The country, in fact the world, has been in the grip of coronavirus for quite some time. However, sooner or later, we shall be able to control this menace, especially when we would succeed in developing an effective vaccine for it. But the apprehension is that our country is not prepared to face the next epidemic – that is likely to confront us in the form of mental health issues. In the 2017 convention of the National Institute of Mental Health and Neurosciences (NIMHANS), the President, Shri Ram NathKovind had forewarned that “India is not only facing the challenge of the mental health, it is facing the prospect of a mental health epidemic.” According to a 1917 report, published in the LANCET,during 1990 to 2017, around 197.3 million Indians have been the victims of one or the other form of mental health issues.And, this rather high number should really make us sit and take urgent actions to meet this worrisome scenario.
During the last few years, the number of patients suffering from mental health has been rising. Just imagine that before the pandemic itself, the World Health Organization (WHO) had forewarned India about the danger of its 20% population likely to be afflicted with mental health problems by 2020– and during the current pandemic, there have been reports of an increasing number of people of all ages suffering from mental health issues. India has been somewhat neglecting this huge issue of mental health and focusing on other major issues of health. However, at times in the form of data, and some other time in the form of incidents, the issues connected with mental health have been attracting attention. On April 7, 2017, finally, the Indian Parliament passed the Mental Healthcare Act 2017, and it was implemented on July 7, 2018. This was a very major step, and of especially huge importance for the patients of mental health and all those working in this area. It strengthened the hands of everyone as it talked about the equal rights of the mental health patients of all ages with regard to all aspects such as treatment, expenditure, rehabilitation and insurance.
Mental Health Also Included From October 1, 2020
October 1, 2020, was that red letter day when the Insurance Regulatory and Development Authority of India (IRDAI), a government body, strictly instructed all the insurance companies to make mental health an integral part of the health insurance. Inclusion of mental health in the ambit of health insurance made it clear to all the citizens that mental health is no less, may be only more, important than physical health; and, the treatment of the apparently invisible or not directly manifested aspects of mental health – such as feelings, emotions and restlessness of heart and mind – is as important as that of the visible ailments pertaining to the domain of physical health. There are great expectations that this decision would help improve the environment for the patients of mental health as apathy, avoidance, aversion and hate towards them would at least lessen. At times, because of our attitude towards the patients of mental health – in addition to their own perceptions – these treatable mental health ailments lead to their avoidable sufferings and even untimely demise. It is hoped that this step would also lead to taking due cognizance of the – thus far neglected – expenditure incurred on private counselling.
According to the July 22, 2020 circular of the IRDAI, now onwards, under health insurance, all insurance companies are to include mental health as well. Some other instructions have also been issued by the IRDAI, and these have been accepted by all the insurance companies. Ramesh Chander Joshi, Director, Target Realtech Private Limited, is of the view that “inclusion of mental health in the insurance will not make any difference to the premium as many insurance companies have increased their premium of health insurance cover by 4.8% in February this year”. He opined that “this decision of IRDAI and stopping of the recalcitrant attitude of the insurance companies with regard to inclusion of the mental health in the health insurance cover was advantageous for both the parties. The customer will benefit as irrespective of a history of mental health issue in the past, everyone will be covered by the health insurance and the insurance companies will get more customer now onwards.”
Praveen Kumar Bhardwaj, the Manager of Star Health and Alliance Insurance, a premier health insurance company, says that, “it is correct that the premium will not be affected by the inclusion of mental health in the health insurance, because it is only an additional feature of the health insurance, but it is not necessary that the treatment taken through the Out Patient Department (OPD) will be included in this premium by the companies. As of now, every company covers a minimum 24 hour hospitalization only.” He further informed that his company is yet to take a call on this issue, and all the companies are likely to require some more time to decide on this very crucial issue with far reaching consequences.
Advocate Gaurav Kumar Bansal, who doubles as a mental health activist, says: “We all know that the insurance companies are in business, but they cannot be allowed to make profit at the cost of human lives. And then the issue is not limited to the insurance, but also includes the fear that every patient of mental health suffers from.” He further said that inclusion of mental health under health insurance will not only provide financial security to the patients of mental health but will also help them secure respectable status – like all others – in the society.
Struggle to Include Mental Health under Health Insurance
In the Mental Health Act, passed in 2017 and implemented in 2018, the government has clearly stipulated that just like the physical ailments are covered under health insurance, the mental health ailments be also included therein. In other words, there would not be separate insurance covers for the physical and mental health aspects, but the two would be covered under same insurance scheme. This way, the Act put the physical and mental ailments on the same footing thereby eliminating any and every scope of discrimination. It was a praiseworthy move by the government, but it remained to be realized in practice. Because of the non-implementation by the insurance companies, on August 16, 2018, the IRDAI instructed all the insurance companies to include mental health – as per the said Act – in all their health products.
On October 22, 2018, once again IRDAI issued a directive in this regard. On September 27, 2019, under ‘Standardization of Exclusion’, IRDAI again issued guidelines to the health insurance companies. Seeing the non-compliant attitude of the insurance companies, Advocate Gaurav Kumar Bansal filed a Public Interest Litigation (PIL) petition – wherein he also included the 2019 application (to IRDAI) that he had filed under the Right to Information (RTI) Act – in the Hon’ble Supreme Court of India. On June 17, 2020, the Hon’ble Supreme Court issued a notice to IRDAI wherein it asked IRDAI to explain its non-performance.
IRDAI informed that when no company was willing to include mental health in the health insurance, on September 30, 2019, it had instructed all the insurance companies to include the mental ailments in the health insurance cover. And, on June 22, 2020, IRDAI once again issued a circular to all the health insurance companies for inclusion of the mental health under health insurance. But there was a difference this time – the circular included the ultimatum to incorporate the mental health under health insurance by October 1, 2020.
The inclusion of mental health under health insurance is a welcome step, but it is yet to be seen if the OPD treatment is included therein. Nevertheless, there is some welcome movement in the matter that was kept in the cold storage since 2018, and it has kindled hope in the people associated with the mental health sector.
(Note: On the occasion of ‘World Mental health Day’, this is the first part on Mental health second part will be soon published.)