Ahmedabad: For families dealing with mental illness, the biggest challenge is often not only finding treatment but also paying for it. Private psychiatrists say many patients continue to struggle with the cost of care as insurance support remains limited. The Indian Association of Private Psychiatry (IAPP) has now urged the govt to bring private psychiatric services under the Pradhan Mantri Jan Arogya Yojana (PM-JAY).The association said that while mental healthcare has gained greater attention in recent years, patients continue to face difficulties in accessing affordable treatment, especially in private facilities. It has urged the state and Union govts to extend the scheme to private psychiatric services, which could benefit nearly 44 lakh PM-JAY cardholders in Gujarat.In a letter, IAPP president Mrugesh Vaishnav said India has around 10,000 private psychiatrists, who provide care to nearly three-fourths of people living with mental health conditions. “Private psychiatry, despite serving the majority of our nation’s patients, continues to face challenges. We are still excluded from PM-JAY. The govt, which has implemented the Mental Healthcare Act, 2017 and assured care for the rights of persons with mental illness, is still ignoring patients with mental illness and their caregivers by not extending PM-JAY benefits to them,” the letter stated.The association has also highlighted difficulties faced by patients seeking reimbursement for psychiatric treatment at private nursing homes. Dr Vaishnav said rejection rates for such claims remain extremely high, with 80-90% of reimbursement requests being denied. “During my presidential address at the Indian Psychiatric Society conference in Lucknow, a group of mentally ill patients and their caregivers raised this issue and appealed to me to fight for this cause. I forwarded these grievances to the health ministry and am awaiting an appointment,” he said.Psychiatrist Hansal Bhachech from the city said many patients with conditions such as severe depression, anxiety disorders and phobias struggle to get insurance coverage because these illnesses are considered “soft psychiatric illnesses” by the insurers. Most patients or their relatives have to pay out of pocket despite having health cover.“Getting reimbursement for psychiatric illnesses is generally difficult, and there is an urgent need for awareness and clear guidelines. Often, patients are unable to work during their illness, and the financial burden falls on family members. Inclusion under PM-JAY will ensure timely treatment and better outcomes,” he said.A senior state health department official told TOI, on the condition of anonymity, that patients requiring psychiatric care are already covered under PM-JAY at govt-run facilities. “The roadblock of private partnership is primarily about definition and scope. There are no clear guidelines about what to include and how to assess the quality of care for specific treatment,” said the official.Dr Pradeep Vaghasiya, a psychiatrist from the city, said about 25% of psychiatric inpatients in private practice currently have private insurance coverage. “There surely is a need for broader coverage, especially after increased awareness about mental health following the Covid-19 pandemic and a rise in the number of patients seeking care.”
