Mental health advocates and government experts now say these exclusions are not only unnecessary but illegal.
Insurance Regulatory Authority said the few private companies covering mental health have introduced sublimits, where the company offers coverage only to a certain amount.
James Ndwiga, the IRA assistant manager in charge of supervision, blamed the problem on the lack of data on treatment costs for mental health disorders.
“Most insurance companies don’t understand financial implications, so they introduce sublimits for mental health by saying you're only covered up to, for example, Sh100,000,” Ndwiga said on Thursday at a forum hosted by the Aga Khan’s University’s Brain and Mind Institute (BMI).
The meeting was held in partnership with the Mental Health Alliance of Kenya, and brought together the regulator, insurance companies, academia, Ministry of Health and non-profit organisations to discuss mental health coverage.
“If the data is not there it becomes very difficult to cost,” Ndwiga said.
The Mental Health Act makes it illegal to exclude or restrict the treatment of mental health in health insurance policies.
“An insurance company which makes any insurance policy which expressly excludes or puts restrictions on the treatment of any person suffering from mental disorder shall be guilty of an offence," the act says.
The 2019 mental health task force estimated that one in every 10 Kenyans suffers from a common mental disorder and the number increases to one in every four people among patients attending routine outpatient services.
The National Health Insurance Fund offers full coverage for mental health in public hospitals.
“It is an offence to discriminate against people with mental illnesses, and the law is clear. Moreover, mental health is an essential package in the Universal Health Coverage. Still, there needs to be proper pricing for mental illnesses,” said Dr Nasri Omar, Ministry of Health, Mental Health System and Policy Lead.
Kiama William, a manager at the insurance lobby Association of Kenya Insurers, said they are ready to offer covers on mental health, but there lacks data on the cost of treatment.
“The industry is aware of the Mental Health Act and HIV Act which requires them not to discriminate. The insurance is able to give covers on these but puts in sub-limits. Optical and dental care also have sub-limits. The rates can be increased but the premiums will be high. It's like vehicle insurance, damages from terrorism and political violence are excluded but you can buy them back by adding premiums,” he said.
Psychiatrist Prof Lukoye Atwoli said treating mental illness has an actual return to the economy.
Atwoli is the BMI associate director and dean of the Aga Khan University’s medical college.
“Therefore, we should look at mental health coverage as an investment rather than an expenditure. Sh87 billion is needed [annually] to treat disorders. You gain Sh161 billion.
For every shilling spent you gain Sh2,” he said, quoting the taskforce Mental Health Task Force Report, released in 2020.
The gains are through increased productivity and savings on further treatment costs.
Prof Zul Merali, the BMI founding director, said people living with mental illness should not be subjected to unnecessary barriers to access to care.
“We need to explore other options for ensuring coverage for mental health. For example, insurance companies can start by testing out excluded mental health coverage and using generated data after a while to make a clearer decision,” he said.
Veteran psychiatrist Dr Franck Njenga, who chaired the mental health taskforce, said insurers were using outdated data to limit mental health covers.
“The actuarial work done on Mental Health is based on the length of patient stay at Mathari [National Teaching and Referral Hospital]. The average is 67 days.”
Dr Njenga said this means insurers have been using the severest form of psychosis to develop their premiums.
“It's like going to do your actuarial activity at the stage 4 cancer ward,” he said.
President of Kenya Psychiatrists Association Dr Chitayi Murabula noted there are almost 300 different mental health disorders which should not be lumped together.
“We’ve been looking at mental illness as just one disorder and we looked at the worst-case scenario, so we need experts who can desegregate,” he said.
“Mental and physical illnesses are closely interrelated, so treating mental illnesses plays a huge role In maintaining a healthy population,” he said.
However, the insurers said clauses that expressly exclude suicide victims or attempted suicide survivors from insurance claims or coverage will remain.
“We don’t pay for suicide because it is illegal. Until it's decriminalised that’s when we will pay. We also can't pay any practitioner not licensed by the practitioner's body,” said Dr Edna Kerubo, the head of Wellness at Jubilee Health insurance.
She noted insurers also do not pay for harms caused by other harmful activities such as drugs abuse.
