The article is written by Harmanpreet Kaur from Amity University, Kolkata. The article will provide the importance of mental health in the purview of the Shikha Nishcal case.
Mental illness is common, complex and costly. According to the reports of 2019 by the World Health Organization, about 800,000 people have committed suicide because of mental illness and instability in their mental health. Besides that, there are many more people who attempt to end their lives. Many people are affected by mental illness, and about 75 percent of the countries in the world are low-income countries that are unable to access the treatment people need, and most of them are in India. Reasons behind mental illness and disorders in India are associated with poverty and living in urban areas, depressive, neurotic, and stress-related disorders among women, and alcohol use disorders among men. With psychiatry’s long-standing relationship with mental health legislation, legislative reform has the potential to improve mental health services and, in many countries, including India, achieve a positive right to mental health and mental healthcare.
Since the 1990s, there have been significant reforms in this direction concerning the UN Convention on the Rights of Persons with Disabilities (CRPD),2008. Considering this, it was apparent that mental health and disability legislation in many nations needed to be modernized. Concerning the convention, India introduced reforms related to mental health by introducing India’s Rights of Persons with Disabilities Act, 2016, and Mental Healthcare Act, 2017.
Physical health has always been prioritized over mental health. Mental health is a concern for everyone. It affects the person’s ability to cope with and manage change, life events, and transitions. Every human being has the right to proper mental health care needs. Mental health should not be different from physical health and should be taken care of at the same level as that of physical health and thus there should be provisions for mental health in the health insurance schemes. The article will talk about the importance of mental health for following compliance with the UN Convention on the Rights of Persons with Disabilities (CRPD), 2008.
The legislation was enacted with the goal of providing individuals with mental health care and services without discrimination based on gender or financial consideration and also provide protection, promotion and fulfill the rights of the citizens suffering from any kind of mental instability or illness, thereby providing them with adequate mental health care facilities and services. The Act has been enacted complying with the basic principles of equality, justice, and fairness for every section of society. It has included some of the provisions like prohibiting sterilization that could be a reason for mental health-related issues, has decriminalized suicide and has promoted community-based treatment, and has also prescribed responsibilities to the agencies and the police officers in respect of mental illness of the persons.
Health insurance can be referred to as the insurance that provides financial protection against any loss or harm to an individual for their future expenditures. It is a written agreement between the parties that is referred to as the health policy which promises to pay a specific amount of money to the individual if faced with any undesirable events including health. Health financing can be provided to the citizens either through government, state, or private health insurance, thus forming a crucial element for universal access and coverage.
Mental health insurance – a part of the health insurance policy
The health insurance schemes did not specifically cover the insurance policies for mental illness, mental disorder, or any problem related to psychiatric conditions. Thus, the non-coverage of the mental services under the health insurance schemes remained a glaring exception to mental health. The issue of including mental health in the health insurance policies was realized because such exclusion amounted to discrimination against vulnerable mental health consumers and also because the cases of mental illness were on the rise in the country. So, the first step towards its inclusion in the health policies was taken by the Ministry of Health by conducting a special meeting of the Central Mental Health Authority (CMHA) in February 2010, stating that mental health should be considered a part of health insurance for the welfare of the people suffering from mental instability. Further, the draft for Mental Health Care Act was introduced in 2013 and included a special emphasis on private and public insurance concerning mental health. The bill received assent, and finally, the Mental Health Care Act of 2017 was introduced in India.
The Mental Health Care Act of 2017 has mandated the inclusion of mental illness and other mental disorders under the scheme of health insurance policies. Section 21(4) of the Act states that it is the responsibility of every health policy insurer whether private or public to include within the ambit of health insurance policy, the insurance related to mentally disabled persons if any or to make a provision in medical insurance for the treatment of mental illness, as has been provided for the treatment of any physical disability.
Mental health insurance policies
- Private health insurance scheme
The private health insurance scheme is the type of insurance provided by the private companies wherein the individual is asked to pay a considerable amount of money at fixed intervals to the company, which could be utilized if there is any case of health problems or any harm or loss. According to the recent orders by the Insurance Regulatory and Development Authority of India (IRDAI), it has been directed to include mental illness and other mental disorders under the health insurance policies.
The company ensures them with the health-related expenditures. The companies providing health insurance schemes are HDFC ERGO health insurance plans and ICICI Lombard health insurance.
- Public health insurance scheme
The public health insurance scheme is the type of insurance that has been introduced by the government that aims at providing health insurance to the various sections of society, mostly the underprivileged and the vulnerable classes. These are the payments that are financed through taxes and do not require a premium or any kind of beneficiaries from the individuals.
Examples of these insurance plans include Rashtriya Swasthya Bima Yojana (RSBY), Central Government Health Scheme, and Aam Aadmi Bima Yojna (AABY).
- Mediclaim policy
The policy was started in 1986. It provides for hospitalization expenditures incurred by the insured owing to illness or any kind of accident. The government has exempted the premium paid by the individuals from their taxable incomes, though entire premium accounts are not exempted. The policy covers only health-related expenses and accidents.
The case of Shikha Nishcal v. NICL, 2021
The case states that the health insurance policies should comply with the provisions of the Mental Health Care Act of 2017 and include all the expenses related to mental illness under the ambit of health insurance policies.
Facts of the case
In this case, the petitioner Shikha Nishcal was acquiring health insurance policies from the National Insurance Company Limited in 2016 in case of any harm or loss to her. She purchased the last medical healthcare policy named national Mediclaim policy in May 2020 which was valid for one year. In June 2020, she was diagnosed with Schizoaffective Disorder, a kind of mental illness. The treatment from the hospital incurred her an expense of about five lakhs. She claimed reimbursement from the National Insurance Company Limited as per their healthcare policy, which provided for all the expenses related to hospitalization if faced with any kind of suffering. The company rejected her claim stating that it is not liable to pay for expenses in case of any mental disorder or illness.
The contention of parties to the case
Petitioner’s claim against the National Insurance Company limited
- The petitioner filed a complaint before the Insurance Ombudsman stating that the company should comply with the provisions of Section 21(4) of the Mental Health Care Act of 2017 and provide the petitioner with all the expenses that she incurred during her treatment and that the mental illness should be treated in the same way as that of the physical illness.
- The petitioner filed a writ petition under Article 226 of the Constitution of India against the National Insurance Company Limited in the High Court of Delhi stating that the mental illness should be covered under the health insurance policies by the National Insurance Company Limited in compliance with Section 21(4) of the Mental Health Care Act of 2017.
Respondent‘s claim against the contentions
The respondent stated in its plea before the Insurance Ombudsman, that the company had paid the expenses of 3 lakhs to the petitioner and the maximum amount of 5 lakhs could not be paid as it was not mentioned in the policy.
Findings of the Court
The Delhi High Court held that all the insurance companies should include the provision of mental health within their ambit and they should provide all the expenses to the persons suffering from any mental illness or disorder.
- Violation of Article 25 of the United Nations Convention on Rights of People with Disabilities
Article 25 of the United Nations Convention on Rights of People with Disabilities was violated, which states that there should be no discrimination against persons with mental illness and it should be the responsibility of the states to keep a check on the insurance companies that they are acting fairly and reasonably in providing insurance to the people with both physical and mental illness.
- Violation of Section 21 of the Mental Healthcare Act, 2017
Section 21 of the act states that:
- Mental illness should be treated in the same ways as physical illness.
- There should not be any kind of discrimination in terms of age, gender, sexual orientation, or any kind of disability.
- Persons suffering from any kind of mental illness or disorder should be provided with the use of ambulances, equal living conditions in health establishments and are liable for every kind of health service.
- The insurers should have a provision for the treatment of mental illness by providing medical insurance in terms of mental health.
Thus, after analyzing the sections and conventions, the Court held that:
- Equal protection should be extended to persons suffering from mental illness in the same way as that of physical illnesses.
- It stated it is the function of the Insurance Regulatory and Development Authority of India to ensure that the laws enacted for the policymakers are compiled by the health insurance companies and with the provisions of Section 21(4) of the Act.
- Rejected the order of the Insurance Ombudsman as it was contrary to the provisions of the Act and recognized the rights of the petitioner.
Realizing the importance of mental health
Mental health and mental illness are determined by the social, psychological, and biological factors, just as the way physical health and illness. There are indicators that have posed a threat to developed and developing countries. A few of these indicators are poverty, low levels of education, poor housing facilities, and income.
- Mental health is linked to behavioral patterns that intensify effects on behavior and well-being.
- Physical health and mental health are related to each other in close proximity, as the poor mental well-being of a person can lead to various physical diseases.
- Mental ill-health can lead to social problems like unemployment, poverty, drug abuse, and economic problems.
Problems faced in the implementation of the Mental Healthcare Act, 2017
Despite the introduction of the Mental Health Care Act of 2017, there are reasons why the Act’s policies are not implemented. They are:
- Many state governments have still not established Mental Health Authority and Mental Health Review Boards, which play a crucial role in the implementation of the Act.
- The Act faces the challenge for its speedy and effective implementation.
- There has been a lack of political commitments at the bureaucratic level in addressing mental health as a legitimate health concern at par with physical health.
- There is poor intersectoral coordination between different government departments and an inadequate trained mental health workforce.
- The legislation has faced judicial scrutiny in matters of public interest for adjudicating important questions on constitutionalism and monitoring the implementation of the Act.
There is no logical reasoning to exclude mental illness from the realm of health insurance policies and schemes. The Mental Health Care Act, 2017 is a welcome step in ensuring medical health that would enhance accessibility, affordability, and mental health care services. Mental health should be considered a priority, in the same way, that physical health. The medical health insurance schemes would protect people from any kind of mental illness and would act as a shield for the poor and marginalized sections that face financial risks.
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