According to the National Mental Health Survey (2016), almost 14% of the Indian population suffered from one or more psychiatric disorders. Despite this high prevalence, the treatment gap for mental illnesses in India is about 85%; this means that 85 out of 100 Indians who need treatment for mental illness do not seek or receive the same.
Poor awareness of and accessibility to mental healthcare cause this treatment gap. But there is another, less-discussed reason: the lack of health insurance coverage for mental illnesses. For a very long time, none of the health insurance policies used to cover mental illnesses. The Mental Healthcare Act of 2017 made it mandatory for health insurance to cover mental illnesses. A Supreme Court ruling in 2020 brought a paradigm shift with the Insurance Regulatory and Development Authority
mandating the inclusion of coverage for mental illnesses in all health insurance policies.
There are two main types of health insurance policies in India: public-funded policies and private policies. The flagship government programme, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, which provides health coverage of five lakh rupees per family per year covering the bottom 40% of the Indian population for secondary and tertiary care in empanelled hospitals, has 10 different packages for mental illnesses, including substance-use disorders. It covers hospitalisation as well as pre- and post-hospitalisation costs and has specific packages for electroconvulsive therapy and repetitive transcranial magnetic stimulation. Insurance by private companies is supposed to cover in-patient hospitalisation costs, pre- and post-hospitalisation, as well as outpatient consultations with psychiatrists and/or registered therapists. It is also ‘supposed’ to cover all psychiatric diagnoses, although the specific details of coverage can vary among policies.
Despite such provisions, the ground reality seems quite different.
The major difficulties confronting insurance for mental health are as follows — coverage of only in-patient hospital stay when major expenditures in chronic mental illnesses are incurred on outpatient follow-ups, rehabilitation, psychotherapy sessions and long-term medications; the capping of the amount for coverage of mental illnesses by certain policies that violate the legal stipulation meant to prevent discrimination between policies on physical and mental illnesses; insurance companies have a predetermined premium loading for pre-existing medical conditions but, at times, insurance is refused as a whole; delay in implementation of the IRDAI mandate by insurance companies even though the IRDAI has issued a notice stating that all health insurance plans need to be updated to cover the treatment cost of mental illnesses by October 31, 2022; usually, a health insurance policy provides coverage
for mental illness after a waiting period of two years. Hence, a claim for mental
diseases cannot be raised unless a policyholder renews the health insurance policy for two consecutive years; disorders related to alcohol or substance use are excluded in most policies.
Similarly, hospitalisation following self-harm is not covered by insurance policies, even though the rates of addiction disorder and suicide are alarmingly high; insurance companies ask for medical history, diagnoses and management details for reimbursement. For mental illnesses, where confidentiality is an important
factor, no clarity exists on how much information should be shared with insurance firms.
Government contribution to healthcare is low, leading to high out-of-pocket expenditures. The path forward is public-private partnership under the guidance of the MHCA 2017, thereby strengthening insurance infrastructure and coverage for people with mental illness.
Chandrima Naskar is an early-career psychiatrist trained in PGIMER, Chandigarh. Debanjan Banerjee is a consultant psychiatrist at Apollo Multispecialty Hospital, Calcutta
