When 35-year-old Brinda Dutta was diagnosed with depression in 2020, she saw her existence reduced to the sum of her symptoms. Sluggishness, lack of desire to get out of bed, which she first attributed to winter blues, and the dread of a new day dominated her routine.
Dutta was shocked when she first saw the treatment expenses. Weekly therapy at Rs 1,200 per hour-long session and another Rs 1,000 a month for medication — all on a Rs 50,000 salary — stretched her budget to the limit. She works for a marketing start-up while supporting her younger sister who is a student at a Delhi University college.
“I take four sessions a month, which is pretty standard, but that alone ramps up the cost to almost Rs 5,000,” she says.
For decades, mental health was kept out of the ambit of insurance in India with cancer, diabetes, kidney failure, knee replacements, and other physical ailments being prioritised. A case of matter over mind.
But with the Insurance Regulatory and Development Authority of India (IRDAI) making it mandatory for insurance companies to cover mental health, there’s a glimmer of hope for Dutta and the many others navigating the costly labyrinth of mental healthcare. The announcement was made in October last year and companies were directed to implement the new rule by the end of the month. Now, well-known health insurance providers such as Niva Bupa (previously Max Bupa) and HDFC ERGO are some of the pioneers that are expanding their coverage to include mental health.
It took the insurance sector five years since the introduction of the Mental Healthcare Act 2017 to reach this point. The Act specifies that “every insurer has to make provisions for medical insurance for the treatment of mental illnesses”. In 2020, the IRDAI issued a circular that listed guidelines for insurers. Finally, after Covid—which exposed the fault lines in the health sector—the IRDAI pushed harder to make mental health insurance mandatory.
In a country where nearly 30 per cent of the population does not have basic health insurance, mental health insurance is a far-fetched dream.
Some of the conditions now covered under insurance are anxiety, depression, post-traumatic stress disorder (PTSD), attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, schizophrenia, obsessive-compulsive disorder (OCD), and psychosis.
“The IRDAI circular does not cover the exact directives, limits, and how policies should be structured,” says Kriti Rastogi, director at Plum, an employee health insurance platform.
The IRDAI’s announcement has led people to raise nuanced questions about what a good mental health policy should be. Psychologists and mental health professionals welcome this first step.
For mental health professionals, it means no more pro bono cases. “This definitely reduces the burden on therapists as well, and also on patients in terms of monetary assistance,” says Ila Kulsreshtha, a clinical psychologist.
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High cost of mental health
In a country where there are only 75 psychiatrists for every one crore Indians, treatment is extremely expensive. Psychologists and counsellors are the second port of call, but more often than not, their services, too, are a luxury.
The IRDAI’s directive drives home the message that treating the mind is not an extravagance but a necessity.
Practo, a healthcare platform where medical professionals across various fields are listed for consultations, also has a roster of counsellors. Their fees start at Rs 800 for an hour-long session. There is no cap on the upper limit, which depends on factors like the issue a patient is being treated for, experience of the counsellor, and the type of therapy being provided. In the case of psychologists, the fees can be upwards of Rs 2,000 per session.
It’s little wonder that when budgets are tight, people skip therapy sessions.
“My therapist charges Rs 2,000 per session, and I have four in a month,” says Sameera Mehta, an ad hoc professor at Jesus and Mary College in Delhi. She has an agreement with her therapist to reduce the number of sessions to three whenever she needs to “adjust” her monthly budget.
“I have benefited immensely from therapy. But if I lose my job tomorrow, then it will probably be one of the first ‘luxuries’ I will cut off from my budget,” Mehta says.
But India is in the middle of a mental health crisis, and therapy can no longer be a luxury like a day in a spa.
A 2017 study by the India State-level Disease Burden Initiative found that anxiety disorders were highest in Kerala, followed by Manipur and West Bengal. Conduct disorders — extreme bullying, hurting animals, biting — among children were most prevalent in Jharkhand and Bihar. Uttar Pradesh and Bihar also recorded the highest number of cases of intellectual disability.
The pandemic and multiple lockdowns exacerbated the problem. A 2022 survey by Deloitte found that 80 per cent of the Indian workforce reported mental health issues.
On World Mental Health Day in October, the Ministry of Health launched a 24×7 television programme called Tele Mental Health Assistance and Networking Across States (Tele-MANAS). The service started in 20 states and union territories and is supposed to expand to the entire country. In 2021, as per insurance aggregator Policybazaar, there was a surge of around 50 per cent in claims related to mental illness.
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How mental health insurance works
While Brinda Dutta is still scouting for affordable mental health services, 29-year-old Tuhin Changkakoti, a Mumbai-based engineer, took the plunge almost immediately. He zeroed in on a policy that covers his weekly counselling sessions.
“My current policy has that option, and it is really beneficial. I spend a lot on rent and commute already,” said Changkakoti who has been going to therapy since 2019.
Insurance policy in India requires a person to be hospitalised for 24 hours to be eligible for coverage. But that has now changed over the years. With advancements in medical care, some surgeries can be completed in a few hours and do not require one-day hospitalisation. But clients can still claim insurance cover for such medical visits under ‘day-care procedure’ plans. That is how outpatient department (OPD) charges began to be covered under health insurance, a feature extended to the mental health category as well.
Currently, there are no separate policies on mental health insurance. Neither is there uniformity in the coverage of mental illnesses.
“There is parity in terms of services and products for people with mental health issues,” says Priti Sridhar, CEO of Mariwala Health Initiative.
That said, people still have to read the fine print while choosing the best insurance plan for their mental health needs. And like any other regular health policy, cost will depend on their particular needs.
Some plans, for instance, cover only hospitalisation expenses. On the other hand, OPD plans often cover the cost of consultations and therapies for the treatment of a psychological disorder. It is the latter that people like Dutta are banking on.
But there are caveats. HDFC ERGO says that any condition arising due to alcohol consumption or drug abuse will be excluded from insurance plans — and neither is ‘incomplete mental development’. For pre-existing conditions, depending on the severity of symptoms, there are waiting periods from 2-4 years.
Public and legal attention doesn’t mean that mental health has got rid of the stigma attached to it. People are reluctant to discuss mental health issues, especially in the workplace.
“I fear that by disclosing my struggle with anxiety, my capacity to work under pressure will be judged, and with appraisals on the line, I really cannot bring myself to discuss it with my manager,” says Rehan who works for a multinational company in Gurugram. While the IRDAI may have initiated the conversation in the public domain, discussions on mental health in the insurance sector are still at a nascent stage.
“It has to be the prerogative of insurance companies to widen the dialogue on mental health. There are on-site dental camps, but one never hears of on-site mental health camps,” says Rastogi of Plum.
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Corporate mental healthcare
Despite their reservations about discussing mental health battles, the Gen-Z workforce is dragging mental health out of the closet.
An HDFC ERGO executive noticed an uptick in the number of young people opting for mental health insurance during the pandemic.
The new generation is more proactive and open to talking about mental well-being. They are actively searching for mental health-friendly workplaces. “It is all fun and games and ‘talk to me’ until someone actually reaches out and says they are suffering from a mental health condition. Let’s face it, there is a bias even among the most privileged sections,” says Ankita Gupta, a 22-year-old freelance content writer from Bengaluru.
And a growing number of corporations are listening—without prejudice.
Mental health issues are costing Indian companies $14 billion a year on account of absenteeism, attrition, and other reasons, estimates in the 2022 Deloitte report say. Of the 4,000 plus workers studied, 33 per cent of all respondents continued to work despite poor mental health, while 29 per cent took time off, and 20 per cent resigned.
And here’s another mind-boggling nugget of data: The World Health Organization (WHO) estimates that depression and anxiety cost the global economy $1 trillion a year in lost productivity.
More and more companies, both large corporate houses and smaller firms, have realised that they need to go beyond paying lip service. They have started taking proactive measures such as offering mental health leave and collaborating with counsellors and psychologists.
“We provide emotional support to our employees so they can enrol for one-on-one sessions with counsellors. These sessions are strictly confidential and the cost is borne by the organisation,” says Sylvia Priyanthi, director at QUEST Alliance.
This is not an isolated instance. More workplaces are trying — at both structural and managerial levels — to provide a safe space for employees. Human resources departments and senior management are realising that instead of being simply ‘compliant’, there is a need to look at mental health and insurance as ways of acquiring and retaining talent.
“Both my bosses, the previous and current one, were very supportive when I spoke to them about struggling at work and extended whatever help they could to make my days easier,” says Gunjan Sharma, a publicity relations professional at Moe’s Art.
“An anonymous pulse survey was particularly useful in understanding the concerns of the entire team. Ongoing one-on-one conversations have also helped us understand team concerns better. We also acknowledged the need for expertise and have engaged a professional counselling partner to offer mental health and well-being support. We have made a start and are constantly looking to support our people in the best possible way,” says Karthik Ram, CEO of Development Solutions.
Saurabh Arora, co-founder of Plum, talks about the questions and anxieties employees have about corporate mental health service: ‘If I get third-party service, how am I paying for the therapy?’ ‘Will the information about the sessions I take be disclosed to my employer?’
To tackle inhibition and fear of stigma, Arora suggests that companies introduce measures to protect employee privacy and prevent data breach. Therapy wallet is one solution—instead of incurring per-session costs, employees can be offered mental health services as a perk. “In order to ensure that employees feel comfortable to avail the benefits of in-house therapy, [companies can introduce] a [virtual] wallet with a particular sum that can be spent without asking for bills.”
But such options may not be available to contract workers like Sameera Mehta. She wants to wait to see how mental health insurance pans out before selecting a plan. “At this point, I don’t know when it will come to me at an institutional level. But I would want that conversation to start.”
(Edited by Humra Laeeq)