Recalibrating mental health support amid shifting priorities

In February, just one week after Lunar New Year, residents across Asia were asked to help curb the spread of COVID-19 by minimising social contact and staying at home. This very soon turned into an extended period of working from home.

Asia became the first region broadly affected by the coronavirus. The festive mood was cut short by an influx of misinformation; and fear overwhelmed us at a time when we knew little about the virus.

Based in Hong Kong, our small city apartments suddenly seemed even smaller. Then one day, when a care package arrived from Swiss Re, I realised our mental wellbeing deserved as much care and attention as our physical health.

I was not alone in feeling isolated and anxious but I am grateful for my awareness of my emotional response to the situation. As with most ailments, early detection and prevention can help people better mitigate the effects and treatment expenses of mental ill health.

COVID-19 encourages us to overcome obstacles with a new outlook. Opportunities now exist for insurers to recalibrate their approach to mental health support.

Turning challenges into guidance

Solutions are not possible without first looking at the problem. Between July and September 2020, Swiss Re conducted mental health research across four Asian markets to assess the status and challenges we face as an industry. A series of interviews covered expert views from mainland China, Hong Kong SAR, Japan and Korea.

The purpose of these interviews: to validate some of our industry's presumptions around mental health and seek guidance from experts on opportunities where we can advise and facilitate access to professional care for more customers. Here are the top challenges common to all surveyed markets:

1.    Reliance on self-reporting – unlike most physical illnesses, assessment of mental health relies heavily on self-reporting. The lack of reliable biomedical markers makes it difficult to indicate the severity of the mental health conditions. For this reason, claims assessment can be challenging due to the subjective nature of the submitted evidence.

  • In Japan, our expert interviews reveal that different psychiatrists should provide the same diagnosis after evaluating the same patient, but the severity may differ depending on the amount of information collected during a consultation.
  • In Korea, experts inform us that it is common patients with little understanding of their conditions find it difficult to recognise and self-report symptoms, and patients visiting the clinicians involuntarily may show negative attitudes towards treatment or even conceal their symptoms.

2.   Variations of local market practices – professional training and cultural background of the psychiatrists also influence the diagnosis:

  • In mainland China, training modules and qualification requirements for psychiatrists vary largely by program. Some training institutions admit general practitioners to specialise in psychiatry with only one-year training.
  • Similarly, in Korea, our expert interviews tell us that certain diagnostic criteria are influenced by the institutional stance.
  • In Hong Kong SAR, we investigated the juvenile conditions and found that as patients move between age groups, there's a discontinuity of public healthcare services. Specifically, the age limits applied to various service groups may confuse patients' ongoing treatment plans.

3.   Comorbidity – the cause of comorbidity is complex and bidirectional, which makes risk assessment for mental health conditions challenging for consumers and insurers. Our experts provided pathological insights into how they determine a patient's physical and mental comorbidities, however, more work is needed to map it out with greater precision.

4.   Ethical dilemma – in all interviews, the experts expressed their concerns over lump sum compensation benefits for consumers diagnosed with mental health conditions as it may increase the likelihood of moral hazards such as exaggerated symptoms and unnecessary hospitalisation. It can also affect the course of rehabilitation, which is contrary to what an insurance policy is intended for.

5.   Prediction, prevention and early detection – considering all the factors mentioned above, it is difficult to identify the right services, online or offline, to support policyholders during the early stage of their mental health journeys. For example, one research study shows that out of 73 mental health apps examined, 64% of them made positive claims about their effectiveness but 33% referred to self-proclaimed scientific techniques of limited evidence. Generally, the interviewed experts are positive about the rise of new technology in this space but are cautious of data privacy and its disease management efficacy due to the complexity of mental disorders.

Today's understanding drives tomorrow's action

To overcome the challenges mentioned above, Swiss Re has embarked on a journey to deep dive into the mental health risk pool. We conducted global consumer research on how a comprehensive insurance proposition could take shape. The research uncovered key insights on what consumers want from insurance solutions. Our intention is to focus on how new solutions can be built, underwriting changes we need to make, and claims support we can offer.

Additionally, we gained an in-depth understanding of the diagnostic definitions for different mental health conditions, severity scales, patient journeys, related risks and behavioural factors across multiple markets in Asia. This allows us to turn our insights into a joint movement with insurers, consumers, medical experts and healthcare service providers to address the need to close the mental health protection gap.

Swiss Re's Asia mental health expert publications will be launched over the next few months, commencing with Hong Kong in November. We look forward to deepening our discussion and working with more insurers on innovative mental health solutions.

We want consumers to know that they are not alone. Mental wellbeing is an important issue, that's why we are taking action to bring broader awareness and understanding of this complex situation. But there's always a first step, just like when I unexpectedly received the touching care package at the peak of the pandemic.

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