The Evolution of Mental Health Assessment
Through the Ages, Past, Present and Future.
Society has come a long way in acknowledging mental health as being an essential part of an individual’s well-being, with increased awareness helping us to make great strides over the last decade. Until recently, stigma and fear prevented people from recognising and declaring their mental health issues, and our industry from understanding that this is a problem that impacts millions of people on a daily basis. Historically mental health problems were only thought to include severe mental illnesses, but now include conditions like anxiety, burn-out syndrome and Obsessive compulsive disorder (OCD).
Although there is still a lot of work to do in normalising discussions around mental health, people’s attitudes, understanding and awareness is shifting in a positive way. Promoting good mental health and a willingness to discuss how you’re feeling is becoming more common today in most UK workplaces. However, to truly remove the stigma surrounding the topic of mental health we must continue to integrate these discussions into our lives, including our workplace and our homes.
Our social and clinical understanding of mental illnesses has improved significantly over the years, and with around one in six people in the UK experiencing symptoms of a mental health problem each week, it is more important than ever that underwriters have the tools to make informed and balanced underwriting decisions.
In more recent times, it has been well documented that people with mental health problems face challenges when trying to obtain suitable insurance cover on terms that are fair and take into account their individual circumstances.
Looking further back in time, underwriting practices deployed 20-30 years ago lacked understanding, with little acknowledgment that mental illnesses vary significantly in their symptoms, severity, and response to treatment. Past guidelines tended to group all mental health disorders under just 4 or 5 headings with little recognition of differing degrees of severity or what constituted positive or negative indicators for long-term health. No doubt, this contributed to a lack of trust in the industry and was largely viewed by consumers as being ill-informed and lacking in empathy. To compound these issues poor understanding within society allowed inconsistent decision making on insurance applications to be deemed as acceptable, even if people were being unnecessarily declined or accepted on terms that didn’t accurately reflect the risk. This may well have resulted in consumers becoming hesitant to disclose mental health problems to insurers. Our data from 2001 to 2012 shows that claims for mental illnesses increased by 67%, even though the total number of claims for all reasons during this period was no more than the average. It would suggest that claimants prior to 2001 were more reluctant to discuss their mental health struggles with the insurer, and instead preferred to claim under an alternative physical ailment.
Today things are certainly better, in terms of approach to gathering information, underwriting decision making and claims handling, but there is still some way to go. Medically the understanding of the wide range of conditions that fall under the term ‘mental illness’ has improved greatly, and with this, underwriting guidelines have advanced as a consequence. However, there was still plenty of work to do as current guidance means that many applicants still have to be shoehorned into a category so that underwriting terms can be produced, leading to some problems of the past still being felt by some consumers.
In order to address these problems, Munich Re has produced a combination of new and revised guidelines for more than 60 mental health related impairments, to be included in our underwriting manual, MIRA. We believe that introducing greater diversification that is underpinned by the latest medical research, is the best way to offer customers improved access to insurance, whilst providing transparent evidence based outcomes for the consumer that can be more readily explained. As part of this review we have also helped to redesign underwriting rules so that they are more relevant to current clinical treatment pathways whilst acknowledging customer vulnerability. These updates will help our clients adhere to the new ABI mental health standards, helping to drive consistency and best practice across the industry.
Looking to the future, medical advancements in the field of precision psychiatry continue to research the potential for use of specific biomarkers to assist with personalised diagnoses and treatment pathways for severe mental illnesses. This type of research could pave the way for bespoke policies that truly cater to the individual needs of the customer, whilst helping underwriters to accurately balance the insurance risk. This will allow insurers to further refine their underwriting philosophies and remove barriers to accessing insurance for those with a history of mental illness, whilst continuing to improve consumer trust.