Mental health insurance in India after COVID-19
Authors: Madhurima Ghosh, Biswa Prasun Chatterji
Journal: The Lancet Psychiatry (2020)

In India in 2017, 197·3 million people had been diagnosed with mental disorders, which equates to one in seven of the population, with the most frequently affected being those aged 30–49 years.1India State-Level Disease Burden Initiative Mental Disorders CollaboratorsThe burden of mental disorders across the states of India: the Global Burden of Disease Study 1990–2017.Lancet Psychiatry. 2020; 7: 148-161Google Scholar However, the Indian Government and private insurers have been extremely slow to introduce mental health insurance. In April, 2017, India passed the National Mental Health Act, which mentions provision of health insurance for people with mental illnesses.2Ministry of Law and JusticeThe mental health care act, 2017: no. 10 of 2017. The Gazette of India, New DelhiApril 7, 2017https://www.prsindia.org/uploads/media/Mental%20Health/Mental%20Healthcare%20Act,%202017.pdfDate accessed: October 14, 2020Google Scholar India has adopted universal health coverage and has introduced schemes like Ayushman Bharat, a National Health Protection Mission to provide health insurance to 500 million people,3National Health Authority by Government of IndiaComprehensive primary health care through health and wellness centers: operational guidelines.http://nhsrcindia.org/sites/default/files/Operational%20Guidelines%20For%20Comprehensive%20Primary%20Health%20Care%20through%20Health%20and%20Wellness%20Centers.pdfDate accessed: October 14, 2020Google Scholar which includes financial support for screening and treating mental illnesses. Those who need care for mental illness should be referred to a high-level facility, which will provide inpatient and outpatient services, counselling services to patients and their family, dispense medicines to patients with psychiatric disorders, and send patients to addiction treatment centres.3National Health Authority by Government of IndiaComprehensive primary health care through health and wellness centers: operational guidelines.http://nhsrcindia.org/sites/default/files/Operational%20Guidelines%20For%20Comprehensive%20Primary%20Health%20Care%20through%20Health%20and%20Wellness%20Centers.pdfDate accessed: October 14, 2020Google Scholar Up to the end of 2019, a search of the internet, newspapers, and journals (by MG) found no signs of private insurers introducing mental health policies. Surprisingly, we observed the effect of the COVID-19 pandemic with lockdown in India from March 25, 2020, changed the scenario. On June 2, 2020, the Insurance Regulatory and Development Authority of India instructed all insurance companies to provide policies for people with mental illnesses by Oct 1, 2020.4Insurance Regulatory and Development Authority of IndiaDisclosure of underwriting philosophy of offering Insurance coverage to Persons with Disability (PWD) and people affected with HIV/AIDS and Mental Illness diseases. Insurance Regulatory and Development Authority of India, Government of India, June 2, 2020https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo4140&flag=1Date accessed: October 14, 2020Google Scholar As of October, 2020, insurance plans for mental health treatment are being provided by HDFC ERGO in the my:health Suraksha Plan.5my:health Suraksha Insurance - Silver Smart PlanWhat is covered in a health insurance policy? HDFC ERGO.https://www.hdfcergo.com/health-insurance/my-health-suraksha-silver-smart#coverd-n-notDate: 2020Date accessed: October 14, 2020Google Scholar The situation for other private insurers is not clear. The Ayushman Bharat scheme of the Government of India included the costs of outpatients and inpatients because of a mental illness. Private insurers like HDFC ERGO have excluded outpatient treatments, which comprise the majority of costs for treatment because of the chronic nature of many mental disorders. We believe India has an unmet need for insurance of mental health. Stigma associated with mental illnesses and little awareness of patients' rights stop many patients from reporting their condition or asking for insurance. The management of chronic mental illnesses requires regular, and sometimes lifelong, investments in medicine and treatment. Out-of-pocket expenditure can lead to untimely cessation of treatment and subsequent relapse. Unless the stigma of mental disorders is removed and insurance is provided for mental illness, universal health coverage in India will not meet its inherent promises. We declare no competing interests.