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Mental and behavioural disorders: a future global cost burden?

Imagine being unable to cope with daily problems or stress, experiencing extreme mood changes or having excessive fear or worries. Even sleeping problems, low energy or a lack of ability to concentrate. These, together with many other indicators, could be signs of mental illness.

Mental and behavioural disorders: a future global cost burden?

The profile of mental health and connected disorders has increased significantly over the last decade. The stigma in many parts of the world is lessening and sufferers are being encouraged to be open about the condition. How will these changing attitudes affect societies and employers? And what role should insurers play? Marco Giacomelli, CEO at Generali Global Health explores in this article.

A global scenario on mental health

Mental health is concerned with the state of a person’s mind, rather than their physical body. If someone is mentally unwell, their psychological and emotional well-being will be diminished to less than normal levels. There’s no doubt that mental health is a prominent world disease. It’s estimated, for example, that 268m people suffer from depression, 275m from anxiety and 40m have some degree of bipolar disorder.[1]

In recent years we’ve seen a change in understanding of what mental health means and in perception towards psychological disorders and those suffering from them. Global campaigns like the World Health Organisation’s World Mental Health Day, and localised activity such as the UK’s Time to Change, the Mentally Aware Nigeria Initiative and Dubai’s Happy Lives, Healthy Communities push, are all helping to change views around the world.  

Few people will argue that de-stigmatising mental ill-health is a bad thing. The challenge for societies across the world, however, is the practicality of dealing with what is likely to be a rising incidence of people seeking treatment.

The American Psychiatric Association has put a direct US$55bn price tag on treating mental health disorders in the USA and a further US$273bn of indirect costs to US society. Granted, healthcare costs in the US are significantly higher than most developed nations, but the proportional scale of the challenge from country to country will still be significant.

[1] https://ourworldindata.org/mental-health

Young people’s mental health in the digital age

As an insurer with a global scope of coverage, the demographics of Generali Global Health’s insured population have a relative prevalence of families with children and young adults.

Reliable studies have demonstrated that approximately half of all mental illnesses begin by the age of 14 and three-quarters by mid-20s (Kessler et al., 2007), and these represent the largest burden of disease among young people.

At the same time, the evolution of digital technology has provided unrestricted, often unsupervised access to social media, as children in OECD countries typically spend more than two hours every weekday online after school, and more than three hours on a weekend day (OECD, 2017).

Whilst there isn’t conclusive evidence that suggests a measurable correlation between mental health and excessive internet use, the excessive use of digital technologies and social media are associated with mental illness (McCrae, Gettings and Purssell, 2017) (Vannucci, Flannery and Ohannessian, 2017): observable symptoms are sleep deprivation, mental conditions aggravated by cyber-bullying, student attainment and motivation, eating disorders (often associated with body image concerns), anxiety and depression. 

An insurer’s perspective

Insurers like Generali Global Health (GGH) will be interested in the support they can provide their members to manage their mental health conditions, and the effect on claims costs should the incidence of treatment rise significantly.

  • Supporting members with mental health conditions

A mental health benefit is now integral to many international private medical insurance policies. GGH, for example, provides full cover within certain time limits for:

Medically necessary in-patient or day-patient treatment of a recognised mental health disorder in a recognised psychiatric unit of a hospital. All treatment must be administered under the direct supervision of a consultant psychiatrist.

Insurers are also interested in prevention strategies for their members. Tools are available to help members adopt strategies to more effectively deal with stress, identify when they might have an issue early in the process or make effective lifestyle choices, such as more exercise.

Employee assistance programmes (EAP) give access to trained and confidential councillors who can support members in need and apps ‑ such as GGH’s Bria ‑ encourage more exercise and healthy living.

  • Effect of mental health treatment on claims costs

A significant rise in mental health treatment costs will increase insurers’ claims costs and ultimately be one of the many factors exerting upward pressure on premiums.

Certainly, we are seeing indications that claims costs are being affected. The Willis Towers Watson 2019 Global Medical Trends report surveyed 307 health insurers across 77 countries. The report’s authors found that 7% of insurers currently believe that the treatment of mental ill-health is one of their top three conditions by incidence in their portfolio. Moreover, this is predicted to rise to 11% over the next five years, demonstrating inroads into a world dominated by more traditional medical conditions such as cardiovascular disease and cancer.

Looking to the future

We know that mental health awareness has only relatively recently begun to improve. But what of the future? How will treatment change? And what learnings can insurers, brokers and employers all take from the prediction?

It will come as no surprise to hear that technology is at the forefront of future mental health wellbeing.

At a macro level, the prospect of improving mass data collection and analysis techniques is likely to prove instrumental in helping clinicians to understand underlying trends that identify mental health behaviour amongst populations. From a micro-perspective, we are witnessing the prospect of new apps with the ability to notice changes in behaviour that could indicate an oncoming ‘episode’, and if the same app can trigger an emergency call for that individual, help has the potential to be delivered faster than current circumstances allow.

One concern around these developments is perhaps too much reliance on technology and the potential for layers of human intervention to be stripped out of the process.

Mental health in the workplace

It has been estimated that mental health disorders cost Hong Kong’s professional services industry up to HKD 12.4bn (circa. USD$1.6bn) a year, UK businesses £35bn (circa. US$46bn) annually and almost AU$11bn (circa. USD$7.8bn) in Australia

Whichever way you cut the data, and whatever report you look at, one thing is clear: mental ill-health is costing the world’s businesses and costing them dear.

We’ve touched on the provision of EAPs, but with a low take-up, these services can’t always perform the role they are designed for. Employees fortunate enough to have access to such a service should be more open to using it, and employers should encourage them to do so. This is especially true for expatriate workers who can sometimes find themselves isolated in a foreign country.

More generally, the World Economic Forum, in conjunction with experts from business, academia and mental health, has developed a seven-step guide to help organisations stay healthy:

  • Understand how the organisation can be adapted to better promote better mental health
  • Learn from colleagues who have acted
  • Don’t reinvent the wheel
  • Understand the opportunities and needs of colleagues
  • Take practical steps towards better mental health
  • Ensure people know where to go if they have an issue
  • Get started now

Episodes of poor mental health as a condition are now far more recognisable than 30, 20 or even 10 years ago, but with understanding and awareness comes the challenge of treatment. Technology will no doubt have a major impact, but societies in general, as well as employers within them, have a responsibility to tackle the problem robustly. IPMI providers like Generali Global Health, who provide for the healthcare requirements of globally mobile people around the world, must continually improve their value proposition to ensure the mental health support their members need is always as vigorous as it needs to be.