Dr Arthur Zulficarov, General Manager of Global Voyager Assistance Russia, opened the session with a look at some of the World Health Organization and American Psychiatric Association’s classifications of mental health conditions to show just how many there are, before showing how, in a sample of 11 insurers in Russia and Eastern Europe, all contained blanket exclusions for mental health issues on their travel policies. Explanations for these exclusions centered around the complexity and unpredictability of the diagnosis, treatment and costs associated with such conditions.

However, IPMI providers offer better cover for mental health conditions, but with limits to avoid the coverage of lengthy in-patient treatment; while psychiatrists that Dr Zulficarov spoke to explained that the costs associated with treating mental health conditions are usually actually quite low.

Another unique feature of this region is the strict government regulation surrounding the care of patients with mental health disorders. In Russia, all such patients must go through the psychoneurologic dispensary (PND), complete the country’s compulsory treatment protocols, and be monitored and dispatched under formal regulations. For medical escorts, strict rules also govern the determining of fitness to fly and the execution of such cases, from obtaining a recommendation from the treating psychiatrist to ensuring one of the escort team is the same gender as the patient.

Brad Dance, Chief Customer Officer at TuGo Insurance, followed with a look at some of the reasons why mental health conditions are excluded from travel insurance policies in Australia until mid-2017, when a legal case in the country had far-reaching effects on the wider industry in terms of how it covers such conditions.

A focus on extreme cases, fears over long periods of hospitalisation and an increase in the likelihood of mental health episodes increasing during travel were just some of the reasons insurers excluded mental health conditions, but the case of an Australian student traveller who cancelled her trip to New York due to a period of severe depression has changed how many insurers now approach such cover. The student had her resulting claim denied, but an appeal to the local courts found in her favour and she was awarded US$15,000 for hurt and humiliation. Subsequently, the Human Rights Commission in Victoria launched an investigation into potential unlawful systemic discrimination against people with mental health issues by the state’s travel insurance industry, and the Insurance Council for Australia called for the development of an industry code around the issue of mental health coverage, with insurers also called upon to contribute to a mental health database.

As a result of this case, travel insurers in Canada sat up and took notice, said Brad, and although some of the top insurers in the country still exclude mental health conditions from their outbound medical and trip cancellation/interruption coverage, they are looking to make changes to this approach. Others have already removed language that referred specifically to mental health and now treat such illnesses like any other. The Canadian landscape is certainly evolving, said Brad, changes are in progress and although coverage and exclusions will not all look the same for Canadian consumers, they will soon have better options. 

Taking a broad look at the scope of mental health issues and associated costs, Dr Mitesh Patel, Medical Director UK at Aetna International, told delegates that over 300 million people faced depression in 2015, and expats were two-and-a-half-times more likely to experience anxiety or depression than their countrymen back home. Mental health will be the number-one health concern in 10 years’ time, he said. Thankfully, the stigma attached to mental health is eroding, if more slowly in certain regions. Dr Patel gave the example of the UAE, where there are 7.25 mental health workers per 100,000 population compared to the US where there are 271.28. 

In terms of cost, mental health conditions not only have associated direct and indirect healthcare costs, but also costs in terms of lost productivity in the workplace. There are things that employers can do to help, however, such as offering Employee Assistance Programmes with access to mental health lines run by counsellors, offering paid or unpaid time off, and the option to work from home. Likewise, insurers can ensure they direct those in need to appropriate local care when they are travelling, offer telemedicine services allowing insureds to talk to a physician in their own language, and provide cultural training for employees pre-trip and encourage them to build local support networks. Providers can use data mining and predictive analytics to provide better care and identify any potential gaps in care and knowledge.