual and family coverage, primarily for physical ailments. In general, coverage includes hospitalization or treatment at hospitals in the country. To indicate the magnitude of health coverage, in 2015-16 health insurance premium collections were Rs27,457 crore, indicating a growth rate of 21.30% compared to the preceding year, according to the Insurance Regulatory and Development Authority. With respect to mental health insurance, its multifaceted nature becomes evident based on anecdotal evidence from mental health professionals across the world. 

For instance, the UK offers complete coverage for medical, surgical, psychological and psychiatric services alike through the National Health Service. Indonesia has public insurance (covering physical and mental illnesses) and private insurance (most of which do not cover mental illnesses). Nations differ widely with respect to the nature of coverage, as well as the extent of implementation of mental health insurance. Limits may be set on the total amount spent (on psychotherapy or psychopharmacological treatments), or the number of outpatient visits, or the number of hospitalizations and so on. India currently does not have any insurance coverage for mental health disorders
.

Still, the nature of healthcare in India is evolving, with some insurance agencies offering coverage for Ayurveda, Yoga and Naturopathy, Unani, Siddha, Homoeopathy (Ayush) treatments. At the same time, psychiatric and psychological disorders appear on the exclusion lists of prominent agencies.

Is this because actuarial scientists haven’t been able to compute how premium rates for mental disorders can be determined? Or because of the stigma associated with mental health as a whole? Or because diagnostic classifications and manifestations of mental illness alter in different cultural contexts? There are many conjectures regarding the motivations underlying the exclusion of mental health insurance, including the problems faced by agencies in corroborating diagnoses with psychometric evaluations. Similarly, there are many reasons why disorders that affect a large proportion (13.7%, according to the National Institute of Mental Health and Neurosciences) of the population should be insured as well.

First, introducing mental health insurance may encourage mental health literacy among the population in a top-down approach. For instance, individuals who opt for health insurance or who receive it from their employers are assumed to have a fairly good understanding of the treatments involved for physical illnesses. Surgery, chemotherapy and the like are familiar terms of treatment. However, if individuals are uneducated about treatment counterparts in mental healthcare (for example, the types of psychotherapy, psychopharmacological medicines, etc.), they may not understand what mental health treatment entails, thereby perpetuating a cycle of ignorance and stigma.

Second, bringing mental health disorders at par with physical illnesses may “normalize” such diagnoses, reducing associated myths and stigma.

Third, access to licensed mental health professionals may increase via such coverage. Insuring psychiatric and psychological illnesses can increase the accountability of professionals, formalize treatment modalities, and decrease the likelihood of clients visiting pseudo-professionals for mental health concerns. 

Fourth, acknowledging that some mental disorders have a biological basis helps determine the actuarial risk of such illnesses and educate relevant stakeholders.

The disparity between physical and mental healthcare is evident across several dimensions, like discrimination, stigmatization, health literacy, health infrastructure, and insurance. Specifically, we can aim to understand how the current mental health scenario in India can benefit from the introduction of mental health insurance. This in turn has policy implications for the National Mental Health Programme with respect to the dissemination of cost-effective mental health services.

India currently does not have any insurance coverage for mental health disorders. iStock photo

Given the burden of mental health illnesses in India, collecting data at the time of the introduction of the Mental Healthcare Act and its provisions can guide the subsequent implementation of mental health insurance. The willingness to pay for mental health insurance will also allow evaluations of the potential outreach of such legislation. Addressing mental health concerns explicitly has the potential to facilitate de-stigmatization, improve mental health infrastructure and psycho-education, reduce costs to patients, and increase compliance with treatment.

Source: http://www.livemint.com/Opinion/wtvnTJn38ZXv7deKCV2B0N/A-market-for-mental-health-insurance.html

Hansika Kapoor is a practising psychologist (clinical) and research author at the department of psychology, Monk Prayogshala, Mumbai.

Provisions under the Mental Healthcare Bill in India

The Mental Healthcare Bill, 2016, aims to provide provide for mental healthcare and services for persons with mental illness and ensure these persons have the right to live a life with dignity by not being discriminated against or harassed.

Definition

The Bill defines “mental illness” as a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs, but does not include mental retardation which is a condition of arrested or incomplete development of mind of a person, specially characterised by subnormality of intelligence.
Mental illness shall be determined in accordance with such nationally or internationally accepted medical standards.

Rights of persons with mental illness

The Bill ensures every person shall have a right to access mental health care and treatment from mental health services run or funded by the appropriate government. The Bill also assures free treatment for such persons if they are homeless or belong to Below Poverty Line, even if they do not possess a BPL card.
Every person with mental illness shall have a right to live with dignity and there shall be no discrimination on any basis including gender, sex, sexual orientation, religion, culture, caste, social or political beliefs, class or disability.
A person with mental illness shall have the right to confidentiality in respect of his mental health, mental healthcare, treatment and physical healthcare.
The photograph or any other information pertaining to the person cannot be released to the media without the consent of the person with mental illness.

Advance Directive

A person with mental illness shall have the right to make an advance directive that states how he/she wants to be treated for the illness and who his/her nominated representative shall be. The advance directive should be certified by a medical practitioner or registered with the Mental Health Board.
If a mental health professional/ relative/care-giver does not wish to follow the directive while treating the person, he can make an application to the Mental Health Board to review/alter/cancel the advance directive.

Mental Health Authority

The Bill empowers the government to set-up Central Mental Health Authority at national-level and State Mental Health Authority in every State. Every mental health institute and mental health practitioners including clinical psychologists, mental health nurses and psychiatric social workers will have to be registered with this Authority.
These bodies will (a) register, supervise and maintain a register of all mental health establishments,(b) develop quality and service provision norms for such establishments, (c) maintain a register of mental health professionals, (d) train law enforcement officials and mental health professionals on the provisions of the Act, (e) receive complaints about deficiencies in provision of services, and (f) advise the government on matters relating to mental health.
A Mental Health Review Board will be constituted to protect the rights of persons with mental illness and manage advance directives .

Mental Health treatment

The Bill also specifies the process and procedure to be followed for admission, treatment and discharge of mentally-ill individuals.
A medical practitioner or a mental health professional shall not be held liable for any unforeseen consequences on following a valid advance directive.
A person with mental illness shall not be subjected to electro-convulsive therapy without the use of muscle relaxants and anaesthesia. Also, electro-convulsive therapy will not be performed for minors.
Sterilisation will not be performed on such persons.
They shall not be chained in any manner or form whatsoever under any circumstances.
A person with mental illness shall not be subjected to seclusion or solitary confinement. Physical restraint may only be used, if necessary.

Suicide is decriminalised

A person who attempts suicide shall be presumed to be suffering from mental illness at that time and will not be punished under the Indian Penal Code. The government shall have a duty to provide care, treatment and rehabilitation to a person, having severe stress and who attempted to commit suicide, to reduce the risk of recurrence of attempt to commit suicide.

Insurance cover for mental illness could raise premium costs

A cause for concern in an otherwise progressive step initiated by the govt

New Delhi, April 7:   

 

More than 150 million patients with mental illnesses could soon get help with coverage under health insurances, but at a cost — insurers are hinting at an increase in premium. 

The Mental Healthcare Bill 2016, which got Lok Sabha’s nod last week, will become law once it receives Presidential assent. The Bill makes it mandatory for insurers to provide insurance to the mentally ill. Health insurers are gearing up to bring mental illness, such as depression and anxiety, under insurance cover. 

The progressive provision, however, may result in more expensive insurance products.

Responding to BusinessLine in an email, Antony Jacob, CEO of Apollo Munich Health Insurance, said: “The inclusion of expenses related to mental health could impact the premiums and some insurers may raise premiums. Currently, most of the mental health conditions are treated on an out-patient basis.” 

While adding that Apollo Munich’s customised group health insurance plans already cover mental illness, he added that the company was reviewing the Bill to chart out ways to include mental health under its products. 

Max Bupa Health Insurance is also in the process of complying with the Bill. Ashish Mehrotra, Managing Director and CEO, said: “There are various ways an insurance company can provide coverage to the people with mental illness, starting from basic hospitalisation coverage to comprehensive managed care services with counselling sessions and medical consultations that would help them get the best treatment for their mental condition. We are evaluating the key parameters and the best way to offer the most comprehensive coverage to such customers.” 

While Mehrotra estimates that 5-6 per cent of the population suffers from some mental health concern, a recent survey conducted by the National Institute of Mental Health and Neuro Sciences (NIMHANS) puts the figure at a much higher 13.7 per cent of the adult population, of which, at least 150 million need immediate medical intervention. This vast number is likely to put pressure on the health insurance providers. 

Johnson Thomas, Director and Co-Founder, Aasra Helpline, which works towards prevention of suicides, said while the inclusion under the insurance was a positive step in improving access to mental healthcare for patients, the potential increase in premiums was a concern. 

He added that the Bill is a start to a more organised mental health sector which is currently dominated by mom-and-pop shop kind of establishments.

Source: http://www.thehindubusinessline.com/money-and-banking/insurance-cover-for-mental-illness-could-raise-premium-costs/article9623584.ece

Why Diversity Inclusion does not include Mental Illness?

It was an absolute delight to see corporate embracing the LGBT community with wide options of acceptance.  Accepting the differences in the natural ways each one of us are made is the best regard we can pay to be having born as human beings.   

  Couple of most encouraging moves of the recent times:

1.  Coverage of health insurance and group insurance schemes of the same gender couple.   All these years, you can add your spouse and children, and in some cases parents in your health insurance policy coverage.  Very recently, corporates started to include same sex couples to add their same gender spouse/ life partner/ live-in partner into the health insurance fold which is a welcoming move.   
2.  Acceptance of same sex spouse/ partner to claim the benefits of the professional or employee, in event of unfortunate death, retirement or personal disability.  In this case, the employee can nominate his or her partner without feeling embarrassed or guilt and could choose the options of inheritance as per their choice. 

Even at the times, when we do not have a legalized system in place for the same sex marriages in India,  we are happy to be welcoming the inclusion of the LGBT community in its rightful share in the society.  

However, what annoys me and frustrates me with pain is the fact that we are yet to get the Mental Illness included in the medical insurance coverage.   Further, forget about the rightful inheritance of the mentally ill, the first and foremost reason for any kind of socially acceptance is itself not available to mentally ill.   

On the lighter note, probably, insurance companies and community will not be able to compensate as every one of us have some form or the other of mental illness.......:-) 

 

What we can do being part of Bipolar Support Group - Chennai, India?

It is a blessing to be associated with a group of like minded friends and families who will understand your situation and instead of showing sympathy, will in-fact share mutual respect and hope.    

Bipolar Support Group Chennai is such a great initiative and during its wonderful launch in the City recently, the families and friends who are all care-givers joined together in a hour long discussion which showcased various ways in which the support group can help themselves and each other.

25 Key Take-aways of the inaugural meeting of the Bipolar Support Group Chennai

1.   Engage in 'me' time.  All participants loved the idea of doing what you like, long forgotten hobbies or interests
2.  strengthen your belief in God and not to lose confidence in recovery
3.  Encourage spouses to trust in marriage and give a good try to make the marriage sustain and successful.
4.  Hope to avoid hatred and feelings to leave and run away from the situations
5.  Eat, sleep and exercise properly
6.  Rewind good old moments and recall all good work done in the past by the patients.
7.  To be responsible for emotional and psychological well being of the family.
8.  It is never possible to take full responsibility and to make every one in family to understand the support system
9. Explain the importance of medication by sharing experiences and suggestions
10.  Awareness discussion on the disease and to remove the stigma associated to mental illness
11.  Take help of doctors or para-medical staff to handle crisis intervention
12.  Plan and discuss to handle financial implications
13.  Take help to handle children, explain and educate them as needed
14.  Stop counter productivity 
15.  Be perseverant in the process of acceptance and focus on harmonious reslationships
16.  Take support when not able to match expectations
17.  Stop over care-giving , possessiveness and pampering that no one else can take care of the patient than you.  It is a myth
18.  Try to read and understand the information of the disease and understand the patient
19.  Build an under current attachment with acceptance and expressed emtions.
20.  Handle conflict information subtly and assimilation and stay informed
21.  Gain good insight of the disease and stop stigmatizing 
22.   Need to balance leaves and loss of job in the process of care-giving
23.  Maintain organizers to manage forgetfulness in handling multiple priorities
24.  Understanding of side effects of medication is very important and this will help to balance the patient's food, routine and sleep requirements.
25.  Practice meditation and yoga.  Keeping faith and confidence in life. 

 
 

Why do we need Mental Illness Support Groups?

Lot of times, we shy away from talking about mental illness or having a need to take care of a relative, family or friend who is suffering from any form of mental illness.  To avoid this situation and also to deal with the care-giving support with full dedication and love,  encouraged by similar souls around us is the best form of medical care we give to ourselves as care-givers.

Why do we need Support Groups-  especially this group?

• To share our experiences and feelings and understand that we have people who can think and help being in our shoes
• Emotional support when we need that pep-up in life as we deal with difficult situation of medical care
• Understanding the role of care giver with help of a doctor or a counsellor
• Provide behind the screen support and fall back on each other during crises
• Feeling that you are not alone and left behind and to improve care giving with mutual help
• Understand the various problems that come in the care-giving process

Frequent Problems faced by Care-givers

1.  Not having adequate care giver education
2.  Repeated disturbance to normal life cycle
3.  Distraction from routine and work 
4.  Influencing children living with the patient
5.  Feeling of slowness to pace with the patients aggressive behaviour and ambitions
6. Humilitation due to stigma of mental illness still existent in our society due to stigma of mental illness still existant in our society.
7. Difficulty to accept dear one's mental illness
8.  Mental fatigue and lack of concentration 
9.  Fear of leaving behind the patient when going to work or running errands
10. Some cases, care-giving will be a life time requirement
11.  Burden of finances as mental illness insurance is still a debate in India
12.  Requirement to keep a watch always on the patient
13. Genetic impact may cause similar symptoms in the children as well
14  Reactions of anger, frustration and not being able to control emotional reactions all the time
15.  Places and situations may demand certain reactions which are answerable to the society.
16.  Not able to differentiate from normalcy and and not able to talk as reactions are not predictable
17.  Not being able to defuse aggressive situations 
18.  Pressure of doing a balancing act, and not able to educate children on acceptance of the illness of a loved one at home
19.  Feelings of helplessness and thinking to leave and go away
20.  Suicidal thoughts as an escape from care-giver role
21.  Guilty thoughts when forced to leave the patient in a home or hospice 
22. Sleeplessness due to fear and panic having ripple effects on care-giving.

A strong support system will help the care-givers address all these issues with confidence,  hope and care.

 
 


 

Know about Bipolar Disorder- Major Contributors and Challenges

Today Bipolar Disorder or the Depression -  any illness related to mental health or well being is not rare in our society.  Atleast 1 out of 100 people suffer from bipolar,  and 1 in 10 suffer from some form of mental illness.   Be it from minute level to extreme difficult medical conditions

Major contributors for mental illness in General and Bipolar Disorder in particular

1.  Genetic reasons
2.  Increasing levels of stress
3.  Circumstances that cause depression
4.  Over activeness
5.  Aggresssive
6.   Economic or Financial anxiety with too much expenditure
7.  Addiction to alcohol/ smoking or drugs
8.  Insomnia or sleep disturbances
9.  Dejection
10.  Introvert not being understood by people arond
11.  Excess sleep

Challenges of handling mental illness or bipolar disorder

1.  Continuous medication
2.  No time limit for cure and needs regular follow ups
3.  Minimum time taken to bring back to normal state usually is longer as minimum of 6 months and above
4.  Need to focus on relapse and remission prevention
5.  Counselling necessary for care givers to handle long term treatment
6.  Necessity to handle anxiety, sleep disorders
7.  Several problems that include, situations not being able to predict normalcy,  no insight into the disease,  agitative patients,  with no understanding,  and the reactions are unpredictable
8.  Aggravated situations that need immediate medical help
9.  Failure to identify early signs and symptoms
10. Restlessness and argumentative behaviour of the patients
11.  Patients insistance that everything is normal and behave overconfident
12.  suffering from multiple patters of sleep disorders, eating and social habits