Medical schemes anticipate increase in mental health claims

Loss of income heightens anxiety

Medical schemes are expecting a rise in mental health claims once the lockdown ends, despite a decrease in hospital admissions for these conditions in the last two months. 

Research shows since the outbreak of Covid-19, 67% of people are reporting higher stress and anxiety levels, while 53% say they feel more emotionally drained and exhausted. Picture: 123RF/CATHY YUELET
Research shows since the outbreak of Covid-19, 67% of people are reporting higher stress and anxiety levels, while 53% say they feel more emotionally drained and exhausted. Picture: 123RF/CATHY YUELET

Medical schemes are anticipating an increase in mental health claims once the lockdown ends, despite a decrease in hospital admissions for these conditions over the past two months. 

Lee Callakoppen, principal officer of Bonitas, says significantly fewer admissions during the lockdown resulted in a 15% decrease in hospital claims for mental health in April compared to April last year.

But he is not anticipating these lower claims will continue as the psycho-social and financial impact of the pandemic hits. 

Discovery Health has also had a 30% reduction in admissions to facilities for mental health conditions during March and April, driven by a reduction in admissions for depression and bipolar mood disorder. 

Dr Ryan Noach, chief executive officer at Discovery Health, says there was, however, a 6% increase in psychotherapy consultations in March relative to March last year.

With a fragile economy and soaring rates of unemployment, increasing depression and suicide rates are inevitable. 
Psychological Society of SA president Prof Garth Stevens

Comparing diagnoses for the first four months of the year to the first four months of last year, Bianca Viljoen, spokesperson for Health Squared, says the scheme has seen a 26% increase in total admissions for patients needing ongoing treatment for depression. 

According to the Harvard Business Review, since the outbreak of the Covid-19 pandemic, 67% of people are reporting higher stress and anxiety levels, while 53% say they feel more emotionally drained and exhausted. 

Professor Garth Stevens, president of the Psychological Society of South Africa, says the longer the pandemic and social restrictions last, the less likely we are to return to the normality of the pre-Covid-19 society. 

In addition, as we consume information voraciously it heightens our anxiety and when working remotely, the lack of boundaries between personal and working life, also elevates stress levels. 

He says with a fragile economy and soaring rates of unemployment, increasing depression and suicide rates are inevitable. 

Know what benefits you can access

Cassey Chambers, the head of operations at the South African Depression and Anxiety Group (Sadag), says members need to be more aware of the mental health benefits their schemes offer, as access to these benefits will reduce hospitalisation. 

Health Squared conducted an unpublished study a few years ago, which showed that members aged 20 to 30 years with psychiatric conditions are admitted to hospital two to three times more than any member with any other disease profile in the same age category.

“In our experience, irrespective of the specific type of mental health diagnosis, patients with psychiatric conditions may be repeatedly admitted to acute care facilities, often with differing diagnoses at each admission,” Viljoen says. 

In order to address this, the scheme now offers outpatient care for members requiring treatment for major depression and other non-prescribed minimum benefit (PMB) chronic psychiatric conditions that includes chronic medication, as well as psychologist and psychiatrist consultations. 

This has resulted in the scheme having the lowest mental healthcare costs in the country according to the Council for Medical Schemes annual report, she says. 

Know your PMB benefits

Some mental health conditions, including major depression, bipolar disorder, schizophrenia, eating disorders, personality disorders and drug and alcohol dependence, are covered as PMB conditions. 

A PMB is a health condition your scheme is obliged by law to cover ensuring that you have access to minimum health services and treatments, regardless of the medical scheme option to which you belong. 

“Treatment is specified for each condition and may include hospital management, outpatient psychotherapy and counselling and/or medicine.  On diagnosis, members apply for access to these benefits. Submission of disease specific diagnostic information is required for authorisation to be granted,” Noach says. 

He says although members still struggle with the stigma that comes with having a mental illness, they are increasingly accessing benefits for these conditions.

Damian McHugh, executive at Momentum Health Solutions says he too has seen an increase in mental health related claims over the past three years across all the schemes Momentum Health Solutions administers. 

“The most common reasons for mental health related claims are as a result of emotional stress leading to burnout and financial distress leading to relationship and legal issues which often leads to depression,” he says. 

Under the PMB benefits, you are entitled to either hospital admission for up to three weeks a year or 15 outpatient consultations for conditions such as depression or bipolar depression. 

An important benefit for these times, is if you are diagnosed with acute stress disorder, you are entitled to 12 outpatient psychotherapy or counselling sessions under the PMB benefits. 

What you can do 

Health Squared’s consulting clinical psychologist Rucksana Christian, says essential service personnel such as frontline health workers, security and supermarket staff, could potentially experience feelings of helplessness due to the possible exposure risks they face on a daily basis. She outlined the following coping tips: 

  • Equip yourself with facts that come from reliable and validated sources only. Avoid social media and any rumours about Covid-19.
  • Be aware of your response and acknowledge your emotions, but stay calm. 
  • Be flexible and consider how you may need to adapt your plans.
  • Stay positive and trust the national processes in place. 
  • Use lockdown time to get closer to achieving your goals.
  • Be mindful and focus on the present.
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