Medics concerned as insurers skimp on mental health coverage

Monday, January 23rd, 2023 11:00 | By
Medics concerned as insurers skimp on mental health coverage
Stakeholders in the mental health space after a consultative meeting by Aga Khan’s University’s Brain and Mind Institute held in partnership with Mental Health Alliance of Kenya on how to improve efficiency in the insurance sector concerning mental health. COURTESY

Concern has been growing in Kenya over an alarming rise in number of suicides.

Kenya loses about four lives to suicide every day. Research has it that for every suicidpe, 135 people are personally affected, which means that in a year, suicide affects up to 6.3 million people.

The ongoing epidemic has also drawn attention to the fact that people’s mental well-being, as well as physical health, must be taken into account. “Similar to any physical illness, mental illness can lead to harmful consequences. When left untreated, mental illness can potentiate physical conditions, such as heart disease, resulting in even more expensive treatment needs. And depressed patients have an increased risk of other major chronic illnesses, such as diabetes and stroke,” explains Martin Waweru a mental health expert.

Exclude suicide victims

 However, despite the crisis, in Kenya, access to quality insurance for people with mental illnesses is still challenging. Many insurance policies do not cover pre-existing conditions except after a year. For example, some private insurance schemes do not cover neurodevelopmental disorders for individual cover holders. Additionally, all insurance providers have clauses that expressly exclude suicide victims or attempted suicide survivors from insurance claims or coverage.

“Mental health is a human right, and people living with mental illness should not be subjected to unnecessary barriers to access to care,” said Prof Zul Merali, Aga Khan’s University’s Brain and Mind Institute (BMI) Founding Director.

Speaking during a consultative forum with stakeholders, including insurance companies, regulators, policyholders, private sector, academia, government and non-profit organisations, for a roundtable discussion on how to improve efficiency in the insurance sector concerning mental health, Prof Zul said the scope of health insurance coverage only covers physical health conditions and illnesses.

They outlined some of the factors undermining the fight against mental health, including criminalisation of suicide, high cost of treatment and lack of sufficient data.

“As a community we tend to discriminate against people battling mental illness. We should stop looking at mentally ill people as disenfranchised humans. We have to make mental healthcare accessible to everyone and avoid stigmatising them,” said Prof Zul.

Fortunately, significant change in this fight has been seen recently as more people with mental diseases are opening out about their conditions as awareness of mental health concerns has grown. There is also the newly appended Mental Health Amendment Bill (Senate Bill No. 28 of 2020) into law has placed obligation on the Ministry of Health to include mental healthcare in National Health Insurance Fund (NHIF)’s insurance cover and tasks insurance companies to follow suit.

Cost of cover

 “A person with mental illness shall have the right to access to medical insurance for the treatment from public or private health insurance providers,” reads the Bill.

Insurance Regulatory Authority (IRA) Assistant Manager of Supervision James Ndwiga said at the meeting insurance companies gives limit to the amount they pay for mental health adding that personal insurance is more expensive compared to group insurance and some insurance companies are selective on what they cover.

The Mental Health Amendment Bill has, however, opened other avenues of discussion where insurers find themselves in a straitjacket situation. This is the case with insuring suicide or attempted suicide cases, which is related to mental illness. The constitution criminalises suicides, yet it’s related to mental illness.

The Ministry of Health in July last year, included mental healthcare in the newly enhanced medical scheme offered by NHIF with a promise that patients will receive services in over 7,000 facilities across the country.

About 80 per cent of health facilities are comprehensively contracted with the bulk of them being government and faith-based hospitals while private hospitals have a non-comprehensive contract.

However, adoption of the policy by private insurers has been slow, and other challenges still persist.

“We have to decriminalise suicide cases because it is among the symptoms of mental health so that it can be insured,” said Prof Lukoye Atwoli the Associate Director at Brain and Mind Institute (BMI).

According to BMI, one in two people suffers from mental illness, such as depression, anxiety disorders, and 90 per cent of them attempt suicide. The institute indicates that suicide is a severe mental issue.

“One in two people suffers from severe mental illness and depression is common among the population. Bipolar disorders, anxiety disorders and suicides are also common out of which nine out of 10 of them attempt suicide. It’s a severe mental issue,” said Prof Lukoye.

The Institute pointed out that the country loses about six per cent of its Gross Domestic Product (GDP) to mental health through mortalities, reduction of productivity in the work place and mobility as seen in 2021 where a total of Sh5.5 billion was used to treat mental illness. They say that Sh81.7 billion is needed to curb the widespread mental illness in the country. However, according to the data, which they’ve collected the spending on treatment of mental health is not a loss to the country as it’s going to double the productivity. Equally, every shilling spent on treating epilepsy and depression which are common mental problems, the return is much higher. They stated that in every shilling spent in treating depression and epilepsy, you gain Sh4 and Sh6 respectively, which means it will drastically increase productivity.

Economic impact

“Money spent in treating mental illness is not a loss, it’s an investment that has an actual real return to the economy. We lose six per cent of the GDP to mental health through mortalities, reduction of productivity and mobility,” Prof Lukoye said.

BMI opines that transparency must be upheld by insurance companies and hospitals in order to solve the problem noting that there are more than 300 mental illnesses affecting people. If the illnesses go unmanaged it will cause economic problems and exclusion of mental health is unjustifiable. They say without mental health there’s no health.

Dr Frank Njenga who is the immediate advisor of former President Uhuru Kenyatta on mental illnesses blames the mismatch between insurers and the hospitals for the woes facing people seeking insurance cover for mentally ill people saying that  insurers try to keep the costs down while doctors are trying to make them pay for it. “There’s no shortage of mental health caregivers. The problem is that people don’t understand each other, the insurance companies tries to keep the cost down, the doctors tries to get the insurers to pay for it and there’s a mismatch. The insurance companies don’t know what the doctors are doing and the doctors don’t know what the insurers are doing. It’s the lack of honesty. So these stakeholders should hold an open conversation,” he said.

He also pointed out that insurers are using old data to do their calculations for insuring patients, which is faulty and doesn’t represent the reality and recommended that fresh data has to be collected to enable insurers to offer better coverage. “Insurance companies use old data to do their calculations. We have to collect data to help the insurance companies to give better covers for mental illnesses,” Dr Njenga said in ending.

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