MakingCent$Meet

The toll mental illness takes on financial health

ST ILLUSTRATION: MANNY FRANCISCO

Patients face income loss, high treatment costs, insurance exclusions

Depression and mental illnesses are on the rise in Singapore but what's really crazy is the toll they take on your financial health.

I know because I had a mother who spent most of her adult life in Woodbridge Hospital, a brother with schizophrenia and obsessive compulsive disorder, and another family member with depression.

The indirect costs can be very high. It's the loss of income when you cannot hold down a full-time job or, as with my mum and brother, work at all. Due to the stigma and fear of those with mental illnesses, they don't have to be severely debilitating to make you, in effect, unemployable.

Then there are the direct costs of treatment. Let's take outpatient treatment, which for mental disorders includes not just drugs but also visits to the psychiatrist and therapy. Most insurers and company health plans totally exclude outpatient treatment for psychiatric conditions.

Thankfully, the Government has stepped in to allow the use of Medisave to help pay part of the outpatient costs, after 15 per cent of the bill is paid in cash. You can use the Medisave of your immediate family members to pay for the remainder, up to $400 per year per account. A maximum of 10 accounts can be used, so theoretically, that's $4,000 per year. Realistically, it's $800 a year from both parents.

Most insurers and company health plans totally exclude outpatient treatment for psychiatric conditions. Thankfully, the Government has stepped in to allow the use of Medisave to help pay part of the outpatient costs, after 15 per cent of the bill is paid in cash.

How easily that's exhausted. For a family member with depression, it costs $90 for three weeks' worth of two types of medication after subsidy. Because it's a mental illness, there aren't cheaper off-the-shelf or generic substitutes that you can make do with. Instead, you often have to keep trying different drugs, hoping to find one that works with side-effects you can endure. You also have to see the doctor regularly for your prescription and to assess how the medications are working, for they can stop working after a while - so there's the cost of consultations as well.

What about therapy? If you go private, it's expensive - like $200 a session - but more readily available so you can probably get to see the therapist when needed. At a subsidised rate at a government hospital, it can be $45 to $60 per session. But if the doctor in June says your child needs therapy, you may finally get an appointment in September. The next one after that may be February - because the therapist is going on leave.

The biggest expense is hospitalisation. The best advice I ever got was to opt for the lowest class ward you can. Mental illnesses are often hard to treat and require stays in hospital that stretch for weeks, even months, with repeated admissions over many years.

Still, knowing and having experienced all this, I upgraded one family member's stay to B1 this year. Why? SGH has just one small psychiatric ward. At the time, it held a patient who, because of her illness, shouted through most of the day and night. Upgrading to a B1 class meant not having to be in the same room as her, though still being in the same locked ward.

You can use your Medisave for up to $150 per day and $5,000 per year for inpatient psychiatric treatment. But what about insurance for the amount not covered by Medisave? When MediShield Life was introduced, insurance coverage was extended to cover inpatient psychiatric treatment but the benefit coverage is capped at $100 per day. To give you a sense of the financial toll, one 25-day stay in SGH in a B2 ward came to $7,086, with $2,058 covered by Medisave. MediShield Life would not be enough to cover all the rest.

Does private insurance offer an answer? In some countries like the United States, parity law says that insurance policies covering mental healthcare must treat that care as they do their coverage for physical conditions. There is no such law here. Private insurers, if they are willing to cover you for mental illnesses, will either offer significantly lower coverage compared with other physical illnesses, or cap the number of hospitalisation days for psychiatric treatments. They may exclude emergency ward charges and pre- and post-hospitalisation treatment.

Then there's the self-harm or suicide exclusion clause that makes dealing with such events even harder. Say you are being treated for depression and cut yourself because your condition worsened. You're hospitalised, your cuts are treated, you get drug treatment or electroconvulsive therapy to treat the underlying condition. Then your insurer rejects your entire hospitalisation claim.

Although the self-harm is the result of a psychiatric condition covered under the plan, it seems insurers can deny coverage not just for the treatment of any resulting physical injuries but also the medical treatment of the psychiatric illness covered by the plan.

It's different from when an insurer that covers head injuries or broken bones rejects covering those injuries as they're caused by risky recreational activities like skydiving or bungee jumping. No one chooses to be mentally ill.

Still, we have come a long way since my mother's time, when having a severe psychiatric illness meant spending your days locked up in Woodbridge with not much hope of getting better. As a caring society today, we urge those with mental health problems to seek help.

There has been help along the way - the doctor who charged only half her usual consultation fee, the clinic that gave free samples of the expensive drugs needed, and the medical social worker who helped us get downgraded to a lower-class ward. If your financial resources really run dry, there is always Medifund.

Still, for those who suffer from mental illness and their families, it can be a draining experience, financially and in all other ways.

A version of this article appeared in the print edition of The Sunday Times on November 27, 2016, with the headline 'The toll mental illness takes on financial health'. Print Edition | Subscribe