key: cord-1033984-tj5fqvef
authors: Ghosh, Madhurima; Chatterji, Biswa Prasun
title: Mental health insurance in India after COVID-19
date: 2020-11-18
journal: Lancet Psychiatry
DOI: 10.1016/s2215-0366(20)30468-5
sha: 6e22600136861cb84b0719ae170202e52c7240b2
doc_id: 1033984
cord_uid: tj5fqvef

nan

www.thelancet.com/psychiatry Vol 7 December 2020 support for screening and treating mental illnesses. Those who need care for mental illness should be referred to a highlevel 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. 3 Up to the end of 2019, a search of the internet, newspapers, and jour nals (by MG) found no signs of private insurers introducing mental health policies. Surprisingly, we observed the effect of the COVID19 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. 4 As of October, 2020, insurance plans for mental health treatment are being provided by HDFC ERGO in the my:health Suraksha Plan. 5 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 ofpocket 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. and nationwide education cam paigns to increase mental health literacy and reduce stigmatisation and discrimination. community members. They are the most marginalised members of south Asian society and are suffering from the crisis of COVID19 lockdown. 2 Social stigmatism forces hijras to earn their livelihood by doing informal activities such as collecting money from shops or blessing newlywed couples and newborn babies, 1 and many earn money as sex workers. A survey found that because of lockdown, most hijras were anxious about money (94%) and food (68%). 4 Another survey related to the effect of lockdown on the hijra community found that about 82% of respondents had not earned "a single penny in the last two weeks", and that 59% did not get any support from aid programmes. 5 About 16% of hijra respondents experienced mental abuse, but relatively few faced physical torture and violence. 2 The multiple and intersecting forms of discrimination and the consequent vulnerabilities experienced by hijras place them at a higher risk of mental health problems, which might trigger various illnesses and longterm psychological complications. 4 During the lockdown, there was discrimination in who received primary healthcare treatment, especially for hijra people. 2 The medical infrastructure is under pressure; obtaining treatment and tests for severe acute respiratory syndrome coronavirus 2 is challenging for hirjas because hospital wards are classified for men or women, with no centre for hijra community members. Hirjas often do not access medical health care because of discrimination, not having legal identification documents, and patient rights violations in health care settings. Healthcare providers' insensitive attitudes towards hirjas make them uncomfortable, such that Hijra people tend not to seek timely COVID19 treatment, compounding their health risks. 5 There is a need for basic safety net programmes, free counselling services specifically for the hijra community,

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. 1 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. 2 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, 3 which includes financial

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