The Future of Mental Health Disclosure: How Generational Shifts Are Reshaping Global Insurance

Worldwide, the subject of mental health has rapidly become a central topic within insurance underwriting and claims discourse. Over the past two decades, there has been a transformation in the willingness of applicants to disclose mental health histories when seeking cover. This shift, however, does not occur in isolation; it is underpinned by wider social, regulatory and demographic changes that have reshaped public attitudes, professional practice, and the structure of insurance markets globally.

One of the most significant factors driving increased disclosure is the changing generational approach to mental health across developed insurance markets. Older generations, shaped by cultures in which mental illness was often marginalised or hidden, were historically reluctant to disclose psychological difficulties to insurers for fear of higher premiums, exclusions, or outright rejection. For much of the twentieth century, concealment was common practice, reinforced by limited public understanding and restrictive underwriting practices across markets (Swiss Re, 2021; Geneva Association, 2023a).

*defined as people under the age of 30

International surveys have found willingness to disclose mental health issues has increased significantly across developed markets, with the Money and Mental Health Policy Institute (2018, 2023) documenting increases from 50% to 70% in the UK from 2018-2023. While similar trends are observed in other developed insurance markets, much of Asia still contends with reluctance to seek care or disclose conditions to insurers. However, this varies considerably by country: disclosure is high in Japan and South Korea, but low in countries like the Philippines and Malaysia (Aon, 2023). These attitudes are gradually changing, especially among especially among the younger population living in urban areas, as awareness of mental health grows and insurers trial more inclusive products.

There are both positive and negative elements driving increased disclosures; these begin at the time an individual first experiences symptoms suggestive of a mental health problem, impact on the pathway through help-seeking to diagnosis and treatment, and eventual disclosure to family, friends, colleagues, employers and insurers (Figure 1).

This upward trajectory is attributable in part to the cultural environment in which young people have come of age. Mental health education is now embedded within school curricula in many countries, mental health literacy has improved, and open dialogue is amplified through digital channels and peer networks worldwide. As national anti-stigma initiatives gain momentum across Europe, North America, and increasingly in Asia-Pacific regions, the willingness to speak openly about mental health has risen steadily (Pescosolido et al., 2021; Corrigan et al., 2014). The normalisation of disclosure is also reinforced by internationally recognised celebrities and public figures who candidly share their mental health experiences, further eroding the stigma that once surrounded the subject.

However, significant regional variations persist (Aon, 2023). In Asia cultural stigma around mental illness remains more intense, causing continued reluctance to seek care or disclose conditions to insurers. Studies across multiple regions show that mental health and suicidality are associated with persistent stigma and discrimination, affecting disclosure patterns differently across global markets (Hendriksen et al., 2023).

The complex social and generational shifts occurring globally make it difficult to determine whether actual rates of diagnosable mental health conditions have truly increased over time. Nevertheless, international surveys measuring subjective mental wellbeing reveal consistent patterns across different regions: people report feeling worse about their mental state now compared to 15-20 years ago. Young people, especially young women, show the most pronounced decline in reported wellbeing (Blanchflower et al., 2025).

The COVID-19 pandemic intensified this downward trend. Extended lockdowns, widespread uncertainty, and financial struggles pushed mental wellbeing to new lows across the globe. Yet the decline began well before 2020, with steady year-over-year decreases in reported wellbeing. Researchers point to several possible causes: young people entering a job market still recovering from the 2008 recession, growing rates of loneliness and social disconnection, and the pervasive influence of smartphones and social media platforms. Most concerning, mental wellbeing has failed to bounce back to pre-pandemic levels, indicating these social and economic disruptions have left lasting effects.

However, these widespread reports of declining wellbeing don't translate uniformly into clinical outcomes like treatment rates, formal diagnoses, or suicide statistics, which show significant variation between nations. Countries like the United States and United Kingdom have recorded rising suicide rates among young people over the past two decades. In contrast, Japan, Australia, Canada, and numerous European nations have maintained stable or even decreasing suicide rates (World Health Organisation, 2025).

As a result of this increase in cultural openness, prevalence and recognition of mental health symptoms, there has been a marked rise in diagnosed mental health conditions worldwide. The World Health Organization reporting almost 1 billion people globally live with a mental health disorder (Dattani et al., 2023; Wu et al., 2023). This is most notable in young people. It is estimated that one in seven experience mental disorders, amounting to an estimated 166 million individuals (UNICEF, 2023), and accounting for 15% of the global burden of disease in this age group (World Health Organization, 2024).

This represents a fundamental shift in the epidemiology of mental health across continents. However, there is substantial regional variation within these figures.

In the United States, around half of adolescents have had a mental health disorder at some point in their lives (Merikangas et al., 2010), and more than half reported discussing their mental and emotional health with a health care professional during 2021-2023 (U.S. Department of Health and Human Services, 2023). The picture is similar in South America, although national statistics are less available.  European data shows similar trends to the US, with young people now having the poorest mental health of any age group, whereas two decades ago the reverse was true (Resolution Foundation, 2021). Despite more gradual changes in Asian countries, mental disorders moved from 13th to 8th in the ranking of causes of disability in Asia between 1990 and 2019 (Chen et al., 2024).

Younger cohorts consistently have higher perceived mental health treatment needs than older adults across multiple countries and healthcare systems (Askari et al., 2023).

In addition, diagnostic thresholds have broadened. As a result, conditions that might once have gone unnoticed are now recognized, diagnosed and treated.

This diagnostic expansion also intersects with the growing acknowledgement of neurodiversity; a concept that encompasses conditions such as autism spectrum disorder (ASD), ADHD and other cognitive differences, with rates of around 15% globally (Skillcast, 2025). International research shows that more young people are now formally diagnosed with ASD than ever before, often accompanied by co-occurring anxiety or depression. Such overlaps mean that for insurers globally, youth mental health disclosure increasingly involves complex, overlapping conditions.

As well as impacting on mental health symptoms, the COVID-19 pandemic exacerbated existing vulnerabilities globally, with prolonged periods of social isolation, uncertainty, and economic hardship contributing to deteriorating youth mental health across all regions. Insurance industry data found mental health disclosures increased significantly across the pandemic period in multiple markets (Geneva Association, 2023b).

Healthcare systems worldwide play pivotal roles in shaping these trends, though with significant variations in approach and capacity. In the United States, expanded mental health coverage under healthcare reforms has led to more diagnoses and treatment pathways, though access remains uneven (National Healthcare Quality and Disparities Report, 2022). European healthcare systems, while generally providing universal coverage, face sustained demand that strains capacity.

Asian healthcare systems show mixed patterns, with some nations investing heavily in mental health infrastructure while others maintain more traditional approaches that may discourage disclosure and treatment-seeking (Chen et al., 2024).

This variation means that while more young people are diagnosed globally, not all receive timely or adequate support, creating regional disparities that can amplify the severity and duration of conditions, with direct implications for insurers assessing long-term risk across different markets.

Insurers rely heavily on healthcare records to validate disclosures and verify claims. However, inconsistencies in record-keeping, variable diagnostic quality and under-resourced services pose practical challenges that vary significantly by jurisdiction. Some applicants may struggle to provide clear evidence of treatment histories, especially when private and public care systems differ markedly between countries. (Geneva association, 2023a)

In workplace disclosure studies, nearly half of workers said that they concealed their mental illness because they feared that disclosure would damage their reputation as a competent professional _{(Elliott and Reuter, 2021)}. Disclosure of a mental illness on job applications may lead to reduced chances of being selected for employment, and current employees fear stigma, loss of credibility, and being passed over for promotional opportunities (Corrigan et al., 2014; Hendriksen et al., 2023).

This dynamic is increasingly relevant to insurers because mental health has become a leading cause of long-term sickness absence across developed markets (Association of British Insurers, 2025). Young millennials and Gen Z are missing the equivalent of one day’s work per week due to mental health issues (Vitality, 2024). In Australia, income protection claims for mental health increased 72% between 2019 and 2024 (McCormack, 2025). In the UK mental health was one of the leading causes of income protection claims paid out in 2023, representing more than 23% of total claims (McCormack, 2025) (Swiss Watch UK 2024).

For income protection policies, underwriters have adapted by probing more deeply into applicants' work absence histories, treatment adherence, and future prognosis. As lifestyle factors, from digital connectivity and sedentary habits to substance use and sleep disorders shape mental health outcomes globally, insurers face the delicate task of balancing fair access to cover with the need for robust risk assessment across diverse regulatory environments.

The confluence of greater openness, higher diagnosis rates and more complex case profiles raises profound questions for the future of insurance claims and underwriting. On the one hand, the expansion of mental health coverage and the easing of blanket exclusions mark significant steps forward for equity and inclusion across markets. Yet these welcome trends bring new complexities that vary significantly by jurisdiction and cultural context.

Further, the economic implications are significant. Mental health-related claims are not only rising in frequency but also in cost across international markets. Globally, mental health-related disability insurance claims have grown to more than $15 billion annually (Swiss Re, 2021), with claims doubling between 2013 and 2020 in many markets. In the UK specifically, the highest value claims were for mental health (£37 million of £177 million total payout) (Association of British Insurers, 2024). These are often prolonged claims, given the difficulties of predicting recovery timelines and the risk of relapse. Insurers must therefore refine actuarial models to accommodate the evolving landscape, consulting mental health experts to ensure that risk assessments remain evidence-based and fair across diverse cultural and healthcare contexts.

The trajectory towards greater mental health disclosure in insurance is likely to accelerate globally as younger, more open generations mature and as societies continue to normalise discussions about mental wellbeing, though at different paces across regions. For insurers worldwide, the task is to adapt underwriting frameworks so that openness is rewarded rather than discouraged, while respecting cultural sensitivities and regulatory requirements that vary by jurisdiction.

Insurers across the US, Asia, and Europe are adapting by expanding coverage, integrating digital solutions, and clarifying disclosure procedures. In Europe almost half of insurers expect a greater than 15% increase in costs per person for mental health services over the next 3 years, whereas 1 in 4 expect this in Asia and the Middle East (Willis Towers Watson, 2024). Consumer protection bodies in Europe and the US are driving more consistent and supportive approaches, while market surveys show mental health inclusion is becoming a priority for both product innovation and public health policy (Capgemini, 2025).

Automated underwriting engines have already made promising advances across multiple markets, enabling more nuanced, immediate decisions. However, as data privacy concerns grow alongside the appetite for detailed health information, insurers must earn and maintain the trust of applicants by safeguarding sensitive data and being transparent about how disclosures are used, with requirements varying significantly by regulatory jurisdiction (Goldacre et al., 2022).

Looking ahead, international industry leaders such as Swiss Re urge insurers to integrate mental health expertise into product design and claims management across all markets (Geneva Association, 2023a). There are calls for clearer guidance on how disclosures are handled and stronger guarantees that honesty will not lead to unreasonable exclusions or loading. Leading insurers across regions are exploring partnerships with mental health organisations to co-design underwriting frameworks that are sensitive to the lived realities of mental health conditions while respecting cultural contexts.

Regulators worldwide have evolving roles in this space. Consumer protection frameworks vary significantly between jurisdictions, from comprehensive anti-discrimination legislation in some markets to emerging regulatory approaches in others. As diagnostic definitions shift globally and more people receive complex, overlapping mental health labels, new questions emerge about what constitutes fair risk-based pricing across different healthcare and cultural contexts.

Young people worldwide, more attuned to mental health literacy and less burdened by traditional stigma, have led the way in normalising openness. Simultaneously, the increasing diagnosis of mental health conditions, including those connected to neurodiversity, and the impact of modern lifestyle factors, have reshaped the risk landscape for insurers across all major markets.

As healthcare systems worldwide strive to meet rising demand while maintaining quality, insurers must adapt underwriting practices to reflect the reality of higher prevalence, longer recovery trajectories (indicated by longer medication prescription duration)CDC Press Release April 2025 and fluctuating conditions. They must also maintain the trust of a global generation that increasingly expects transparency, fairness and sensitivity in how disclosures are handled, while respecting the diverse cultural, legal, and healthcare contexts in which they operate.

The challenge for the coming decade will be ensuring that disclosure leads not to exclusion or punitive pricing, but to a more personalised process by which insurance access, support and peace of mind is assured. Support can be offered by insurers, even in the simplest of life products, by offering insured lives access to services, such as Wysa, that track and support wellbeing, or in-force offerings that route to timely clinical services. In providing a more holistic offering, from application through the policy lifetime, insurers will not only protect themselves from moral hazard and fraudulent claims but will also contribute to the broader societal goal of destigmatising mental health and supporting those who live with it. If openness is to be the norm, it must be met with fairness; a principle that will define the insurance industry’s social contract for years to come.