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The financial cost of attempted suicide, depression, and getting better

The cost of getting better.
The cost of getting better.

Canadians who attempt suicide or try to hurt themselves may have to foot their own medical expenses because of the fine print in certain health insurance plans. The ensuing costs could be exorbitant--and not just financial, according to a leading mental-health advocate.

Manulife, Desjardins, SunLife, and Great-West Life are just some of the insurance companies that have clauses in individual and employee health insurance policies that entitle them to reject coverage for medical costs associated with self-inflicted injuries or attempted suicide, according to a recent CBC investigation.

Bill Wilkerson, executive chair of Mental Health International, describes the provision as a “hangover from the distant past”.

“It throws us back into bad old days when suicide was pronounced a crime on the part of the law and a sin on the part of church, and anyone who attempted suicide violated one credo or the other,” says Wilkerson, a former insurance-industry executive who educates employers on the impact of mental illness in the workplace. “We’ve gone way, way, way past that. Suicide is not an act for which there should be blame to anyone especially anyone who survives an attempt because…a first suicide is the greatest risk factor in a second attempt. What you don’t want is an individual having tried but survived it for whatever reason then facing a kind of condemnation from their employer or their insurance company saying they are not eligible for funded health benefits to recover their heath and to get past the likely depression that was the main triggering effect.

“That is, to put it mildly, counterproductive, socially unacceptable, and just downright inconsistent with insurance companies’ modern-day approach to mental health,” he says, noting that for the most part insurers have dramatically reformed their practices over the last decade to support clients and their own employees dealing with mental-health issues.

No one from the Canadian Mental Health Association was available for an interview.

It’s impossible to put a specific price tag on how much treatment for a suicide attempt or injuries from self-harm could cost, given the variables from case to case, but what’s undeniable is that medical expenses could quickly add up.

While psychiatrists’ fees are publicly funded, people in such circumstances would likely require treatment and services of a registered psychologist, fees that are not covered by government insurance but through some employee health benefit plans. Most of those plans have a maximum limit for psychologists’ fees, many around $500 annually. That doesn’t go very far when the charge for a single visit can range anywhere from about $80 to $200 or more, according to Wilkerson.

The Canadian Counselling and Psychotherapy Association, meanwhile, states that prices can range between $60 and $150 per 50-minute session, depending on the type of therapy being used and a person’s geographical location.

Canadians pay $278 million in fees to psychologists and social workers in private practice per year, according to a 2009 report by the Mood Disorders Society of Canada.

In most cases, people have to pay for therapy at the time of their sessions, even if their insurance plan covers the cost, and the benefit plan may only offer partial reimbursement. For many, these expenses are out of reach.

“Psychiatrists have limited availability, and you can’t do psychotherapy every eight months,” Wilkerson says. “The time has certainly come for provinces to look at psychologists as a national extension of the health-care system and cover their fees.”

Another cost facing those who have attempted suicide or self-harm is that for prescription drugs. Costs for anti-psychotic, anti-depressant, and other medications vary greatly, depending on the type, brand, and province. However, Canada is the only developed country with a universal health-care system that does not provide universal coverage of prescription drugs.

Annual spending on antidepressants was $1.4 billion in 2012-13, according to the third edition of the Canadian Rx Atlas, produced by the Centre for Health Services and Policy Research at the University of British Columbia in 2013. The atlas also found that per capita spending for antidepressants taken by women was double that of men. In the 40-64 age group, for example, women spent more than $550 million per year for antidepressants, compared to $270 million spent by men.

Regardless of what type of medications they need, many Canadians can’t afford them, and they compensate by skipping doses, splitting pills, or simply not filling their prescriptions, according to a July 2015 survey by the Angus Reid Institute. Conducted in partnership with Mindset Social Innovation Foundation, it found that more than one in three Canadians said they have friends or family members who have financial difficulty paying for their prescriptions.

In some cases, they can’t afford their medicine because they have no drug coverage, but even patients with insurance can experience financial barriers when they have to cover deductibles and co-payments.

“If you don’t have expenses covered by disability coverage at work, you’re in dire straits,” Wilkerson says, adding that people who do try to kill themselves need a support system that’s going to be in place over the long-term. Sometimes, families have no choice but to take on costs for help like home care or supplemental therapies.

Then there is the emotional toll that suicide attempts take on individuals and families.

“I know of parents who have had to take shifts to be around when the other wasn’t when their son was released from hospital,” Wilkerson says. “It’s very complicated, very demanding, and very debilitating for the whole family.

“You need all hands on deck versus some prior judgmental system that puts a fate of responsibility or blame on the individual for having taken that step in first place,” he adds. “It’s not just about recovery from possible wounds from attempting to take one’s own life but about recovering from the underlying reasons behind the suicide attempt. It’s a complicated, long-term proposition.”