Expanding Mental Health Insurance: A Vital Reform In India
In a recent publication in The Lancet Psychiatry, titled "Mental Health Insurance Reform in India," authors Sheikh Shoib, Ilham Zaidi, Fahimeh Saeed, Debanjan Banerjee, Sarya Swed, and Miyuru Chandradasa shed light on the urgent need for mental health insurance reform in India. The article underlines the stark realities of mental health in the country, where mental disorders affect millions of individuals, leading to significant disability-adjusted life years. However, despite the high prevalence of mental health issues, the sector remains under-recognized and often underfunded.
As the article highlights, mental health services in low- and middle-income countries like India face numerous challenges, including stigma, sociocultural beliefs, and political barriers. These obstacles hinder the development of mental health services, leaving many individuals without access to the care they need.
One notable aspect the authors emphasize is the lack of insurance coverage for psychosocial treatments. In India, individuals can only claim insurance for mental health conditions if admitted to the hospital or receive outpatient care, mainly for pharmacological treatment. This approach has its shortcomings, as many individuals are reluctant to be admitted to hospitals for psychiatric illnesses, and this can lead to delays in seeking help and contribute to social discrimination.
The authors acknowledge that India has made significant progress in healthcare services over the past two decades, improving parameters such as immunization, life expectancy, and mortality rates. However, several barriers, including stigma, misinformation, and limited medication availability, continue to impede mental health services' growth.
One of the main issues raised in the article is the lack of universal health coverage in India due to economic constraints, political beliefs, and the sheer size of the population living below the poverty line. While the National Health Mission focuses on social determinants of health through primary care, the implementation of policies has been slow.
To address these challenges, the Mental Healthcare Act (MHCA) was approved in India in 2017, emphasizing the need for medical insurance to cover mental disorders. Although this was a positive step, the implementation of the MHCA has been slow, with many components still in development.
The article highlights that insurance coverage for mental disorders is essential in bridging the treatment gap and ensuring affordable mental healthcare. It suggests recommendations to improve insurance coverage, including revising the list of eligible mental disorders, covering non-pharmacological interventions, and expanding the implementation of insurance for mental disorders under existing policies and service provisions.
Furthermore, the authors point out that Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), one of the world's most extensive health coverage systems, has taken steps to include mental healthcare services. Insurance companies like Manipal Cigna Health Insurance, the National Insurance Company, and the Oriental Insurance Company have also incorporated mental disorders in their policies, albeit with certain limitations.
The need for mental health insurance reform in India is critical to addressing the mental health crisis in the country. By expanding insurance coverage and implementing the recommendations presented in this article, India can take significant steps towards providing accessible, evidence-based psychiatric treatment and reducing the burden of mental illness. Mental health should be a priority in India's journey toward comprehensive healthcare coverage.
