According to the World Health Organization (WHO), one in four people will be affected by mental or neurological disorders at some point in their lives, and such disorders currently affect 450 million people worldwide.
Mental health issues are a leading cause of ill health in travellers and a common reason for medical repatriation. But they should not prevent people from seeing the world if they want to. International travel can be a stressful experience for many reasons, not least leaving friends and family – who often represent an integral support system – behind, as well as the possibility of unfamiliar threats to health and safety, and the impact of adjusting to foreign cultures.
It is therefore crucial that efficient and effective support is easily available to travellers with mental health conditions. With the conversation surrounding mental health issues opening up and stigma decreasing, better protection is available and improving all the time. ITIJ spoke to insurers and assistance companies alike to discover how they are evolving their policies and better tailoring their services, as well as improving how they work together to provide the best support possible to those who need it.
No distinction, no discrimination
For Deborah Avery, Head of International Assistance at Anvil Group – a UK-based company that delivers business resilience solutions – there is no difference between mental health support and other assistance services. “For us, mental health support for travellers has always been part of the overall service delivery. We don’t really see a distinction between that and the other assistance services that we provide,” she told ITIJ.
This is great news, as part of the stigma surrounding mental health issues is the falsity that ‘invisible’ health conditions of this kind are somehow less valid than physical, visible ailments such as a broken leg. This is also true for Nel Mooy, Travel Director at AXA Insurance: “We treat mental health conditions in the same way as physical health conditions: we evaluate the risks, based on past claims, and that is how we calculate the premium."
In terms of the support Anvil Group offers, Avery explained that the company’s Anvil Assist service provides multilingual 24/7 medical and security assistance wherever in the world its clients may be. “It’s a one-call comprehensive traveller assistance service that’s designed to embrace any event that could impact the health, safety or wellbeing of a corporate traveller or expatriate,” she said. “Part of this is our own in-house clinician-delivered medical assistance service, which includes remote counselling and support for general wellbeing or more serious mental health concerns.”
Avery explained that, in addition to in-house clinicians, Anvil Group has a team of counsellors who can provide professional counselling services over Skype or telephone 24/7 to suit client needs. “We can also arrange face-to-face counselling if necessary, and will support the individuals in whatever options they, and we, feel are most appropriate,” she said.
“In the very worst cases, we can facilitate their admission into hospital for treatment, and we can also repatriate people, with a medical escort if necessary, should this be an appropriate course of action. It’s all about ensuring that the individual feels, and is, safe and well throughout.”
Prevention, preparation and personalisation
Dr Laurent Taymans, Regional Medical Director of medical and travel security services firm International SOS, which has headquarters in the UK and Singapore, recognises the impact that remote environments and long-term business travel can have on mental health: “These exacerbate mental health issues, as the individuals no longer have their support structures around them to help them cope.”
For him, prevention is key. “Pre-travel screening, as well as simplified access for employees and managers to tools that address mental health issues, really improve the landscape, as prevention truly plays a role. Self-help and awareness tools are also extremely important.”
When assistance companies and health insurers work together, a particularly powerful synergy results to both identify real issues of importance and to plan to mitigate any associated risks
Avery agrees: “It’s all about early identification and about giving the individuals the confidence that they know support is there if they need it, in whatever format they may need.”
Preparation is another key ‘p’ when it comes to shaping industry partnerships, as Simon Worrell, Global Medical Director at Collinson, a global leader in the provision of medical, security and travel risk management services, highlighted. “It is important to undertake formal risk analyses of businesses prior to signing,” he said. “Such analysis should include all risks to an organisation’s proposition, both medical and security, but psychological welfare should also take a prominent position – planning for increased care of those insured and those working for the company abroad. Through sharing expertise with new clients in the early stages of the relationship, processes can be honed, benefiting all parties involved.”
ITIJ also spoke with Damian Lenihan, Executive Director of UK-headquartered international medical insurer Aetna International, who underlined the need for personalisation, indicating that the better tailored support is to a specific individual’s needs, the more effective it will be, as well as highlighting the importance of collaboration: “The best support is always going to be highly personalised and bespoke, and it’s so much more effective when different companies are able to work in tandem to keep members safe and well,” he said. “For example, we have used our in-house teams and partnerships with travel risk management services to ensure crisis response teams are able to intervene and bring people to safety when necessary.”
Collaboration, communication and courage
Avery is also a proponent of collaboration within the industry for shedding more light on mental health services and providing better assistance. “I think the more we can all work together to develop a deeper understanding around mental health and the impact that it can have on the travelling population in general, the better,” she said. “It also requires us all to work a lot more closely with the market – our actual clients – and to help with the broader educational component; companies just being more aware of the issues around mental health and in particular the impact on travellers themselves.”
Worrell also believes collaboration and a tailored approach are key, for a number of reasons. “When assistance companies and health insurers work together, a particularly powerful synergy results to both identify real issues of importance and to plan to mitigate any associated risks,” he said. “These partnerships allow a tailored approach to providing enhanced services, and as new needs emerge, responding by developing further innovations. This is particularly relevant to corporate customers, who often request bespoke offerings for their employees and end customers.”
Along with collaboration, conversation is another important ‘c’. Aetna International offers an employee assistance programme (EAP) that provides free emotional support to members and acts as a confidential first port of call for those experiencing mental health issues. “This champions our belief that we need to get people talking about what is on their minds,” Lenihan said.
By having more open conversations with each other, by learning from the experts, by being more transparent and by being willing to adapt, we can really start to make a difference
“While things are changing in the West, talking openly about mental health isn’t always so easy elsewhere, so the EAP offers confidential assistance towards better mental health, provided by clinical counsellors, coaches and work-life experts, every hour of the day, every day of the year.”
Communication is inarguably paramount when it comes to mental health issues. Having the courage to talk about the feelings and struggles they may be dealing with can often represent an individual’s first step towards accessing support. Plus, it can help to spread awareness and understanding about mental health issues and stamp out misinformation and unhelpful taboos.
Avery agrees. “There’s still a lot of disparity within the industry and I think that often comes down to a lack of real understanding. It’s such a complex area, but by having more open conversations with each other, by learning from the experts, by being more transparent and by being willing to adapt, we can really start to make a difference,” she told ITIJ. For those affected by mental health issues, Avery believes that having someone to talk to can make a world of difference: “Just having a trained professional to talk to, in confidence, who understands their culture and speaks the same language, can provide significant reassurance in stressful times.”
Aetna International’s Lenihan has also witnessed the benefits of enhanced communication surrounding mental health issues, which is crucial because insureds not disclosing conditions can cause problems. “It’s important for people to disclose any pre-existing condition, as not doing so could invalidate the terms of their insurance. You certainly don’t want to get into a situation where you are not covered for something you desperately need,” he said. “Previously, shame or stigma might have prevented people from opening up about their mental health issues, but media attention and the willingness of many high-profile people to speak out about this has really made a difference.”
Insurers and brokers today have a better understanding of mental health than in the past and people will probably find they can access cover more easily
Transparency for the win
AXA Insurance’s Mooy also highlighted the importance of declaring pre-existing conditions: “Pre-existing conditions, whether they’re linked to physical or mental health, do have an impact on premiums.” She explained that AXA Insurance recently launched a Travel Health Calculator, into which people can confidentially enter their medical conditions and receive advice about where to buy a travel policy – e.g. whether they need a specialist or if they can go to any provider – and what they should look out for in the policy. She believes that awareness and understanding regarding mental health conditions has improved, which has had a beneficial impact for insureds. “In the industry in general, insurers and brokers today have a better understanding of mental health than in the past and people will probably find they can access cover more easily,” she said.
When it comes to improvements to the support available to travellers, Lawrence Watts, Head of Insurance at Collinson, which has operation centres in the UK, Ireland and South Africa, also believes things have got better in recent times. “Most leisure travel insurance policies now treat diagnosed mental illness like any other within their medical warranty, leading to premiums that better reflect the claim risk.
At present, leisure travel premiums do not adversely impact those with mental health issues, but in many cases, there is a chance of underestimating their impact on claims and assistance services,” he told ITIJ. “For example, there is often a need to provide greater levels of communication and peace of mind, which may impact costs, and consequently premiums, in the future.”
In addition, Watts has noted that there has been an improvement in insurers’ and assistance companies’ capabilities in the mental health arena. “The ability to better cater for and identify mental health [issues] at the distribution and assessment stage has improved in recent years, which helps to alleviate this potential excess stress on claims and assistance,” he said.
Digitisation and innovation have also advanced the field, enhancing available options. For example, Watts said, offering a choice of service channels, such as phone, online, app or web chat, has provided customers with the flexibility to communicate in a manner that best suits their needs.
Despite this, though, the power of face-to-face communication shouldn’t be underestimated. “Many argue that human interaction is the best way to identify and manage vulnerable customers, though potentially digital channels can evolve with increasing investment in technology and artificial intelligence,” Watts pointed out.
Ticking boxes with technology
Technology certainly holds great potential in the area of mental health insurance and assistance services, and this is something that Collinson’s Worrell has noted. “Technology is certainly enhancing the global reach for personal psychological support,” he said. “For some, it is the anonymity provided by technology which is particularly helpful. Where employees feel that disclosing psychological issues to their managers may cause adverse issues, technology allows these employees to engage in wellbeing initiatives more honestly if their identity is withheld.
Being more nuanced and sensitive in the way we word things could help people to understand what they need to declare and why
“As some wellbeing measures are text-based, anonymous contact is facilitated, but therapeutic advice can still be dispatched. It’s important to note that technology is a facilitator of better, faster care, but in no way a replacement. The best assistance providers offer all options of care.”
Aetna International’s Lenihan is also au fait with the role of technology in assisting travellers with mental health conditions. “Our recent launch of Aetna DNA, a health and lifestyle genetic test that looks at things like sleep, stress and nutrition, is a case in point,” he said. However, like Worrell, Lenihan believes that in spite of the many merits of technology, the human touch cannot be replaced. “It’s also important to take a very human approach, so consultations, face-to-face time and follow-ups are still of the utmost importance,” he told ITIJ.
And, looking ahead, Aetna intends to continue building on the options afforded by technology. “We’ll keep looking to expand our range of interventions to include coping behaviour techniques such as mindfulness-based stress reduction, as well as medication planning and continuity of treatment, to ensure we meet needs, whatever they may be,” Lenihan said.
Anvil Assist’s Avery, too, values the role of new technologies in helping to deliver effective assistance, particularly in providing options for remote support and initial counselling. She pointed out that it is in everyone’s best interests to provide the right support, and doing so requires flexibility and the ability to adapt. “We’re constantly analysing and looking at the types of cases that we’re seeing in order to identify some areas that maybe require better support,” she said. “Mental health is one of those, absolutely. If you haven’t got the right level of support in place for people, particularly when they’re travelling abroad or when then they’re out of their comfort zone, you’re actually putting yourself as a company at risk, as well as those individuals."
In addition to the rise of technology, Avery told ITIJ that another trend she has noted is an
increase in demand for traveller assistance programmes, although there is still room for improvement. “We are seeing a much wider adoption of traveller assistance programmes, which is a huge step forward. More focus on pre-travel assessments, specifically around mental health and wellbeing, would also really help,” she said. “For instance, we work with a number of companies on pre-trip medical screening, asking travellers specific questions about their mental health needs or psychological issues around pre-existing conditions. And it’s not to stop them travelling … it’s to help better support them and put measures in place while they’re abroad, particularly if they’re going to some countries that maybe don’t have the most modern cultural attitudes towards mental health, so we can help organisations plan better for their individuals.”
It’s all about ensuring that the individual feels, and is, safe and well throughout
A trend Aetna’s Lenihan has observed is a positive shift in attitudes towards mental health, which he believes is beneficial for building healthier communities. “We are seeing a significant shift in the awareness of and attitudes towards robust mental wellness,” he told ITIJ. “We know that many of our members want to take proactive steps in looking after their holistic health and are looking for bespoke, accessible support in doing so. Healthcare providers are ideally placed to ensure members derive real value from their plans by delivering preventative measures and building bridges towards delivering that support. In fact, I’d go so far as to say that the sector has a responsibility to engage in the broader health of populations and play a part in building heathier communities.”
The journey continues
So, what remains to be done? Lenihan said that there has been an increase in mental health claims, which shows that people are becoming more confident about seeking support, but there are still improvements to be made. “There is still some distance to be travelled, and perhaps one way in which the situation can be improved is to do with the language we use in our healthcare plans,” he told ITIJ. “There is a big difference between the support required by someone who occasionally experiences worries and anxiety, and the support someone needs if they are bipolar or suffer from a diagnosed chronic anxiety disorder, for example. Being more nuanced and sensitive in the way we word things could help people to understand what they need to declare and why, which in turn will help us personalise the support and quality of care we can offer far more effectively.”
And what of the future of mental health coverage and assistance? “As we plan to mitigate the psychological effects of working in stressful jobs or travelling to problematic locations, we aim to reduce the risk for both the patient and the insurer. The industry is working to harness new preventative strategies, ensuring early support when needed to help stave off an acute event,” said Worrell. “Utilising global providers of mental health services, we see virtual consultations via smart devices growing in number, helping to deliver expert care in the most remote settings, in addition to the more traditional means of counselling, such as phone consultations with a psychologist.”
Worrell explained that, as the presence of technology in assistance and care grows, it will allow earlier intervention and support, meaning that, in many cases, emergency help following psychological distress will be required less. “In the long term, this will not only provide better care for travellers, but also reduced premiums, and more successful journeys abroad,” he said.
Our enemy – complacency
There have been a number of important shifts and transformations in the industry, leading to significant improvements in the support available to international travellers with mental health conditions. In fact, we are in a better position than ever before. These evolutions include advancements in technology, which have led to improvements in the modes of communication available to travellers who require assistance and support, as well as enhanced flexibility in how support can be delivered and received; and a shift in how mental health conditions are perceived, with better understanding and education on the topic leading to less misinformation and improvements in transparency – as travellers are more willing to declare their mental health conditions – as well as enhanced understanding from insurers and assistance companies.
Collaboration between insurers and assistance companies has also improved, enabling them to deliver better support and identify areas for improvement. Furthermore, available support is much more personalised – time and time again it has been proven that a one-size-fits-all approach doesn’t work, and tailoring support provides optimum outcomes. Better preparation – both among travellers themselves ahead of travel, and among assistance companies and insurers embarking on partnerships – has improved the state of play. Policy wording, too, has become clearer, more nuanced and more inclusive.
Despite these impressive and welcome improvements, there remains work to be done in all of these areas, and this is something that the industry is aware of and working on. When it comes to mental health, we can never be complacent.