Edvard Munch’s famous painting The Scream is a symbolic representation of the universal anxiety of modern humans. The agonised figure in the painting is reduced to a garbed skull shrieking in the throes of emotional crisis. The image shakes one to the core and resonates in sync with the silent yet powerful scream emanating from the viewer’s soul.
The current state of affairs all over the world marked by violence and strife has a deleterious effect on our mental health. Wars, conflicts, deaths, bombing, rapes, murders, domestic violence are a few of the terrible things that we witness or experience on everyday basis and due to which our mental health is in jeopardy.
According to World Health Organisation (WHO), mental health particularly depression is a leading cause of health and disability worldwide, with nearly 30 crore individuals living with depression. By 2020, depression will be the second leading disease in the world.
India is no exception. “In fact, statistics reveal that India is one of the most depressed countries in the world, where one out of every six individuals suffers from mental illness such as depression or anxiety,” said Hansika Kapoor, senior consultant psychologist based in Mumbai.
Arijit Choudhury, 41, battled depression for more than a decade and had to seek medical help for sometime. However, during his second bout, Choudhury chose to heal himself naturally. “Even after years of struggle and medication, when depression hit me for the second time, I decided to fight it out on my own. After reading up a lot on the subject, I was determined not to let any external factors affect me. I surrounded myself with as much positivity as possible. While the process was gradual, needless to say, I was successful and today I am leading a happy and contended life,” said the Bengaluru-based social-media influencer.
So, how does one deal with mental illnesses? Is there any cure and even if there is, are insurance covers available? Sadly, there is no concrete answer.
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.”
“Inclusion of mental health treatment for insurance purposes is indeed a welcome change as introduction of such policies shall be instrumental in paving the way for reform,” said Samir Parikh, Psychiatrist, Fortis Hospitals. Delhi. He further stated that, despite the wide gap of awareness and stigmatisation that still needs to be overcome, these policies seem to be positive steps towards the vision of making mental health a priority.
Adding on to it, Prasun Sikdar, MD and CEO, Cigna TTK said, “Introduction of mental health insurance will have an overarching impact as it will provide the right to mental health cure to every citizen.” He is confident that it will ensure a life of dignity for those who have mental health issues and promote mental health literacy among masses, thus reducing myths and stigma associated with them. Sikdar further stated that, “It will certainly help in better planning of medical expenses related to treatment of mental health conditions. It will also open avenues for financial support that in turn will enhance care and facility for management of mental conditions.”
However, while Insurance Regulatory and Development Authority (IRDAI) made it mandatory to include mental illness among insurance, not many insurers tend to have taken it seriously. Insurance providers are yet to come up with structured policies that cover mental illness despite nearly 10 per cent of the country’s population suffering from some kind of mental illness.
When enquired about the issue, Ashish Mehrotra, MD and CEO, Max Bupa Health Insurance, said, “We still need some more time, data and experience from international markets to gain a better understanding to design products appropriately which covers all aspects of mental health related illnesses.” He further stated, mental illnesses do not always require hospitalisation except in some severe cases. There is no defined treatment for mental illnesses and hence finalising the premium is difficult. Here, experience from international markets and reinsurers would have to be used to decide the premium rates. Psychologist Atika Shukla feels that since there’s a lot of stigma attached to mental illness in India that might act as a hindrance towards regularisation of insurance regarding the same.” However, takers of mental health insurance in India feel positive about the efforts.
Not everyone like Choudhury would openly discuss the importance of mental health conditions. As a subject, it is often kept under wraps, except by professionals in the field; insurance regarding the same is way beyond discussion.
There is a dearth of service providers as well as the 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 urbanised centres, lack of integration with primary care services, and lack of experience and training among mental health professionals.
“Insurance is badly required because mental health cure may not be expensive in the initial stages but treatment is often prolonged which sums to a higher amount of expenditure. Some form of insurance is welcome,” said Dr. Amit Desai, Consultant Psychiatrist at Jaslok Hospital and Research Centre.
The IRDAI’s step brings to the forepart numerous issues that have riddled the mental health industry with obstacles in proper implementation of a provision of services. This is because insurance companies will now become shared stakeholders in the country’s mental health dialogue.
At present, health insurance providers offer individual and family coverage, primarily for physical ailments and the coverage includes hospitalisation or treatment at hospitals. In the absence of any insurance coverage for mental health disorders, most of the payments for treatment are out-of-pocket expenses.
After the regulator’s directive, insurance companies will have to include cover for mental illness too. However, the premiums are likely to be high for conditions such as depression and anxiety.
Analysts are of the opinion that, insurance providers will now have to make actuarial calculations to calculate premium rates on mental disorders. Moreover, limits may be set on the coverage or claims for various treatments. In the earlier months of 2018, Star Health Insurance launched an insurance cover targeted at individuals suffering from autism, aged between three and 25 years. The sum insured is ` 3 lakh and also has sub-limit for certain ailments and treatments. The gross premium (excluding tax) for this policy in the age group of three -10 years is `4,800; for the age group of 11 to 20, it is `5,325 and for those in the 21 to 25 years age group, the premium is ` 6,075. The policy is renewable till the person is 25-years-old. After that, the company states in its brochure, the coverage will be offered in suitable alternative products with continuity benefits.
Commenting on IRDAI’s directive, S Prakash, COO, Star Health Insurance, said, mental health insurance is definitely a move in the right direction.
So, going ahead, can we expect insurance providers to come up with more innovative and usable products enabling people to deal with mental health illness?
Commenting on this, Mehrotra added, “Yes, going ahead we do expect products which will provide specific coverage and benefits for mental health issues. However, new products from any insurer need to be filed with the IRDAI before launching it in the market. Hence, there would always be a time lag between any new regulation and respective product launch in the market.” He further stated that the new products that would be launched in the coming months’ would definitely include the mental illness cover as a part of the core product design, keeping in view the new regulation by IRDAI.
But what will insurers pay for? A typical health insurance policy pays for in-patient hospitalisation and not out-patient treatment. In other words, your consultation with your doctor or medicines that you buy will not be payable. But if you are hospitalised on account of a mental illness, then the policy will cover you. However, it’s still a small part where mental illnesses actually need hospitalisation. In most cases, a majority of people with mental conditions need out-patient care like consultations and medications, which health insurance policies in their current form do not cover.
While the circular may intend to increase coverage and weed out disparity between physical and mental illnesses, in practical terms, the person insured may only enjoy limited benefits if the industry doesn’t innovate to bring about meaningful OPD products. Rajiv Kumar, MD and CEO, Universal Sompo General Insurance Company, concludes, “We are at least moving towards wellness and preventive care and areas which till date have not been talked about like surgical side infection.”
Mumbai-based Fatema Muckra fought mental illness for long time. The 38-year-old marketing professional went into severe depression after battling several issues on the personal front. She resorted to medical help that comprised medication and series of counselling sessions. There was constant fear of being judged and misunderstood by society. Muckra is thankful that her family stood by her throughout the rocky patch.
However, after a while Muckra was determined to fight it out on her own. First thing she did was to accept the fact mental illness is just like any other physical illness which is curable. Gradually, with solely exercising her will power, Muckra was not only able to reduce her counselling sessions but also do away with her psychiatrist and medication.
Today, few years down the line she is leading a normal and happy life.
* Noted Bollywood actor Deepika Padukone not only battled depression but also chose to open up about it. Today, she runs an organisation named The Live Love Laugh Foundation that foscussed on creating awareness about mental health. In an exclusive interview with Sampurna Majumder she opens up about battling and overcoming depression.
“Acceptance is of utmost importance”
1 You battled depression at the peak of your career. Did it become a roadblock?
Yes, defnitely to a certain extent if not completely. Mental illness is same as any other physical aliment. Just as having a severe headache would hold you back from concentrating on your work, so does mental illness. Rather at times, it can be more taxing since it becomes difficult to focus and concentrate as the individual often feels directionless.
2 When in depression what should one do?
Well, I think the first step is to identify the symptoms of the disease and then act accordingly. Acceptance is of utmost importance. Then, opening up to close family members or talking to friends may be the initial process. However, seeking professional help from a psychologist or a psychiatrist is very essential as it not only helps you to understand the root cause but also help you deal with the same at a more professional level.
3 What kind of role family should play?
Role of the family members is very crucial. It is not only the person affected, but severe depression can often take a toll on immediate family. However, being panic stricken is not the solution. The family should be able to accept it first and then donne the cap of a caregiver. They must be extremely patient and compassionate in dealing with the individual. Allowing them to open up and hearing them with patience is very essential. The person battling mental illness should never be made to feel wrong. Family members must ensure that they give a very safe and secure environment.
4 In India, mental health is considered a taboo. How challenging and important it was to talk about it?
While I agree to the fact that there is a lot of stigma surrounding mental health in India, for me opening up was never a challenge. Rather, I took this as an opportunity to not only speak up about battling mental illness but also spread awareness regarding the same. I had a single-minded motive in terms of spreading awareness and also to let the world know that mental illness is curable, provided you follow the right path. Hopefully, our efforts can reduce the stigma.
5 What initiatives Live Love Laugh is taking to create awareness regarding mental health?
Mental illness, especially depression and anxiety has become too common in India and we are working towards not only creating awareness regarding the same, but also help it fight. Earlier we have launched campaigns like #DoBaraa Poochho where the idea was to encourage people to become more empathetic towards mental illness survivors. Our campaign titled #NotAshamed was all about breaking taboos and opening up about mental illness, where we featured real-life survivors.
Our next target happens to be both urban and rural India where we intend to educate people more on mental illness, especially teachers at educational institutions. We are looking at spreading as much awareness as possible so that we succeeded in diluting all kinds of stigma attached to the same.