Psychiatrists: insurance lack in UAE 'problematic and unethical'

Doctors say the quality of treatment available to patients with mental illness is suffering because of a lack of insurance cover.

Psychiatrists say the quality of treatment available to patients with mental illness is suffering because of a lack of insurance cover.

Most local insurance companies do not include psychiatry in their health plans for expatriates, which means patients are not even covered for medical tests that are an important precursor to psychiatric treatment.

For some patients, the problem is severe enough that they feign symptoms of an emergency in order to qualify for free treatment.

Dr Yousef Abouallaban, the medical director at the American Center for Psychiatry and Neurology in Abu Dhabi, described the insurance shortfall as "absolutely unethical" and detrimental to the profession.

Dr Abouallaban said the insurance gap was causing psychiatrists to "suffer enormously to be able to practise really good medicine".

He noted that standard practice in psychiatry was to do a full physical examination of the patient, including blood tests, to rule out any medical issues that might be causing the psychiatric condition. Vitamin D deficiency, thyroid abnormalities and pancreatic cancer are some of the medical conditions that can cause depression, he said.

"Psychiatrists are physicians like any other physicians, but it's cumbersome to do the assessments," he said.

As patients cannot always afford to pay for the tests, he has to take the extra step of sending them back to their primary doctor, who can request blood tests and do the checks on his behalf.

Dr Faisal Al Nowais, a psychiatrist at Sheikh Khalifa Medical City in Abu Dhabi, said "no health insurance companies are comfortable covering psychotherapy".

He said he often has to explain why he is doing certain tests and that his requests for them to be covered are "constantly rejected".

"Even though these are standardised tests we have to do, we are constantly fighting with the insurance companies," Dr Al Nowais said, adding that some patients needed weekly tests.

He said if a test or assessment is not covered, the cost comes out of the hospital's budget.

"Our job is not just to be a mental health facility, but to pave the way to make insurance companies aware of what is important," Dr Al Nowais said.

Treatment for mental illnesses is covered by the national health scheme for Emiratis, Thiqa.

Psychiatric treatment is not covered in the general plans of most private health insurance companies, including Alliance Insurance, AXA Gulf and Green Crescent, but can be added at an extra cost.

Daman, which manages Thiqa, only covers it in its Premier Plan.

According to Dr Sven Rohte, Daman's chief commercial officer, emergency psychiatric treatments that require hospitalisation are covered in all their plans, "as they are considered emergency cases".

"An example would be an acute stress attack," he said.

An 18-year-old student at New York University Abu Dhabi who did not wish to be named said she had regularly feigned acute stress attacks to qualify for free therapy sessions and proper medication.

The student, who suffers from depression and borderline personality disorder, said her therapist told her she had to "prove it is an emergency" to have the cost of her weekly treatment covered.

"I had to convince them that I was suicidal and act really depressed," she said.

Her younger sister was diagnosed with the same condition and has been told to do the same thing.

"Shortcuts are sometimes necessary," Dr Al Nowais said. "She's not feigning a panic attack to get high, but to get medicine she needs. More power to her."

Dr Al Nowais said the lack of proper insurance cover was not just a risk for patients, but also for society. "These patients will go out in public, and if they're not properly treated, you never know what they might do."