Time group insurers put heads together on mental health

Sally Rose

By

03/07/2017

SPONSORED ROUNDTABLE | A recent gathering, hosted by Investment Magazine and sponsored by AIA Australia, brought together 14 leaders from the superannuation, group insurance and mental health sectors. The group identified a major opportunity to improve collaboration and information sharing. 

Few experts would argue there is not great benefit, both social and economic, to be gained from supporting early intervention and prevention to combat mental illness.

The group insurance sector, which provides automatic cover to about 8 million working Australians via their default superannuation fund, is uniquely placed to play a pivotal role in making this a reality.

Estimates from the Australian Bureau of Statistics indicate that 3000 lives were lost nationwide through suicide in 2016, more than twice the national road toll. But it is not just severe cases of mental illness that are affecting lives, reported cases of depression and anxiety are also on the rise.

Among Australians, 45 per cent will experience a mental health condition in their lifetime, meaning that, on average, 1 in 5 staff members in a workplace are likely to be experiencing a mental health condition at any given time. Every year, untreated mental health conditions cost Australian employers $10.9 billion in compensation and lost productivity.
Mental Health Australia chief executive Frank Quinlan stressed the urgent need to shift more focus to early intervention and prevention initiatives.

“Across government, across non-government, across workplaces, our focus has been on the crisis end and, slowly but surely, we need to shift it to early intervention and prevention,” Quinlan said.

Mental Health Australia is a peak body for large national organisations working in mental health, including various professional associations representing general practitioners, psychiatrists, psychologists, social workers and nurses, along with some research groups. The organisation’s core purpose is to understand the experiences of its stakeholder organisations and convert that understanding into cohesive and sensible policy advice to government.

AIA Australia & New Zealand chief executive Damien Mu said one of the insurer’s objectives in sponsoring the roundtable was to try to figure out how different players in the group insurance sector might better work together to share “the infinite amount of research and data” that they are all gathering individually.

“If we can collectively get some of our resources together…I feel optimistic that we can continue to make more of a difference, to improve the lives of millions of people,” he said.

A spirit of collaboration

All the roundtable participants agreed that a stronger culture of collaboration between superannuation funds, their group insurance providers, the medical profession and mental health sector advocates could produce a much-needed body of evidence about what works.

“We are all working in a very disparate way, yet there is absolutely a fundamental alignment around our purpose and objective, which is to help people get back to a healthier state of mind and back to a productive lifestyle,” Mu said.

AIA Australia, one of the largest providers of group insurance in the country, has gained valuable insights about which early detection and prevention strategies work for clients participating in its Vitality program. Likewise, the insurer’s rehabilitation program, Restore, has helped it gain a better understanding of how different early intervention measures can help get people back to work.

Quinlan said it would be great to learn from the group insurance sector about how its early intervention and prevention programs work. He said that within the mental health carers’ sector it was considered “a general rule of thumb” that even for people with severe mental illness often only about 20 per cent of their recovery needs are medical.

“Secure housing, employment, social inclusion and intimate relationships – these are the types of things people seek help with,” he said.

Quinlan laments that a lack of big data sets about what types of psychosocial supports work makes it difficult to get the necessary investment from business and government. He said a major problem in assessing the success of different programs is the highly fragmented nature of mental health policy and funding between the states.

Biopsychosocial approach

SuperFriend chief executive Margo Lydon is enthusiastic in her support for the idea of fostering more collaboration between the group insurance and mental health sectors. SuperFriend is an industry-funded non-profit organisation (backed by 23 super funds and seven insurers) dedicated to promoting workplace mental health.

Lydon said that while the Diagnostic and Statistical Manual of Mental Disorders acts as a reference for diagnosing mental health conditions, there is no similar handbook for assessing the efficacy of biopsychosocial treatment options, which are those that focus on a combination of biological, psychological and social factors.

“I think there is a terrific opportunity for the insurance industry to work in partnership with medical and allied health practitioners, and a range of other people with expertise, to build a single source of truth on best practice that every insurer in the country…could access to get the very best and most up-to-date information about treatment options.”

Financial Services Council (FSC) policy manager, life insurance, Jesse Krncevic also saw merit in the push to foster closer ties between the group insurance and mental health sectors.

“I think we’re all aligned, there’s work going on in silos, but it’s smashing those walls down and bringing us all together and actually working towards a common goal,” Krncevic said.

UniSuper insurance and claims manager Amalia Faba said she would like to see better communication channels between the group insurance sector and the medical profession.

Faba highlights the need for a greater role for non-medical responses to people suffering from conditions such as stress and anxiety, while acknowledging that medical responses “obviously play a vital and critical role” for people with severe mental illness.

“As an industry, we rely very heavily on the medical model…and I think we have an opportunity to…take advice about how to use a more social approach and start demanding biopsychosocial recovery pathways for people on claim,” she said.

“I certainly believe there are many people who are misdiagnosed, over-diagnosed, and over-medicated…Disappointingly, mental illness is a very high-claims cause for [UniSuper’s] demographic, so it’s very high on our agenda.”

A priority for funds

First State Super head of insurance Sarina Aarons said mental health is also high on that fund’s list of priorities, given that many of its members work in emergency services and policing, occupations that place people at high risk of experiencing trauma and distress. Meanwhile, the fund is also seeing a distressing rise in claims related to workplace bullying, she said.

Official statistics show young men working in construction are more than twice as likely to die by suicide as their peers in other industries. In response, a decade ago, construction industry super fund Cbus Super began supporting a range of mental health support programs for its members.

Cbus general manager, industry partnerships, Chris Lockwood has oversight for these initiatives, including Mates in Construction, which has been lauded for its success as a peer-to-peer support network.
Lockwood’s advice to funds looking to launch similar initiatives is to empower their industry stakeholders to take a leadership role. SuperFriend recently launched the SuperFit Mates program, which was inspired by the Mates in Construction model.

Commonwealth Superannuation Corporation head of product Matthew Beardmore said a more collaborative approach between super funds could go a long way towards attracting investment and support to scale up early intervention and prevention.

“We’re certainly not going to solve this one by one or individually,” he said.

Beardmore also suggested that super funds flex their collective muscle as investors to put more pressure on ASX-listed companies to demonstrate that they are taking action to foster mentally healthy workplaces.

Listening to claimants

QSuper last year became the first non-profit super fund in Australia to gain a licence to start its own life insurance division, QInsure. The group has looked to best-practice examples from Canada to determine how to engage with its contributing employers to improve mental health outcomes among its members.

“Our program is entirely biopsychosocial,” QSuper general manager insurance Michael Rogers said.

As an example of how that is delivering results, he points to early successes QSuper has had in increasing the number of people on claim for depression who have been helped back to work.

This has been achieved by identifying when a person is on claim because they hate their job, and then providing them with access to an outplacement service to find a new role in which they are happier.

“Of course, the real challenge in implementing that kind of approach is that your claims managers have to become very, very competent,” Rogers said.

National Mental Health Commission chief operating and finance officer Kim Eagle said it’s important to listen to affected individuals about what works for them.

“Bringing consumers and their carers into these conversations is important because then you get good knowledge, advice and experience about what works, what’s effective and how you can get better outcomes.”

Early intervention works

AIA Australia chief group insurance officer Stephanie Phillips said mental health is the third-biggest cause of all claims the group insurer receives.

She supports the idea that the industry needs to shift focus from just paying out claims to getting smarter about early intervention, education and awareness.

“For us, there’s a question of how we effectively better educate individuals and employers and super funds to intervene earlier to stop the condition from getting worse,” she says.

AIA Australia’s Restore program is designed to help claimants get back into society, which may mean going to the gym a few times a week or some other healthy routine, as a precursor to feeling ready to
get back to work.

“We’ve got 50 per cent of [Restore participants] back to work, which is amazing…Some of them have taken 12 to 18 months to get there,” Phillips said. The program is optional for funds, employers and individuals.

Berrill & Watson principal John Berrill, a specialist lawyer and long-time adviser to the Superannuation Complaints Tribunal, argues that the group insurance sector needs to do more to standardise the forms they require claimants to get their medical providers to complete.

Phillips said there is room to improve the claims experience with more standardised language and definitions around the non-competitive areas of group insurance, but that providers need to be able to distinguish themselves to compete.

Berrill said default group insurance is “an amazing” feature of Australia’s superannuation system that should be retained but it also needs reforms to strike the right balance between affordability and adequate coverage.

Don’t stifle innovation

Association of Superannuation Funds of Australia director of policy Fiona Galbraith said it is critical that the new industry guidelines, and any changes to the prudential standards framework, leave enough flexibility in the system so fund trustees don’t face too many barriers to trying new approaches. She said the current regulatory settings around conditions of release need updating to allow innovation.

Krncevic said the FSC has been advocating for some time now for regulatory changes to allow life insurers to introduce a mechanism that will allow them to make special payments targeting early intervention measures.

“There are restrictions in the legislation that don’t allow insurers to provide payments at an earlier stage when they could help people get back to work and enjoy a fruitful life,” he said.

Jane Hume, a Liberal Senator for Victoria, said mental health is high on the government’s agenda for a number of reasons.

“Obviously, the most important [reason] is that a civilised society is defined by its ability to look after those who can’t look after themselves,” Hume said. “But also, on the other side of the ledger, this government is very focused on improving growth and productivity and, of course, the drain on the productivity that mental health in the workplace imposes is, I think, hugely underestimated.”

Hume said “something has to give” or the cost of mental health to the taxpayer is set to “explode”. She encouraged her fellow roundtable participants to pursue their intentions to work towards more information sharing to promote best practice in early intervention and prevention.