Demonstrators in Beirut hold up signs in support of mental health NGO Embrace's hotline. July 2020. (Credit: João Sousa/L'Orient Today/File photo)
BEIRUT — Amid a mental health crisis in which thousands are thought to need treatment, insurance coverage for depression, anxiety and other conditions is hard to come by in Lebanon, according to a survey by L’Orient Today and interviews with medical experts.
Experts add that this gap could have negative repercussions on productivity, and subsequently the economy.
Despite the obvious need for it, Lebanon is far from achieving mental health parity — that is, equal coverage for mental health and physical health care.
Based on interviews with a dozen insurance companies in Lebanon, L’Orient Today found that fewer than half of them provide mental health coverage — not to mention the thousands of people in Lebanon who either cannot afford healthcare or do not receive insurance through an employer.
According to Dr. Georges Karam, psychiatrist and executive director at mental health non-profit IDRAAC, 25 percent of the Lebanese population suffered from a mental health condition, the top two being anxiety and depression before 2019.
The years since 2019 have seen a worldwide pandemic, an economic crisis of historic proportions, and the Beirut port blast, which killed more than 200 people and destroyed parts of the capital.
“After 2019, the numbers [of mental illness cases] have increased dramatically,” says Karam. The data still need another two to three months before they can be published, and were so unwieldy, Karam explains, that he and his team brought in Harvard researchers to help analyze them.
Non-profit mental health organization Embrace also witnessed an increase in the number of calls to its National Lifeline (1564) — Lebanon’s sole mental health crisis line. According to a 2022 report by Embrace, the organization saw a more than 25 percent increase in calls during that period, nearly a third of them with “suicide ideation present.”
Now it is estimated that nine out of 10 people who need help cannot get it because of limited resources and high prices for treatment and medication.
Mia Atoui, a clinical psychologist and president of Embrace, explained that private psychotherapy can cost $40 to $120 per session in Lebanon. Moreover, the cost of medication ranges between LL1 million to 2 million (that is, between $11 to $22 at the LL90,000 market rate). With more than half of the population now living in poverty, many people cannot afford to continue seeking treatment without insurance coverage or subsidies.
“Some employed people are still getting paid in Lebanese lira; some have reported that a cost [of] LL 300,000 [for a primary health care center consultation] is still too high for them, so financial means constitute a barrier,” said Atoui. She also cited transportation barriers, lack of awareness and social stigma.
A view of the Beirut seaside. (Credit: João Sousa/L'Orient Today/File photo)
On top of that, out of the 294 Health Ministry-run primary care centers in Lebanon, only 50 provide mental healthcare, Atoui added. The Health Ministry did not respond to requests for comment.
Implications for productivity and the economy
There are signs that this problem could be hurting the economy, too. For employees who have a mental disorder that is not treated, research conducted by Dr. Karam and his peers has shown that employers and employees lose on average one month of productivity per year in Lebanon.
Embrace further reported that employees skip workdays because of stress and anxiety more than from physical illness or injuries. Moreover, the non-profit has reported that one in four employees will suffer from a mental health problem at some point during their career.
Some companies in Lebanon have become aware of the problem and are actively working to provide their employees with the resources to take care of their mental health.
One employee at Murex, a financial software company, said the group began providing “collective workshops” for workers after the 2020 Beirut port blast by partnering with NGOs and psychologists.
Though she says she found the workshops, which focused on “anxiety, how to find sleep” and other topics, helpful, “not everyone was comfortable sharing their thoughts in front of others.” The employee requested anonymity because she did not wish to speak publicly on behalf of Murex.
Later on, support turned to more individual mental health coverage.
“Once we changed our insurance package, we included mental health coverage in 2021 for both psychiatrist and psychologist visits,” she explains. She adds that the company also provided a list of known psychologists employees could reach out to.
Still, the majority of employees across the public and private sectors do not receive these types of benefits. Those who can buy health insurance plans or get coverage through their employers remain only a lucky few.
Convincing insurance companies of the problem
According to Karam, when he was secretary of the Lebanese Psychiatric Society from 2012 to 2018, they convinced “15 companies out of 40 insurance companies in the country” to start providing mental health coverage.
“By covering mental health, they [insurance companies] would in fact be saving on costs, by lowering their bills associated with physical health down the line.”
That was in 2015, years before Lebanon’s economic downturn began. “It was a big change,” says Karam.
“However, after the financial collapse in 2019, insurance companies are finding any excuse not to cover anything, so the number of companies providing this type of coverage dropped back down.”
Which companies offer mental health coverage in 2023?
Out of 12 major insurance companies contacted by L’Orient Today, only five (Comin, SNA Lebanon, Arabia Insurance, AXA Middle East, and Bankers) with operating offices in Lebanon reported offering mental health coverage, provided insurees purchase specific products that contain this type of coverage. Two companies declined to participate in the survey.
Lebanon is host to around 40 health insurance companies, according to Dr. Karam.
Mental health coverage differs by type and extent of coverage for insurance companies that do provide it. While Comin and Arabia Insurance reported covering psychotherapy sessions, psychiatrist visits, hospitalization and medication for both individual and group plans, SNA Lebanon reported covering all the above, but only for group (or corporate) medical plans. SNA further mentioned that the coverage can be customized.
Bankers reported only covering ER cases, psychiatric evaluations and medication (provided it is purchased under a separate product or coverage).
For Axa Middle East, coverage differed between individual and group plans upon adding mental health coverage to the policy. While coverage can be added and provided for any mental condition under group policies, coverage for various conditions are only covered under “in-hospital” treatment for individual and family plans.
International insurance companies like BUPA and April Insurance also reportedly provide this type of coverage in Lebanon. These are usually purchased and offered by employers across different industries in Lebanon.
The need to restart the conversation
However, even among the lucky few who have access to mental health coverage, few of them are using it.
Roger Zaccar, a founding Partner at Comin, told L’Orient Today that the company started providing mental health coverage around two years ago, when the economic and political situation took a turn for the worse.
Still, he reported that only a small percentage of people insured actually make use of this coverage, as many don’t know it is included in their insurance policy to begin with.
Arabia Insurance similarly reported to L’Orient Today that a small number of people are utilizing their mental health coverage.
Neither Zaccar nor Arabia Insurance could provide the exact number of clients who utilized their mental health coverage.
Can parity of care still happen someday? Atoui says parity between mental and physical health it is one of the reasons she helped found Embrace. She adds that the NGO offers medication, hospitalization and therapy sessions to those who cannot afford it.
“The burden of mental illnesses is almost the same if not greater than that of physical illnesses,” Atoui tells L’Orient Today.
“We tried to start a project related to parity three years ago by reaching out to insurance companies, but this was put on hold following the economic crisis.”
Now, though, it could be the right time to “restart these conversations.”
If you or someone you know is struggling with mental health, you can call the Embrace National Lifeline anonymously at 1564.