Despite Supreme Court guidelines and distressing mental picture of the valley, insurance providers are yet to bring mental health under the ambit of health insurance in Kashmir.
By Aaqid Andrabi
A tight and overly-cramped lane in Downtown Srinagar leads to a barely maintained one-storey house of Abdul Manan.
One can see his two pre-teen sisters running and frolicking around in the tiny front yard.
Until November 2019, Manan had a job with a private firm in Kashmir. He found himself left hanging high and dry when he lost his means of survival due to the layoffs that ensued from the perpetual blockade imposed on the erstwhile state of Jammu & Kashmir after the abrogation of Article 370 in August 2019.
As much as lack of employment is a problem, Manan was diagnosed with chronic depression nine years back. The loss of a job didn’t help that.
Coming from a lower-middle-class family from Central Kashmir, Manan has to fend for a family of 6 and would do so at a paltry salary of Rs 9000 a month.
To manage all that, he had to borrow money from a private money-lender who comes knocking every fortnight for the repayment.
Manan’s medicines and psychiatric medicinal expenses were a bit too steep for him, so he opted for an insurance policy from a private insurance provider.
He was in for a bitter surprise when he found out that the provider has placed a maturity period of a few years on the ‘pre-existing’ conditions and won’t be covered during that period by his insurance provider. His medicines alone cost him Rs 10,000 a month plus fortnightly psychiatric consultations, costing Rs 3,000 per session.
Running helter-skelter to remedy the same didn’t prove to be of much use since his insurance provider cited the health cover conditions, denying the consumer any benefits until the maturity period has lapsed.
The distressed downtowner’s trysts with his mental health and lack of support show the irrefutable need for comprehensive insurance policies covering mental illness and disorders.
Data gathered by Kashmir Observer from various district hospitals of the Kashmir division suggests that, on average, a specific district hospital has a monthly footfall of 300 patients who come in with one or the other mental disorder or illness.
The infrastructure necessary to deal with conditions is of sub-optimal levels, to say the least.
Our investigation led us to conclude that the number of patients consulted at the district levels snowball into a much bigger quantum for the entire Kashmir division in its entirety.
The dedicated psychiatric hospital at Rainawari, Srinagar, on average, houses at least 300-400 patients every month. These numbers don’t include those patients who are treated and sent home. That amounts to a rather significant caseload when looked at in the larger context.
The data provided by the Baramulla district hospital shows a fair amount of patient footfall who come seeking psychiatric treatments.
In January 2021, 370 patients sought psychiatric help at the hospital, showing the common masses’ dire state of mental affairs. Even the previous surveys and studies have painted the distressed mental state in the strife-laden valley.
In an MSF survey (Medicine Sans Frontiers/Doctors Without Borders) in 2015, 45 per cent of the adult population in Kashmir valley showed significant mental distress symptoms.
Among those surveyed, 41 per cent exhibited symptoms of probable depression, 26 per cent showed signs of potential anxiety, and 19 per cent showed symptoms of probable PTSD—post-trauma stress disorder.
Those numbers are more or less likely to have increased significantly over the last five years.
A study conducted in 2005-06 earlier revealed that the prevalence of depression among Kashmiris was 55.72 per cent, and this was much higher in rural areas (84.73 per cent) compared to urban areas (15.26 per cent). There was a higher prevalence of depression among females (93.10 per cent) than males (6.8 per cent).
As distressing as they are on their own, the numbers were not the primary subject of investigation.
A perusal of publically accessible hospital records enabled us to determine that lack of monetary support for such patients from governmental and non-governmental establishments is one of the most pressing issues.
Barring a few, most private insurance providers don’t have much to offer when it comes to mental health and the incurred or to-be-incurred costs. It is the patient or their caretakers who primarily bear the expenses of therapeutic care or medicines.
On average, a consultation session with a professional psychiatrist/psychologist costs somewhere around three thousand rupees an hour. Multiply that four times a month, and that comes up to twelve thousand a month. Add to this the cost of medicines that the patient has to take, and it comes up to around twenty thousand rupees.
That is an amount that the mostly middle-class population of the Kashmir division would certainly feel making a dent in their monthly expenditure plans.
These findings further substantiate the issue of significantly high (60 per cent) out-of-pocket expenditure incurred by Kashmiris on health.
HDFC Ergo is one of the few insurance providers that offer insurance cover on the costs incurred while dealing with some mental illnesses, albeit with its conditions and caveats.
There is a ‘maturity period’ of three years, which means that even after getting the insurance cover, the beneficiary will have to wait for as many as three years before he can benefit from the insurance cover that he has nonetheless been paying for the past three years.
Furthermore, pre-existing mental health conditions are not covered by the insurance provider. That leaves a lot to wish for even after paying hefty premium amounts.
Interestingly, mental illnesses did not come under the insurance ambit till 7 April 2017, when the Mental Healthcare Act (2017) was passed. It came into force on 7 July 2018, with Section 21(4) of the Act stating that “every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for the treatment of physical illness”.
Subsequently, in August 2018, the Insurance Regulatory Authority of India (IRDAI) directed all insurers to comply with the Act’s provisions. Very few have complied so far.
All this shows the irrefutable need for comprehensive insurance policies covering mental illness and disorders.
We tried to delve deeper into the issue and spoke to one of the managers working with a national insurance provider: “It all comes down to what the company gains when it gets involved in such transactions with a customer. Covering any mental illnesses isn’t a lucrative business model for an insurance provider since, as we have noticed lately, there are too many claimants for the same. The Covid-19 pandemic and the ensuing restrictions on life as we knew it has brought to fore the real damage that people have incurred or will incur, psychologically speaking.”
Such revelations were almost the same throughout the industry. Another person working with yet another insurance provider had to say the same about the insurance providers: “When the company provides you with an insurance cover, they tend to look for what profits they get from any such policy. There aren’t many claimants that don’t suit any insurance provider’s for-profit business model for ‘claim ratios’. Every insurance provider wants to earn more than they have to shell out when an individual claims the benefits. The lack of knowledge about such products is also a significant factor of insurance providers not wanting to offer such services since there isn’t much demand if we talk about Jammu and Kashmir’s state (union territory). The blame lies on both sides; the public doesn’t want to pay considerable premium amounts or isn’t just aware of the available options. On the other hand, the insurance companies also aren’t putting in much efforts to educate the common masses about such products of theirs.”
To understand the effects of such significant expenses on the already distressed individuals’ psyches, we spoke to a practising psychologist, Dr Seema Malik.
“This is quite a tricky situation when it comes to people dealing with depression or anxiety or any such kind of mental problems,” she said.
“The fundamental problem itself is the disease, and when we add the extreme pressure brought on by the incurred expenses, it creates a high-pressure situation for the affected individual. I have noticed significant erosion of the progress an individual had already made just because they have no way to manage the expenses thus incurred.”
When asked what the solution could be, she said, “First of all, we need to identify the erratic areas that are causing the issues to those who are afflicted. One of the major problems is the disparities in income and expenditure. Insurance providers need to bring mental health under the ambit of health insurance, as directed by our country’s Supreme Court. And then, there also needs to be the recognition of mental health and associated problems deserve. We still treat these issues as taboo. One can barely talk about these issues to their friends, family or peers. We need to get rid of that attitude. Also, there need to be mass-awareness campaigns all over the valley about the illness and the economic remedies (insurance cover). I believe adopting these few steps could help those among us who suffer from such problems.”
However, Manan is yet to see the light at the end of the tunnel.
After getting the insurance, he was hoping that at the least, it will take care of his medical expenses.
“That turned out to be a false sense of hope,” he lamented.
“I have a large and dependent family to look after. My father passed away seven years back, and since then, it has been my job to bring the bread home. Even though I don’t have any physical disability, I still feel like a cripple who barely manages to feed his family.”
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