Mental health dominates total permanent disability claims

Amanda Lyons

7/10/2019 4:09:54 PM

With the majority of TPD claims made for psychological concerns, GP Dr James Antoniadis sees a major red flag about the state of mental health care.

Dr James Antoniadis
Dr James Antoniadis believes the numbers reflect ‘people’s expectations of mental health and what they’re able to achieve in the form of treatment’.

Advocates have long been concerned about the health insurance industry potentially discriminating against people with psychological problems, despite the fact mental health concerns are on the rise within the Australian population.
New data compiled by the Financial Services Council (FSC) and KPMG Australia around the underlying causes of claims for total and permanent disability (TPD) reflects this rise, finding that mental health conditions are the basis for the majority of claims, at 24.1%.
The statistics also reflect an unusual situation in the insurance industry in that a majority of these claims – 91%, slightly higher than claims for other causes – are paid out. This is in spite of challenges such as the complexity of judging levels of disability or that many Australians delay making claims for mental illness six months longer than for physical causes.
While such high payout rates may sound positive, GP and psychodynamic psychotherapist Dr James Antoniadis is more cautious about the issues that lie behind the numbers.
‘I think it reflects people’s expectations of mental health and what they’re able to achieve in the form of treatment, and needs not being met,’ he told newsGP.
‘These days we consider that ten or 12 sessions of CBT [cognitive behavioural therapy], perhaps repeated a couple of times, and a few courses of medication, is enough, and then beyond that it’s considered failed.
‘That’s a significant indictment of the state of treatment for mental health, that despite the money being thrown at it, people often end up with no real resolution and are being told they’ve got a total and permanent disability, which I think is very sad.’
Dr Antoniadis is particularly concerned about situations in which young people are encouraged to claim for TPD.
‘I think we shouldn’t be giving up on people at that age,’ he said.
‘While it might seem we’re doing them a favour, getting them off the Centrelink merry-go-round, declaring a young person totally and permanently disabled might also be cutting away any motivation they might have to make a life for themselves.’
Dr Antoniadis believes an over-emphasis on ‘organic’ roots for mental disorders – meaning a biological or physical basis that can only be managed by medication – is partly to blame for the increase in TPD payouts.
‘There are a lot of ideas about the organic basis for mental health, serotonin deficiency and so on, which are still doing the rounds, even though there’s no real scientific evidence for them other than the fact that giving an SSRI [selective serotonin reuptake inhibitor] seems to make people improve,’ he said.
‘That has made a lot of people believe that a person with depression, for instance, has a biological problem with serotonin that will be lifelong, organic and not amenable to any sort of permanent resolution.
‘When people get spoken to like that by experts, they can take on a helpless position which causes them to give up on treatment … when in fact it can be a matter of referring people to the right type of therapy.’

The FSC’s latest figures show mental health concerns are the basis of most claims for total and permanent disability insurance.

Dr Antoniaidis is aware this situation can be difficult for GPs, who may feel caught between patients, insurance companies and best practice.
‘Quite often there’s pressure from patients who are in a short-term bind to make solutions which are too long-term,’ he said.
‘And then it becomes self-fulfilling, because those people then go and talk to other people who have similar conditions and say, “Why didn’t your doctor know about this? Your doctor’s obviously not a good doctor. Go and get a TPD claim or a pension”.’
Dr Antoniadis wants to emphasise he is not against TPD claims on the basis of mental health, but would rather like to see improvements to mental health care generally, as well as greater support for patients and GPs, that might lessen the need for such claims.
‘I think it is good that our system is trying to make people’s lives easier with insurance claims,’ he said. ‘All I want is a word of caution that we don’t condemn people to the scrap heap before we’ve really tried all avenues.’
Dr Antoniadis would like to see mental illness treated more like physical health, with a reduction in stigma and a greater emphasis on ongoing care and treatment – and hopefully the same result of a reduction in insurance claims for permanent disability.
‘As we conquer more and more physical conditions, we’ll be left with a mountain of mental health-related problems that will be the last health area of decline. We need to get better at that,’ he said.
‘This is going to be the way of the future. We are going to have to really evaluate how we treat and what we spend our money on for effectiveness, rather than the next quick fix. I don’t think there are quick fixes in mental health.
‘I think mental health is a software problem, and software is much more difficult to treat than the hardware.’
The FSC data also provides a further breakdown of the types of mental health conditions for which TPD is claimed:

  • reaction to severe stress, such as post-traumatic stress – 22.9%
  • depressive episodes – 16.8%
  • recurrent depressive disorders – 13.2%
  • other anxiety disorders – 10.3%
  • bipolar affective disorder – 6.8%
  • schizophrenia – 6.6%
  • use of alcohol – 0.9%
After mental health conditions, the next highest amounts paid out are for TPD claims caused by:
  • musculoskeletal issues – 21.6%
  • accidents – 15.6%
  • nervous system disorders – 13.9%
  • cancer – 8.1%

insurance mental health total and permanent disability

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Dr Paul Laszlo Pers   9/10/2019 5:36:37 AM

I agree with Dr Antoniadis sentiments. It’s a sad indictment if we are using TPD as a way of dealing with “mental health issues”. Many of our patients have multiple life predicaments, rather than mental illness, that do not respond to standard medical treatments or the “talking therapies”. The social identity and social scaffolding approach has much promise as it enables people to recover and cope better with life’s complex challenges. GPs are well positioned to lead in these approaches.