Question

Mental illness management includes both pharmacological and other therapeutic methods for treatment. Summarize how this is managed and the support of insurance. Is is sufficient and what could make it better? Be specific and support your statements with a minimum of two outside resources.

Answer 1

1. Mental Health Treatments
Psychotherapy. Psychotherapy is the therapeutic treatment of mental illness provided by a trained mental health professional.
Medication. Medication does not outright cure mental illness.
Hospitalization
Support Group
Complementary & Alternative Medicine.
Self Help Plan
Peer Support
2. One of the important provisions of the Mental Healthcare Act, 2017, in section 21, is the inclusion of “mental illnesses” for health insurance coverage. This is a progressive step toward considering mental illness at par with physical illness, which will, in turn, ensure better access to mental health care. In this context, the article summarizes the concept of “health insurance” and then goes on to talk about various provisions for persons with mental illnesses in India. We also discuss some of the relevant concerns that may arise in this context. Whereas insurance for mental illness is a welcome step toward achieving universal health coverage, there is a need to deliberate on various issues before we can achieve that.One of the important provisions of the new legislation in mental health, the Mental Healthcare Act (MHCA), 2017, in section 21, is the inclusion of “mental illnesses” for health insurance coverage. This is a landmark moment that has come at an opportune time in which India is looking at achieving universal health coverage for all her citizens. In this context, the article summarizes the concept of “health insurance” and then goes on to talk about various provisions for persons with mental illnesses (PMI) in India. It finally discusses the various questions that can arise during the implementation of insurance for mental disorders.
HEALTH INSURANCE
Health insurance can be defined as insurance for future medical or surgical expenditure. In simple terms, it is a contract where an individual or group of people purchase, in advance, health coverage by paying a fee called the “premium.” Based on the type of insurance plan, usually, the insured person is either required to pay for the health expenses from his/her pocket, which is then reimbursed by the insurance company, or the expenses are directly borne by the insurance provider who pays it to the service provider (the so-called cashless facility). The service provider in this context refers to the clinic, hospital, physician, laboratory, or any other establishment where the health care was provided to the insured and to whom the insured is expected to pay for the same. At present, in India, health insurance is available only for hospitalization or inpatient care. Outpatient services, which form the major part of health-care expenditure, are not covered. Broadly, health insurance can be divided into two types: private health insurance and public health insurance (government funded). This article critically evaluates the provision of health insurance in mental illness.

Private health insurance
Various private companies offer health insurance policies (for example, HDFC ERGO Health Insurance and ICICI Lombard Health Insurance). Here, the individual has to pay a fixed amount of money (known as “premium”) at fixed intervals of time (monthly/quarterly/annually) to an insurance company that pools similar risks and insures them for health-related expenses. The main distinction is that the premiums are set at a level that is based on an assessment of risk status of the consumer (or of the group of employees) and the level of benefits provided, rather than as a proportion of consumer's income.

Public health insurance
These are funded by the government and aimed at providing health insurance coverage to certain sections of the population, mostly the underprivileged and vulnerable. These insurance programs are financed through tax and typically do not require premiums or user fees from beneficiaries. In some programs, the insured persons may have to pay a minimal amount as premium to avail the benefits. The major burden of premium in these cases is borne by the central and/or state governments. Some examples include Rashtriya Swasthya Bima Yojana (RSBY), Employment State Insurance Scheme, Central Government Health Scheme, Aam Aadmi Bima Yojana, and Ayushman Bharat.

In addition, in the public sector, the General Insurance Corporation (GIC) and its four subsidiary companies (National Insurance Corporation, New India Assurance Company, Oriental Insurance Company, and United Insurance Company) provide voluntary insurance schemes. The most popular health insurance coverage offered by GIC is the mediclaim policy.

The mediclaim policy
It was started in 1986. It reimburses the hospitalization expenses incurred due to illness or injury suffered by the insured, regardless of whether the hospitalization is domiciliary or otherwise. It does not cover outpatient treatments. The government has exempted the premium paid by individuals from their taxable income to various extents (not that the entire premiums are exempted). In addition to the general insurance companies, several life insurance companies also offer health insurance.

IMPACT OF HEALTH INSURANCE ON OUTCOMES
There is limited evidence from the developing countries on the impact of health insurance on the health and economic well-being of beneficiaries. Published reviews suggest that while insurance improves utilization and reduces personal expenditures, the evidence on health outcomes is mixed.

3. Physical activity also releases endorphins, powerful chemicals that lift your mood and provide added energy. Regular exercise or activity canhave a major impact onmental and emotionalhealth problems, relieve stress, improve memory, and help you to sleepbetter.

Most people with a mental illness recover well with appropriate ongoing treatment and support. People with mental illness severe enough to cause disability are able to live independently in the community, if given the opportunity and support to do so.