Mental health insurance and attempted suicide: Need for a reappraisal.

Sir,

Mental Healthcare Act (MHCA) 2017[1] has brought along several progressive steps in the care of persons with mental illness. According to Section 21 (4) of the act, “Every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness.”[1] Insurance companies have finally included insurance for expenses related to hospitalization of persons with mental illness with effect from July 2020 after directives from the Insurance Regulatory Development Authority of India and a Public Interest Litigation by advocate Gaurav Bansal.[2] Public insurance companies such as National Insurance Company and Oriental Insurance Company and several private insurance companies such as Apollo Munich, HDFC Ergo, and others have come up with packages covering hospitalization and certain other expenses for mental disorders as defined in MHCA 2017. However, a closer look at the terms and conditions of all these health insurance policies reveals a common exclusion treatment of expenses incurred following an attempted suicide. Most of the companies mention in their list of exclusions: treatment for intentional self-inflicted injury and attempted suicide. Policy wordings of Apollo Munich Health Insurance go a step further to specify in their nonmedical exclusions, “Intentional self-injury or attempted suicide while sane or insane.”[3] MHCA 2017 clearly states in Section 115 (1): “Notwithstanding anything contained in Section 309 of Indian Penal Code, any person who attempts to commit suicide shall be presumed, unless proved otherwise, to have severe stress and shall not be tried and punished under the said Code.”[1] Apart from decriminalizing suicide, the act further states in Section 115 (2): “The appropriate Government shall have a duty to provide care, treatment and rehabilitation to a person, having severe stress and who attempted to commit suicide, to reduce the risk of recurrence of attempt to commit suicide.”[1] While the intention of the government is clearly progressive in this regard, the decision of the insurance companies to carry on with the age-old exclusion of attempted suicide is truly regressive. Sgobin et al.[4] reported the average cost of attempted suicide in Brazil to be as high as 7163.75 US$. Suicide attempt is associated with stigma and shame in addition to fear of punishment since there is widespread confusion regarding decriminalization of attempted suicide. If the cost of treatment is not reimbursed, it would serve as an additional deterrent to proper reporting which would affect long-term treatment of individuals with suicidal behavior. Thus, it is imperative that the issue is taken up by various stakeholders including the government, mental health professionals, suicide survivor groups, and the IRDAI so that costs related to treatment of attempted suicide can be brought in the purview of health insurance just like other categories of mental illness.

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Nil.

Conflicts of interest

There are no conflicts of interest.