Insurance companies must stop discrimination

By LUKOYE ATWOLI
Sunday Nation 13 December 2009

John K (not his real name) suffers from a condition known as Major Depressive Disorder. This is characterised by periods of intensely low mood and loss of interest in usual activities, as well as poor sleep, poor appetite, impaired concentration and memory, feelings of hopelessness and worthlessness and even suicidal thoughts and plans.

In extreme circumstances, patients with depression attempt suicide. John is also a responsible family man. He has taken out medical insurance for his entire family in order to ensure that sudden illnesses do not interfere with the family’s financial goals as often advised by the legion of financial advisers.

His cover is provided by a prominent insurance company on whose board sits many prominent Kenyans both in the health sector and in the legal fraternity.

Two weeks ago, John went into an episode of severe depression. He could not go to work and felt so despondent it was difficult to leave the bed in the morning. He stopped eating and would only take a sip of fruit juice before retiring to bed.

One night, he went into the bathroom as if to relieve himself. When his wife followed him there after he had been there for a while, she found him with a rope around his neck, attempting to kill himself. She managed to cut the rope in the nick of time, and called the neighbours to help her take him to hospital.

He was admitted with the diagnosis of “attempted suicide” and, after being reviewed by a psychiatrist, he was found to have “Major Depressive Disorder” and put on appropriate treatment. A few days later he had improved sufficiently to start making arrangements for the payment of his hospital bills.

That is when he was hit by the shocker to the effect that the insurance company had written to the hospital informing them that both “attempted suicide” and “any mental illness, including depression” were “exclusions” under his medical cover. He would have to foot the bill himself.

Suffice it to say that his condition worsened after he received this information, and he stayed longer in hospital than he would otherwise have. Further, upon discharge, he stopped paying his insurance premiums, and thus lost the cover completely.

It is an established fact that a significant proportion of Kenyans will suffer one mental illness or another in their lifetime. A recent study carried out by Professor Ndetei and colleagues in Nairobi and surrounding areas revealed that approximately half of the people who visit hospitals for non-psychiatric complaints have mild to severe depressive illness.

The multifarious “exclusions” by insurers mean that despite having medical cover, most of these people will be compelled to pay for mental health services out of pocket.

This alone is sufficient ground for human rights and other activists to begin beating war drums and asking the government to intervene and improve this state of affairs.

However, the bigger tragedy is that the supposed “exclusions” are in fact against both the letter and spirit of the law. Section 46 of the Mental Health Act (1989) expressly prohibits insurance companies from making exclusions based on mental illness.

It reads: “46. (1) Every person in Kenya shall be entitled, if he wishes, to insurance providing for his treatment as a person suffering from mental disorder and no insurance company shall make any insurance policy providing insurance against sickness, which excludes or restricts the treatment of persons suffering from mental disorder;

“(2) An insurance company which makes any insurance policy which expressly excludes or puts restrictions on the treatment of any person suffering from mental disorder shall be guilty of an offence.”

One need not be a lawyer to see that this section clearly prohibits creation of the infamous “exclusions” with regard to mental illness! The fact that many mentally ill persons and their families are unaware that there is such a provision in the law should not be a reason for insurance companies to continue fleecing them mercilessly.

As insurance companies continue flouting this clear provision, they make an already bad situation worse for the mentally ill and their families. A clear relationship has been demonstrated between mental illness and poverty.

The mentally ill have lower incomes as a result of declining productivity, and the little available resources are channelled towards paying for their treatment.

It has been said that societies are (or should be) judged by the way they treat their most vulnerable members. This wilful discrimination by insurance companies must stop, and the mentally ill must be assured of the same level of care as those with other illnesses.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine www.lukoyeatwoli.com