Leena Khurana, then 14, was bullied by her classmates. Soon after, she suffered her first psychotic episode. Payal Kumar, Leena's older sister, recalls how her younger sibling was an extraordinary girl with a high intelligence who excelled at swimming and music as well as in school. The family settled in Manchester, England where Payal and Leena's father K.M. Khurana was a doctor in National Health Service. Leena was never able to recover from her breakdown. She tried suicide several times and experienced uncontrollable anger.AdvertisementLeena, now 52, was diagnosed with schizophrenia in 1983. K.M. Khurana, who retired about 20 years ago and returned to India, brought Leena along. Leena's condition deteriorated over time and she was forced to be institutionalized. Payal stated that my parents tried everything to help her and that her case inspired me to do a lot of advocacy work on mental health. Three years after his death, Payal has become Leena's primary caregiver in New Delhi. Payal is the sole caregiver for Leena, with no family support. She must pay for Leena's hospital stay, medication, counselling sessions and consultations with doctors. She has not been able to get a policy of medical insurance for her sister in all the years.AdvertisementAdvertisementAdvertisementUntil the Mental Healthcare Act 2017, India's 2017 legislation, mental healthcare was not covered by Indian medical insurance. The law stipulates that every insurer must provide medical insurance to treat mental illness.Payal was thrilled, hoping that the new law and IRDAI direction would allow her to get insurance for Leena. This would make their lives a little easier. Insurance companies are still slow to act. Payal informs insurance companies about Leena's pre-existing illnesses. They then tell her that they need to create rules and regulations within their company before they can comply the Mental Healthcare Actpuzzling considering that it has been four years since its passage.AdvertisementAccording to a 2015-2016 survey conducted by the National Institute of Mental Health and Neurosciences, more than 100 million Indians suffer from mental illnesses. About 10 percent of Indians require immediate treatment. This could be a small number in a country that is plagued by stigmatization and people who are afraid to seek help due to mental health issues. Experts believe that India's mental health crisis will be worsened by the second wave of COVID-19 pandemics. Anxiety disorders are on the rise. This pandemic has had a devastating effect on mental health. There is also a constant fear and uncertainty in the general population," said Lakshmi Vijayakumar (psychiatrist and founder of SNEHA suicide prevention centre in Chennai).AdvertisementAdvertisementIndia's public health spending is among the lowest worldwide. A small amount is also spent on mental healthcare. Accessibility and affordability of Indian mental health care can often be deterrents. Mental health activists claim that the process of diagnosing and treating patients can be slow. The majority of mental health professionals work in cities. Rural Indians must travel long distances to get support. Vijay Nallawala (author and founder of Bipolar India, a mental health support group in Mumbai) said that there is a huge gap between the demand and availability of mental health services.Payal's experience has shown that insurance companies pretend they don't have the time or resources to implement the policies required under the Mental Healthcare Act. While insurance companies are required to comply on paper, patients with mental illnesses are often told by them that they don't have the right insurance. Gaurav Kumar Bansal, a New Delhi Supreme Court advocate and mental healthcare activist, stated that while insurance companies are expected to comply. The Delhi high court ruled in April that one refused to honor the claim of a young lady who had spent a month at Gurugram Hospital for Schizophective Disorder. The court ordered all insurance companies to adhere to the 2017 Mental Health Care Act and warned that any delay will be considered a violation.AdvertisementAdvertisementBut injustices still continue to occur on the ground. Nallawalas Bipolar Indian community is trying to collect evidence from people with mental illnesses who are facing hardships on the medical insurance front. An insurer denied a claim for $4,706 to a member of the family who was a caregiver for their son. Nallawala stated that this is not an isolated incident.Vijayakumar states, "Some companies clearly state that they will 100 per cent reimburse physical health but only 50 percent for mental illness conditions." This is discriminatory.Vijayakumar stated that most insurance plans only cover in-patient treatment. However, the April court decision shows that even in-patient hospitalization coverage is possible to be denied. Patients suffering from anxiety or depression have difficulty getting reimbursements for long-term medication and outpatient therapy. Vijayakumar stated that people often go into debt and borrow money to pay for these costs.AdvertisementExperts believe the verdict of the Delhi high court is favorable for activists and patients in mental health. Soumitra Pathare is the director of the Centre for Mental Health Law and Policy, Pune. If a person is denied coverage for mental illness they need to file a complaint with the IRDAI and the insurance ombudsman. If the problem persists, they should go to court.This could lead to a lot more people going to court. Payal found that most insurance companies don't respond to her disclosures of pre-existing illnesses, or they respond vaguely after Payal's Delhi high court verdict.Even more difficult is the lack of standard guidelines by insurance companies or IRDAI regarding what should be covered. This is why people are unable to get insurance. Jitendra Solanki, an IRDAI-based personal finance expert and estate planer for persons with disabilities, stated that this gray area causes delays in getting insured. According to Solanki, India is still in the early stages of mental illness and needs comprehensive health insurance coverage. Solanki said that you might find a company that covers outpatient treatment, but not another.People like Leena, her caregiver Payal, and others such as them will not have any recourse unless proper guidelines are established. Insurance companies offer her policies for her siblings, but not for her family. She asked, "Why are people with mental illnesses discriminated against in such a way?"Future Tense is a collaboration between Slate, New America and Arizona State University. It examines emerging technologies and public policy.
