Episode 4 | Mental Health

*** Disclaimer: In this episode we are going to be talking about mental health conditions and in particular suicidal thoughts and attempts. Please be aware that some people may find some of the content upsetting.***

Hi Everyone,

We had a really insightful time at last week’s Cover Mental Health conference. It was great to hear from our peers and new friends, about how we are all taking every step that we can to support people living with mental health conditions.

Kathryn is not one to shy away from saying that she has had generalised anxiety disorder for many years, and experienced agoraphobia a couple of times. She is incredibly passionate about people living with mental health conditions, getting fair access to insurance.

Andrew has been working alongside insurers to determine the best ways to develop current medical underwriting stances, especially the language used, when it comes to mental health. He is currently developing a mental health training programme for advisers, so that they can support their clients fully.

Our 3 key takeaways,

1. 26.8% of 16-24 year olds have had suicidal thoughts.

2. Example Vulnerable Customer policy.

3. Case study client that was able to have life insurance after a suicide attempt, without a permanent suicide or self-harm exclusion.

We always love to hear from you, please do let us know your thoughts of the podcast and if you think that our ramblings are good, bad or simply not your cup of tea.

 

Kathryn: Hi everyone, this is episode four and it’s all about mental health.  I’m Kathryn.

Andrew: And I’m Andrew.  This is the Practical Protection podcast.

Kathryn: Right Andrew, I know you’ve got some really, really important things to be discussing today and whilst we want to keep it obviously serious and not make light of any kind of the topics, we do still have our truth or lie to go through from last – last time that we had an episode.  And I think I’m going to blow your mind away a little bit by the way on the Twitter poll.

Andrew: Oh God.  Go on.

Kathryn: We’ve had our highest number of people voting this time and I’m really happy we got into double figures.  Ten people – 10 people voted as to whether or not – which one of us was telling a truth or lie. So would you like to reveal if you were being truthful or lying please Andrew?

Andrew: So my claim was that I have one piercing and that is a lie.  And unlike you I don’t kind of do half-lies. So I don’t have seven piercings or ten piercings, I have no piercings.  I was out-and-out lying, which I guess means –

Kathryn: I’m being out-and-out truthful.  I have seven tattoos.

Andrew: Wow.

Kathryn: And they’re all in places where none of you will ever see because the only time you would see them is if I was in a bikini and none of you are ever seeing me in a bikini because I would be mortified!  So there we go. We’re all sorted. So today is all about mental health and I’m sure that everybody listening to this is very, very aware that both of us are very passionate about this. I – for anybody who doesn’t really know me too well, I’ve had generalised anxiety disorder since the age of 20 so that’s 14 years ago.  I had two very, very nasty bouts of agoraphobia. It’s interesting to know how many people – so I’ve been looking at some statistics and one of the things is that – that come through with Mind – is that one in four people will experience a mental health condition each year in the UK.  

So one in four people.  So that’s quite a high amount of people.  And then they’ve got a few other statistics which – there was – the first ones I don’t find like massively shocking in a sense.  So it was saying that generalised anxiety disorder, that 5.9 people out of every 100 have it, which, it doesn’t sound like a lot but really when you take this to how many hundreds of people we have in the UK, that is a good amount of people.  Depression was 3.3 people per 100 but the one that really, really stood out for me was suicidal thoughts and that was 20.6 people per 100 people have suicidal thoughts. And I found that really, really quite surprising.  

So I know suicidal thoughts, it’s something that we’re going to chat about later – it’s quite a contentious issue when it comes to say like life insurance applications.  But that’s a pretty significant – that’s a fifth of people that should be saying really, on these applications, that ‘Yeah, I’ve had a suicidal thought.’

Andrew: Yes, yeah and it’s – well I – I think all of that, as you say, that – as someone who knows and loves people with mental health conditions, then those numbers almost instinctively seem low to me.  As with anything, you’re in your bubble and I think probably both of us are in bubbles where we – we would expect, if anything, certainly in those numbers for anxiety and depression to be higher. I still do the school playground test because I’m not imaginative.  And to be clear that on average means that, you know, one parent has depression in every class and a couple, sorry, yeah, and a couple have anxiety and, you know, as with always as with the theme of these being kind and understanding when you’re speaking to those people who – you probably won’t know which one it is, is a key thing.  

The suicidal thoughts I know we’ll come back to so I’ll hold fire on that but I, yeah, I agree.  It’s an amazingly high number.

Kathryn: There’s a thing as well, because I did some mental health first aid training recently with Alan and we did it in York with a person from Mind at York and it was the one that is offered by Mental Health First Aid England and again they have some statistics which I think are something that is really going to come into play a lot more with all the social media and everything else.  All the pressures that young people have at the moment. It’s going to have quite an impact I think when people are starting to go through their insurance. So like the next generation start going for their insurances. With them they had the – obviously 26.8 percent of 16 to 24-year olds have had suicidal thoughts and 18 percent of students between the ages of 12 and 17 have self-harmed.  

So that’s a fifth of teenagers have self-harmed and you kind of think, well at some point there’s going to have to be some kind of reaction to – I know that means also that four fifths haven’t.  Just in case any underwriters are wondering if I don’t realise the other side of it, that there’s going to be four fifths of people who don’t have that. But it is such a significant amount and – and I think we’re seeing more and more that what people are going through and potentially the bullying and the different things and sometimes the glorification of self-harm and things on social media, on TV shows, is kind of – it seems – it’s almost sort of like normalising it in a lot of places.  

And I kind of think that there’s going to be more and more instances where insurers are maybe going to have to be adaptive to – and being more reactive to how long it was or the age that person was when that was happening.

Andrew: Yeah, absolutely.  And I think almost a first check for insurers is to go and check your stats and see how often people are disclosing those things, if you’re asking about them on an application form.  And if, as for most, the numbers are much lower then you – then you have to kind of challenge yourselves as to why that is and is that because – is that because these people are simply not applying to life insurance?  It seems unlikely in the long term. Or is it that people are – I guess interpreting questions in a different way because we can’t possibly mean that or they can’t possibly mean that.  

I think that’s, you know, some of that honesty about the whole process is probably needed to move us forwards in some of this because, yes, as you get older, then those numbers start to decline and in some instances – in some instances – but the rate of disclosure while increasing for mental health is still much lower than any of these kind of independent stats that you get from charities.  And I think being able to explain that or otherwise risk being told at claim stage that ‘Well you knew you weren’t getting honest answers to these questions and you continued to process,’ is frankly, from a risk perspective, why insurers need to treat this seriously.  

There’s lots of other reasons why they need to treat this seriously but from a risk perspective there’s, you know, there’s potentially a big underlying issue here.

Kathryn: Well I want to reflect as well a little bit as well on us having the Mental Health conference with Cover last week.  It was lovely to be on panel with you. It was really, really – it was quite surreal and actually quite anxious for me to come down to London because I was getting – obviously we do have everything with the coronavirus and we’d planned on staying on for two nights.  The night before and the night of Mental Health and then as soon as the session was over, I have to say, we just immediately packed up and headed home because I’ve got three kids. Obviously one of them was with me but the other two were at home. My dad’s ill with Parkinson’s and I just had this awful feeling and anxiety that they were just going to shut the walls and the roads to London.  

So I do apologise that I didn’t stay for the full thing but our session went really well and we’ve had some lovely feedback.  I think some of – there were some really good key takeaways from that and I think one of the big things for me was that everybody there – you know, there was this clear passion and unity to try and be better and support people more and that was really, really lovely to see.

Andrew: Yeah I agree and I think it – it’s a different community.  I mean, don’t get me wrong, I guess the 10 – the 10 people I always sit with at a conference I still sat with at a conference but – going and do the circuit – so it’s lovely to see Johnny and other people.

Kathryn: Yes.

Andrew: But it is just kind of I think – where it becomes really interesting is those different perspectives.  Whether it’s charities, whether it’s some of the other mental health kind of first aider trainers, whether it’s some other, I guess, support services or value add services and things like that.  Looking at the corporate wellbeing side as well, which –

Kathryn: Yeah.

Andrew: Yeah, as you know, I think that’s where you get good ideas from, and not necessarily a clumsy kind of corporate links up with one of those companies but just in the conversations and in the stuff in between.  So I thought it was a really good day. I think personal highlights for me were probably two talks close to our hearts. So Mental Health UK, Sarah from Mental Health UK – they’ve done a really interesting survey of – of people who have applied for life insurance with mental health backgrounds, with mental health disclosures and some really interesting insights coming out of that.  And then almost the other side of the fence was Keith Robertson from the Holloway –

Kathryn: I think you mean Keith Richardson.

Andrew: Yes sorry.  Keith –

Kathryn: That is a joke for the people –

Andrew: Yes.

Kathryn: Who were there.

Andrew: Who just, you know, who I guess embodied the –

Kathryn: He was amazing.

Andrew: He embodied the everyman underwriter, you know, of kind of – he’s been around a bit.  He’s seen a few things and he is that person who sits in the middle of many underwriting teams unheralded, trying to do a good job and finding it quite difficult at times but doing his best to find a way through it.  And I know, from a personal perspective, he shared some of his story on the day –

Kathryn: Yes.

Andrew: But I know within, you know, within Holloway he has been instrumental in kind of pushing that forward.  So it was really, really good to see him have that opportunity and, as I say, just so powerful when you actually get people who really make change, talking and opening up rather than it being, dare I say it, the typical person three levels up who’s kind of been briefed as to what they should say.

Kathryn: Yeah.  He was absolutely – the presentation he did was brilliant.  It was the perfect level of seriousness with comic timing, information and, as you say, the personal aspects of it that he brought to it was just absolutely, you know, it was really, really touching.  And it was really nice because I think we do see it as advisors as well sometimes and I’m not saying this is of Keith, but you know, anything before I’m – but we do sometimes see it with underwriters where they can sometimes seem like these distant, grey kind of walls that aren’t listening to anybody or anything.  Sorry underwriters. But that is kind of what it feels like sometimes. You just feel like a barrier, you know? It’s just kind of like the riot police, you know, kind of coming up.  

It’s the underwriters there with the barriers and the batons going ‘No, no, no.  They’re not going to let you pass,’ kind of thing. And it’s really nice when we do meet an underwriter and you see them there and, as you said before, you know, underwriters are human too – and you are.  You know, it’s nice to see the human behind it and to see that it’s not somebody who is deliberately trying not to cover people. You know, it’s – you know, there is rules that they have to go by but they are also trying really hard to constantly evolve and change things and to – you know, they’re proud of what they – what they’re doing and they want to make it as best as possible.

Andrew: Yeah.  No, absolutely and I think – I mean, so much of that is culture and I think, you know, anyone in any place would – or who’s moved companies a few times would go ‘Well at some places I was more able to be myself than others,’ and I definitely think underwriting is quite an extreme example of that.  There would be places where you go and it’s – you do just have to follow rules and that becomes your job. Some – from an underwriting perspective – a willingness from different companies to try different approaches and to ask different questions and I think, again, an honesty that it’s very unlikely that they will suddenly have come up with the perfect new set of questions for everyone.  And I guess again that’s – that’s to be encouraged albeit that, you know, you want improvement and you want things to get better quickly.  

I think – I think that engagement and that willingness to try and ask different questions which may be more applicable, even for some clients and others or for some advisors to use than others, will become probably an increasing theme in this area, I think, in the next couple of years.

Kathryn: Yeah, I think so.  So, suicidal thoughts.  You’re going to let me loose with this, aren’t you?

Andrew: Go on.

Kathryn: So, I will – like, so for any underwriters or any actuaries or anybody who’s listening, I’m possibly going to say some things that you may not like or may make you wince a little bit.  But there’s reasons, so bear with me. So obviously we chatted a little bit with Sarah Murphy from Mental Health UK and one of the things that I asked her at the event was basically, what is a suicidal thought?  Now this is the thing that is so hard for clients and it’s so hard for advisors and it – you know, it’s – in fairness it may be hard for underwriters too but we don’t know because we don’t really get kind of that – there’s just not that kind of transparency about what a suicidal thought is.  So like I’ve said to quite a few different underwriters, you know, what is a suicidal thought? And I’ve never had a clear answer to be honest.  

So it’s kind of a thing of I have to say to people – and they say ‘Well what is a suicidal thought?’  Well it’s like, well I have to say ‘Well I don’t really know to be honest because is it that, you know, you’ve seen one of shows – like that 13 Reasons Why show, which is all about suicide.’  You’ve watched it and you’ve thought ‘Ooh that’s all about suicide, ooh,’ and then later on you’re thinking about the show. Well hang on a minute, does that mean that you’re thinking about suicide because you’re thinking about a show about suicide?  

Is it that you have been, you know, this has happened to Alan quite a few times when he’s coming back from Kings Cross.  Is it that you’ve been somewhere and your train’s been delayed because unfortunately someone has decided to take their life in that sort of area and you sort of, you know, I know that it’s probably quite natural to think ‘Oh, well I don’t know if I was going to do that I don’t know if I’d do it that way.  I’d probably –’ You know, again, is that a suicidal thought? Is it the point where you’re sort of going ‘Oh well the world would just be better off without me,’ but then there’s different levels of saying that. There’s saying that in the sense of ‘I’m frustrated with the world and, you know, everything’s getting me down and that’s it,’ and then there’s actually it being much, much more of an actual statement.  

And then there’s the people who have had the suicidal thought where they’ve gone ‘Right, I’ve got the – I’ve got the paracetamol, I’ve got my favourite gin.  Friday night, I’m doing it.’ There is such a range there of what a suicidal thought is and the difficulty is – is that it can be such a change as well in what the insurance underwriting will be.  So, you know, especially when it comes to self-harm and the suicide types of things, I know some insurers they class them as the same thing and I have to say, it’s incredibly – as an advisor I find it incredibly insulting sometimes if someone says to me ‘Well I’ve been declined because I’ve self-harmed,’ and stuff like that and it’s insulting for me to have to say to them ‘Well I’m really sorry but it could be – I’m not saying for definite, but it could be that some insurers treat a self-harm as the same as a suicide attempt.’  

That is a huge difference in between those two things.  And I’d – I’ll argue for a while with anybody who would like to argue with me that that is not right at the moment that people are doing that.  But I think there’s – I mean it’s such a huge thing that we can’t possibly cover it all in one podcast, but with the suicidal thoughts, with Sarah Murphy when I asked her, she turned around and said – it’s something I’ve heard – it was from Karen Lloyd as well, basically said “Insurers aren’t the thought police.”  And it’s true. I mean, what – and so can you explain to me, because it would really help me, what is a suicidal thought and why is it that it is so, so important in these applications?

Andrew: I can try and I can, you know, in the spirit of this I can do – do my very best because I recognise all of those issues.  To start at the end, insurers aren’t the thought police but disclosure is important. And because otherwise you risk the claim not being paid and, you know, big and heavy as it sounds, that is what we’re up against here.  And I think a common theme is ‘Well insurers don’t know what I’m thinking,’ and they don’t today but if in – let’s run a scenario forward where in six months’ time you go and – someone goes and seeks help and says ‘I’ve had these thoughts for 12 months,’ i.e. before the application.  ‘I’ve never taken any actions but these thoughts have been going on for 12 months,’ and then another 12 months the worst happens –

Kathryn: Yeah.

Andrew: You commit suicide then, you know, then probably that claim won’t be paid because you – you’ve misrepresented, you’ve lied on your application form.  So I think that’s – that heightens the need to get clarity on what insurers actually mean when they ask this question. And we’ve talked before about the importance of answering questions and not – not doing anything more or less than that.  And I think, almost the insurers’ deal on that is the wording they use must be very carefully considered in order to allow people to do that. And to that extent, I think, you kind of – you go through it logically and say insurers have the opportunity to ask “Have you ever made plans to commit suicide?” or “Have you ever taken physical steps to do that?”  

That’s a question I’m much more comfortable with from both an evidence perspective and a – and a way of measuring the severity.  And I think there are some insurers who have done that but most insurers, you therefore have to conclude, consciously decide to throw the net wider than just that.  

Kathryn: Yeah.

Andrew: Because they’re not asking that.  And they’re certainly not asking ‘Have you seen a doctor or have you had medical support around this?’  Which does then lead us into this, yeah, very grey area as to – I – an acknowledgement that anyone listening to this now is thinking about suicide.

Kathryn: Yeah.

Andrew: So, you know, to all of your examples given, add that one and say, ‘Right, so if you’ve listened to this podcast, you now have to say yes.  You now have to say yes to that application question.’ We can’t possibly mean that. I would say that a well-structured application would then ask other questions that would reveal the lack of severity, should reveal that but as you say, I – I can’t hand on heart say that that does – that that always happens.  And especially in an automated world. So, so I guess long answer coming to a close, it does become back to the exact wording used and I think you do end up having to take some responsibility for – for saying “This is something where you have personally thought about suicide for yourself.” Rather than this kind of – in the more abstract concept.  

I – I think – I think I have heard and I guess the consensus ends up being this mix of saying ‘If you have thought about, you know, how you would do it.’  Or ‘If you have thought about what physical actions you would take.’ I think that seems to be this, where a lot of underwriters would begin to draw the grey line.  But I can’t help but thinking we could and should do better. Bluntly, because otherwise it does just leave –

Kathryn: It’s –

Andrew: So much uncertainty –

Kathryn: It’s so open.  And I think as well, sometimes in some ways – and I know that this probably goes against it, you know, what I’m saying – but you know, we can’t control our thoughts sometimes.  You know, if you are watching something and if you – if you are seeing something, you know, say if you see someone actually, you know, do that, maybe when they step out in front of some kind of public transport or something and you’ve witnessed that.  One, you’re going to obviously mentally – obviously need a lot of support mental health-wise and emotional support – but also I don’t think that you could really – I don’t think you could ever blame someone for kind of going ‘Well I couldn’t ever do that.’  And that would naturally maybe go to ‘Well, if I was going to do it I’d maybe do –’  

You know, and it’s kind of a natural kind of progression I think but I understand though that that’s not easy for either an underwriter or the person or the advisor or the person applying to handle but –

Andrew: Yeah.

Kathryn: I do think that at the moment, like you say, that thing of maybe saying ‘Have you, you know, have your purposefully taken steps, you know, or thought – have you purposefully planned your own, you know, suicide?’ in a sense.  So ‘How were you planning on taking your own life?’ Then that’s different. It’s still the thought. They’ve not necessarily gone through it but it does just feel like it could be – at the moment it does just seem a bit too much of a catch-all.  It kind of feels like it’s deliberately catching as many people as possible.

Andrew: Yeah and the challenge – so there is data that links suicidal ideation.

Kathryn: Yeah.

Andrew: [inaudible] ideation which in essence is the grand word for suicidal thoughts with an increased chance of suicide and that makes sense.

Kathryn: Yes.

Andrew: But it still doesn’t help you understand that when people answer that question, where on the spectrum they were, what had caused those etcetera?  And still, as you say, the – I do think this is one where mental health is different, where – and this kind of ‘throw the net wide’ – you then – you then, even if then the next three questions you ask are very reasonable, because potentially the next question could be, you know, ‘Have you only thought about it when listening to podcasts when waiting for a train?’  You know, you could try and then kind of build it back up from there to become more inclusive but –

Kathryn: Yeah.

Andrew: A) that’s not what people do – that’s not honestly what insurers are doing today.

Kathryn: Yes.

Andrew: And B) it would be a very odd and intrusive way to go about it.  So – so for me, insurers need to look harder to try and change. I think this is one way that you and I need to call out – Kathryn – you’ve – we have tried to engage people on this both publicly –

Kathryn: Yeah.

Andrew: Privately and struggled.

Kathryn: Absolutely.

Andrew: And I think that probably does say that actually people are kind of doing their head in sand a bit on it and going ‘Well it’s not – it’s not right – it’s not perfect but as we can’t think of anything better, we’ll keep leaving it to the advisors and the customer to deal with rather than us.’

Kathryn: Yeah.

Andrew: And that’s not – that’s not right.

Kathryn: I think a big thing would be engaging with charities, I have to say.  You know, I think there’s so many consultations and everything that are done kind of within our industry and I know there’s a lot of stuff going outside to different people as well.  But, you know, really sitting down with, you know, lots of different mental health organisations and saying ‘Right, tell us what we need to do.’ You know, that would really help. And I have to say, I’m going to be – need to do this for fairness as well – is that I have spoken to many underwriters who have been absolutely incredible with mental health and they have sat and they’ve listened and, you know, there’s somewhere – you know, so I say “Look, you know, there’s – this just puts it way out of our acceptance.”  

So it’s just a case of ‘Okay, you know, we’ve tried and thank –’ but they’ve took the time to listen to the person and I have to say that I do have some, you know, really, really incredible conversations with people where they are supportive.

Andrew: Yeah, I think – I guess for me on that Kathryn it’s the theme though of going, you know, overall – and we both acknowledge this right?  I guess anyone who’s trying to move things forward does that in the short-term there are – there are heroes throughout and whether that’s heroic advisors as many at Cura will be on these cases or –

Kathryn: Ah, thank you.

Andrew: Or heroic underwriters but –

Kathryn: Oh yeah, who win awards at the CII – what was it the other day?  Yeah? Yeah, yeah.

Andrew: But that – fundamentally, fundamentally we shouldn’t need heroes in this and so often where these wordings – where question word – I think there’s a – it’s shifting the focus right, from outcomes to actually what’s – how you got there and it would have turned so many people off along the way, either to not complete the application or, you know, or to then not take up the policy because maybe they didn’t quite answer it as they maybe should have and they know that but they don’t want to tell the advisor.  So I think – I think kind of giving ourselves pats on the back either for high acceptance rates or for ‘Oh but there’s this great case where we went extra and did this’ kind of misses the point on this – on this specifically for me.

Kathryn: Yes.

Andrew: But I know you –

Kathryn: No, it does.  No, it should be for everybody but, you know, it’s just for the time being, you know –

Andrew: Yeah.

Kathryn: We’re slowly I think making those changes but another things in regards again to suicide – so it’s slightly different.  So I’m going to just mention one more thing on suicide and then I was going to go on to vulnerable customer policies. Just potentially some tips to give out to other organisations as well.  Not saying that ours is perfect but I put it together so it’s pretty perfect! So the other one is that the thing of ‘Have you tried to commit suicide?’ And there was something that just popped into my head when we were on panel last week and it just sort of stood out for me.  You know, we were saying, you know, we need to ask if people have tried to commit suicide if they want life insurance. And, you know, I imagine that there’s maybe some people who say ‘No, not if it’s after a certain amount of time.’ 

I’m kind of in that thing of thinking ‘Well actually if I was the insurer, I’d want to know that.’  You know, that kind of thing. So I get why they’re asking and I’m not advocating for advisors to start sort of like going out and asking all these additional questions but part of my process, obviously in the specialist way that I do it, is that it’s – there’s a very, very different set – you know, getting somebody – getting an insurer to consider somebody who’s had a suicide attempt is one thing.  But that is just one thing. There’s so much more to the suicide attempt than just that. So, you know, we all know if you say you’ve had a suicide attempt then immediately that application is going to be going for a doctor’s report. There’s no other way about it in a sense at the moment.

And so basically you could put anything else on the rest of it.  Everything else could be absolutely – no, that is going to go for a GP report.  But then the problem is, is that’s not all the information that you need to be able to give your client an accurate quotation and to do your research.  So one of the big things is obviously a trigger. Now this is very, very difficult and a very sensitive thing to bring up with somebody when you’re speaking to them because they may not be in a position to be able to talk about the trigger.  Or they may be – and then you may find it actually triggers something in yourself. It depends on how open they are, whether or not this is something that you’ve experienced yourself or sometimes potentially how detailed they go into the information.  It can be very, very harrowing some of the things that you can hear.  

The other thing is the method of how they tried to harm themselves.  So insurers, as I believe it’s right for me to say that some insurers class suicides in a sense as one thing but then there’s violent suicides that take it all into a completely different ball game when it comes to the underwriting side of things.  I believe, you can obviously correct me if I’m wrong. So it’s very important to know the method. So if somebody has in a sense – if you’ve got somebody who has decided to take some tablets, that’s treated differently than somebody who’s maybe decided to do more of like a physical self-harm.  

What we would class something as violently and obviously not wanting to do anything – kind of trigger anybody who’s listening – but it would somebody who’s maybe tried to hang themselves or possibly cut themselves and tried to commit suicide that way.  Now – so it’s quite hard because I wouldn’t advocate advisors to suddenly start going off and willy-nilly asking this of people and adding that on to the question set when they’re doing these applications but it’s really hard because we still – in these applications, I don’t know what the answer is but we’re only capturing like a third of the information we need.  We need to know the method that they used and the trigger for it before we can actually still know whether or not that client’s going to be able to go forward with that insurer.

Because that insurer may be able to accept somebody who’s had a suicide attempt but then by the time they’ve got the GP report, if it’s been a violent attempt, if the trigger was something that they don’t necessarily think was a significant trigger maybe?  Then that could be that person’s out. You know, and they’ve maybe gone months down the line for a GP report and then you’ve got somebody who, rightly so, has had previous suicide attempts being told that ‘We’re not going to insure you for life insurance,’ which is inherently because you think they’re a higher suicide risk and that could potentially be triggering to that person.

And I know that there’s no answer to it and I’ve no idea what you’re going to take from that Andrew.  I don’t even think there’s anything – I’m just kind of going off on one here.

Andrew: No, no.

Kathryn: And I say, you know, it’s so hard.  For everybody involved it’s so hard.

Andrew: Yeah.  I think – I think the two most – the two most important things for underwriters about – if we’re talking about suicide attempts specifically, are how many suicide attempts a person has had and when the last one was but, as you’ve described there, there are a whole load of other factors that then kick in.  And I mean on those two most important, I think it’s pretty obvious that, yeah, longer ago is better and only one is a lot better than two or more.

Kathryn: Yeah.

Andrew: And then you kind of – then you build the picture around that.  I think – I think all the rest that you said is kind of – encapsulates this challenge that underwriters have in going ‘Well, do I want to – do I want to force the advisor to ask these extra questions when potentially I’m not going to be able to get them cover anyway?’  And depending on the advisor and the relationship and so on then there may be – again, there may – it may be exactly the right person to have that conversation with.

Kathryn: Yeah.

Andrew: Or exactly the wrong person to have that conversation.  But – and I think therefore that’s kind of why you end up with this.  Unlike, frankly, for probably more physical conditions, let’s say diabetes where there’s kind of a ‘Oh well we’ll throw – we’ll ask as many questions as we can think of that could possibly be useful.’  Where lots of insurers would be, to hear where it’s ‘Well we’ll – we’ll stop asking once we’ve got that core information and then we’ll, you know, don’t you worry yourself about it.’

Kathryn: Yeah.

Andrew: And that’s kind of where the group thing’s taken us to and I think it’s – hopefully that gives a, you know, some explanation as to why but what it doesn’t do is help out for – for the many people, whether it’s advisors or applicants, customers, who go ‘Well actually I’m, yeah I’m quite comfortable talking about this.  You know, I’ve got good understanding of it. I’d rather tell you it than, again, than have someone else tell you about it. Obviously you can go and check that.’ But yeah, I think those questions you’ve gone down would be valid and again I guess for insurers almost to produce their own, I guess, best advice questions where there is that good relationship.

Kathryn: Yes.

Andrew: Or good understanding would definitely be helpful.  And I suspect that they’re not really out there at the moment other than in a scrawled-on Post-It note in advisor offices across the land, from some of those more helpful underwriters within teams.

Kathryn: Yeah.  And one of the things I wanted to talk about now is vulnerable client – customer policies.  So just as an idea because I know some people will be listening to this and there will be plenty of advisors who are doing very, very well supporting people with mental health conditions.  But I know there will be some who aren’t massively sure what to do. So we put in a process in Cura and it – actually we got quite a lot of inspiration because we visited RedArc Nurses last summer.  We went over in the summertime, it was lovely. We went into their offices and they had this brilliant system where – I can’t remember the exact reason that they used it for, but they had basically these little red flags on everyone’s desk.  

And if there was a problem they would, you know, they’d wave their little red flag and the others would know to support.  And we thought that this was a brilliant idea so what I did is I built a customer – a vulnerable customer policy kind of system in – within Cura.  And we are very much a technological company so there’s – a lot of it is kind of automated as well but basically everyone at work now has a red flag on their desk.  And there has been incredible warnings if they are used in any way other than what they are intended to be used for. So essentially – what it is, is that anybody – that’s admin, it’s, you know, advisors, it’s managers, it’s anybody – if they are on the phone and they think that a customer is potentially at risk to themself or others, they simply raise their arm with the red flag and wave it.  

We’re in an open-plan office so this works for us.  At this point, everybody who’s not engaged say on the phone immediately stops what they are doing and pays full attention to that employee.  What we would then do is we have an internal messaging system. At that point, managers would immediately – and everyone else needs to monitor as well – we immediately contact that person through the messaging system to find out what’s going on.  Is it that they think that the person is at risk of self-harm, they’re saying that they’re going to harm others, so that we can provide some initial guidance and that person can then be – you know, in a sense we can try and talk to them to say ‘Are you happy to speak to a mental health first aider that we have?  Are we, you know, are you prepared for us to at some point – if you think that there’s a significant situation going on –’  

You can start to progress to sort of like say ‘Do you have somebody nearby?  Do you have a family or friend we can contact for you? Can we potentially contact your GP?’  And in very, very extreme circumstances it would be potentially calling the – sort of like the ambulance services.  So with all that’s happening, there’s also another thing – aspect to that – is that as well as that, anybody who sort of like contacts and has that situation, there’s that kind of like automated systems where the – you know, whoever’s in contact with them can press a button on their computer and it immediately sends – and it sends a message to the managers so that we know to go in to sort of like listen to call recordings, to find out what’s going on, to record everything down so that we can say ‘Right, well this is what’s happening, this is how we’ve followed things up to make sure that that person is getting the support that they need.’

There’s another aspect to it though as well.  So people in our team can also use the red flag if they themselves are struggling.  So if they’ve been on a phone call that has been maybe triggering for themselves, they’ve maybe heard things that are just far, far too upsetting and – or the person that they’ve spoken to has gotten very upset because of the conversation and it’s just been hard for them emotionally to support the person, then again they can raise the red flag.  Again, we all do that thing of stopping and it could just be that they message us all and say ‘I need a cuppa and a cuddle after the end of this phone call.’  

At which point we’re all ready, you know, it will be there ready for them and, you know, we can go – and we’ve also got support systems and follow-up systems for them to have some specific, dedicated support to help them through anything that they’ve – that they’ve experienced.  So I think that’s kind of a – it’s a good way I think, at least as a starting point. And I’m not saying it’s perfect but it’s a good starting point to have in place. You know, have the systems, you know, have the process in place within your internal systems to in a sense flag if you think that somebody is potentially at risk.  And that’s not just a case as well, you know, sort of like people who are maybe, you know, people who are outwardly, you know, sort of like saying to you something that you think that they are at risk of self-harm to themselves or to others.  

It could be that you think that the person is maybe not comprehending what you’re saying properly.  If you think they’re maybe sounding a bit confused. Maybe sort of like more significantly agitated, not following the conversation.  It could be, you know, if somebody even indicates to you that they’re maybe quite an impulsive, compulsive person and that they sort of like get their mind into something and then they just must have it immediately.  It could be that they are maybe sort of more like a compulsive buyer so you need to be careful as well in that kind of a situation. So have that kind of system in place in your internal systems but then have something as well where it’s easy for team members to be able to signal to each other that something isn’t right and that they can then, you know, carry on.  

You can contact them and carry them easily without it maybe being obvious to the person who’s maybe on the other end of the phone or the person who’s also – who is there in person so that they can try and keep that conversation going and keep everything as calm as possible.  But I think they’re sort of like my main tips, initial tips anyway for anybody. Please, if I’ve said anything wrong, anybody from any mental health charity or anything like that listening, please do let me know if you – if anything I’ve said is wrong and I will correct it on a later podcast.

Andrew: Yeah that’s really interesting and I think, just to give it a scale, so last summer I did a survey with Protection Review for a session that you chaired, Kathryn.

Kathryn: Me?

Andrew: And helped promote.  But just – just one – just – let me just kind of find this.  One question and answer specifically on that. So we asked advisors and insurers – but we’re looking at advisors.  We asked advisors ‘In what proportion of cases has the person responsible for communicating a decision around mental health had appropriate training with regards to managing potentially sensitive areas around mental health?’  And for advisors, the answers were Never – 27 percent, Sometimes – 37 percent, Mostly – 27 percent and Always – eight percent. So I know that’s a lot of numbers and a lot of words but –

Kathryn: Yeah.

Andrew: Suffice to say, only in eight percent of advisors would say that someone talking about decision, in this instance around mental health, would the advisor always have had training.  Which kind of feels – I’m trying to find a polite word for it and I – and obviously, much of today has been focused on underwriters and finding the write words but I – I just – I mean –

Kathryn: There’s a responsibility with advisors as well, you know?

Andrew: Yeah.

Kathryn: And we need to make sure the advisors are trained well.

Andrew: There’s a responsibility for the advisors in terms of how that customer feels but – and equally for whoever is running that advice firm that, you know, if you’re paying people, if you’re asking your employees or whatever the set up is to kind of have that call with someone, to potentially go back and, you know, go through the at-a-distance conversations you and I have had today about suicide and suicidal attempts and things like that.

Kathryn: Yeah.

Andrew: But with someone who’s actually got their own story to tell.  I just think it’s – yeah, I mean it’s –

Kathryn: Yeah.

Andrew: It’s bordering on negligence to put someone in that position and, you know, I think you need to be very aware of the potential consequences of doing that.

Kathryn: Yeah.  I agree.  And I would say in – completely agree with that.  I would also say advisors could be supported more with insurers if they didn’t send out decline letters.

Andrew: Yes.

Kathryn: That said ‘You’ve been declined because of your mental health history or previous –’ you know, ‘You’ve been declined because you’ve had cancer.’  It’s just like wow.

Andrew: Yeah.

Kathryn: Slap in the face.  Wow that’s wonderful, thank you.  You know, that just doesn’t help a situation at all and it actually makes it seem – and I know – and I know so many insurers and I know the people there are so lovely but it’s stuff like that.  It’s those letters that don’t help that kind of negative perception that people have where they’re basically – they think of insurers purely as businesses. You either suit them or you don’t and if you don’t suit them then they’re just going to cut their losses with you.

Andrew: Yeah.

Kathryn: So – so I do have a case study about – have you got other stuff that you wanted to chat about?

Andrew: No, let’s – no.  Let’s move on today – just to flag at this point – so I mean it won’t surprise anyone who knows us, to know Kathryn and I – we’ll keep coming back to the theme of mental health and the plan is in future podcasts to do that.  I guess today we’ve ended up focusing on suicide attempts and I think that is a good kind of single subject to talk about. So we’ll do a couple of case studies on that but just to flag, there’s obviously loads of other areas, issues, challenges within mental health as a whole and we will come back to those.  So if you have specific – if you want to sort of direct us towards the next time we come back to this, any questions you have on that broader subject, please do get in touch through the usual ways.

Kathryn: Absolutely.  Yes there is – it’s kind of an endless amount of mental health conditions really, to discuss them.

Andrew: It’s like trying to do a podcast on physical health, right?

Kathryn: Yeah.

Andrew: Or, you know –

Kathryn: Yes, it’s just like a – yeah.  Absolutely.

Andrew: So – but yeah, go on.  Let’s do case – let’s do a couple of case studies.

Kathryn: So, so my case study is one that I’m incredibly proud of and this is one where our team member – so Alan’s executive assistant Victoria, she won the latest Legal & General Hero in the Middle Award for this one.  So basically, they had a woman that had come to us. She had a history of eating disorders, alcoholism that had caused her a bit of liver cirrhosis and the suicide attempts. Now, she’d come to us – and this had been – she’d been teetotal for nine years and she’d been declined before seeing us and we were seeing quite a lot of declines with the insurers that we were approaching as well.  And in all fairness, on the face of it, I’m sure most people have just heard those things that I’ve said and probably thought ‘That’s going to be a difficult one to get, you know, get arranged.’  

And it really, really was but something that Victoria – she took that time to listen to her and to really go through everything and something that just absolutely got Victoria by the heart strings was that basically this woman – her suicide attempt had been because her children had been kidnapped.  Now, I don’t know how I would react if my children were kidnapped. I’m pretty sure – I’m going to say it, I’m pretty sure I’d go batshit crazy, let’s put it that way. You know, I would absolutely flip and I would – I’m the kind of person where I would tear down everybody’s front doors everywhere that I could go to find them.  Well I think that would be my reaction.  

But I’ve – touch wood – I’ve not been anywhere near that situation and I can’t, you know, I can’t possibly rule out that that would be my reaction, you know, it would be – I really don’t know and it isn’t – I can’t even think about it, let’s just put it like that.  I just can’t even think about it. And so it just really got to Victoria and she just basically said – she goes ‘I’m not having this. I’m not having this at all.’ And what we’d ended up finding out was she – so she obviously – she scoured through this lady’s medical reports and everything and she’d found out that basically the liver cirrhosis, that was the thing that was causing the massive issue actually.  And there’d been no follow-up scans to show that her liver had returned to normal. 

So she spoke to the insurers and she basically said ‘Look, the suicide attempt, you tell me that you could say without a shadow of a doubt in an extreme circumstance that you wouldn’t do that.  And also, you tell me that it’s feasible that she would be in that situation again. How about if we –’ And obviously she basically said ‘So with all that to the side and the fact that she’s not had this follow-up on her liver, if we get her to get a follow-up on her liver and it’s all fine, will you look at it?’  And amazingly, yes, an insurer turned round and said ‘You know what, actually, yeah we can’t – you know, in that situation you can’t hold really anyone to account for what they do in many ways.’  

And so we managed – took a few months but we managed to get her to have another CT scan and her liver was normal and so we went from – we went from declines everywhere to 150 percent increase in the life insurance premium.  So that means, again, for anybody who’s not familiar with those kinds of ratings, just in case you don’t have them quite often. It’s if you take the base premium and generally if you take the base premium and times it by 2.5 that will be your 150 percent increase on the monthly premium.  There is things that – with plan fees as well, but we won’t go into that.  

But that is our – sort of like of our most probably recent shining example and I really wanted to – to sort of like get Victoria’s achievement out there with that as well because it was incredible what she – and how obviously she spoke to this lady a lot and she talked through the situations she had been in and Victoria is currently 20 weeks’ pregnant now and just – it absolutely – it floored her and it was – I think there was plenty of times that she had a little cry over that one as well, at just what that woman had been through.  But yes, that’s my case study for it. So even though you may be getting declines everywhere, sometimes – as I’ve said plenty of times before to different people – there is sometimes something hidden in the GP report that can be causing that. And it – don’t always assume that they are absolutely never going to be able to get the cover. Sometimes it just needs a bit more digging.

Andrew: Yeah.  And I’m going to go off piste here briefly.  So I think – so rather than doing a case study, maybe it’s time to talk about extra mortalities and per milles because for suicide and mental health this is where you’ll sometimes find very similar cases get very, very different ratings, very, very different premiums charged sorry, which can be confusing to advisors and end customers.  So just listening as you’re going through that case Kathryn, obviously the first decision any underwriter has to make is, ‘Is it a decline or is it – or can we accept it?’ The second is ‘Well if we’re going to accept it then what’s the right premium to charge?’

And there’s two entirely different ways an underwriter can go about that.  One is the extra mortality which you’ve just very well described Kathryn, which is – in essence kind of adds to that premium that was based on the age of the person.

Kathryn: Yeah.

Andrew: So that’s extra mortality.  Whereas per mille ratings are based on the sum assured and in essence – so the per mille should be applied where the increase in risk is not related to the age of the applicant.

Kathryn: Yeah.

Andrew: So the fact that they are 45 rather than 25 makes no difference.

Kathryn: So your offshore workers would be a really good example of that.

Andrew: Yeah absolutely.  So traditionally, mainly used for occupations and things.  Suicide historically would always have been – suicide attempts would always have been one where you’d say ‘This is independent of age.’  So, you know, it comes back to this, the primary things that go into ratings around recent suicide attempts are when it was and have you only had one?  But, but what you can see kind of is this flip between almost what’s the more important thing? What’s going on here? Are we – are we – is the underwriter mainly assessing the suicide risk or are they assessing the overall depression or anxiety or whatever the mental health disorder is?

It – as I say, it does mean in practice you sometimes get wildly different decisions coming out which I think almost comes as a surprise to an underwriter as much as anything.  Because the underwriters – the underwriter – and this is a problem in modern day underwriting, says Old Man Wibberley, but that you kind of – the underwriter – the last thing they see of the decision is ‘This is seven per mille for five years,’ which means nothing.  None of those numbers are very big but potentially, you know, goes and puts on £140 per month to the premium whereas the plus 100 might put on £10 per month to their premium. So you suddenly get wildly different decisions.

So I think that’s just pretty unique to these kind of case studies and these kind of areas.  As I say, when we talk about occupations they’re all per mille. When we talk most medical conditions, they’re all extra mortality.  But along with the whole issue we have in society around mental health and the focus on it, it is this I guess odd place within underwriting as well where you have that extra bit of confusion.  So probably worth just pulling out and again I’m sure we’ll come up with other examples in future podcasts of some other things like that.

Kathryn: Yeah, and are you going to be testing me on a case study?  Was that – were you – 

Andrew: No I’m not.  I’m going to leave that one.  Looking at what we’ve ended up talking about, I think that’s more at the – I guess more minor end of stuff.

Kathryn: Okay.

Andrew: So I’m going to leave that for a future podcast.

Kathryn: Is that like mental health podcast two?

Andrew: Yeah, I think so.  So I’ll leave that.

Kathryn: Okay.  Well we’re getting towards the end of the podcast.  So one of the things that we both wanted to talk about as well was the whole thing around coronavirus right now.  So there are, I imagine – I think there’s a lot of people with some heightened anxiety at the moment with coronavirus and we are seeing that quite a bit as well at Cura.  So a lot of the time, people are starting to try and contact us about income protection and I think there’s quite a few things about the income protection that need to, sorry, be made clear a little bit.  And it’s – it is horrible as an advisor because people are coming to us and wanting in a sense what’s known more sort of like a continuation of business kind of insurance.  

So they’re basically saying ‘I’m not worried about getting coronavirus, however if, you know, if my work hours reduce, can I get some kind of income protection for me not working as many hours?’  And it’s really hard and you feel horrible because we’re having to say to people ‘Well I’m sorry that’s not what it does. I can give you something that will help you if you get coronavirus,’ but people are so worried about this lack of hours and rightly so.  We’ve had quite a few airline pilots contacting us. We’ve had quite a few medical professionals, so people who may be self-employed but are hired into the NHS. They’re getting quite concerned because obviously for them especially, if there’s any kind of symptoms, they’re being told to self-isolate, potentially for even longer than other people, from what I’m hearing when I’m speaking to people.  Potentially even longer because there’s just that absolute risk of they cannot be anywhere near other people.

So it’s really – it’s just really, really hard at the moment because people are really wanting insurances and it doesn’t feel right, I have to say, to sort of turn round to someone and go ‘Oh, well I’m sorry, that’s not going to, you know, obviously the income protection isn’t going to do what you want it to.  However, you probably do need life insurance. Have you thought about that?’ You know, there isn’t just that natural kind of flow of things and I think it’s really important, as I’m sure that the advisors who are listening to us, I’m sure that the ones that listen to us are actually going to be thinking – doing exactly what needs to be done and really being very, very clear with people as to what it does and doesn’t cover.

There’s also been that very quick reaction by a lot of income protection providers where they are now putting on either full coronavirus exclusions or at least partial ones for the time being, possibly likely to become 4(1)’s, probably imminently in a sense.  I think some people may, not everybody, but I think some people may think that’s quite harsh of them, Andrew. I mean I understand it from a business point of view but can you sort of maybe explain to people from a business point of view why these exclusions right now, while people are kind of en masse wanting the insurances, make sense from business point of – from an insurer point of view?

Andrew: Yeah, it’s frustrating.  I mean, I understand – on the one hand this is the moment for the insurance industry to step forward and say ‘This is what we do, you know, this is exactly what we do.’  And I think people are doing that where there are claims on – for existing policyholders or members in the case of mutuals. The complicating factor there is around self-isolation and kind of the half-way house of some government advice and recognising it’s changing every day but I think – I think every provider that I’ve seen is very clear that if there’s a valid claim for coronavirus on an existing policyholder it will be treated in exactly the same way as an existing claim for any other condition.

Yeah, as you say Kathryn, the – for new policyholders or members there are an increasing number of insurers who are putting exclusions on and that really is just down to the fact that this kind of en masse anti-selection and risk of early lapse after – so risk of someone taking out a policy for 25 years but only having it for one is just too great to ignore.  So I think so far all of the exclusions I’ve seen are quite tightly worded and so everyone would still be able to claim for other medical conditions for example and that kind of thing but frankly this is absolutely a case for advice and a case for speaking to someone who knows what they’re talking about at that moment on that day for your circumstances. And I, you know, that’s not a plug just for you and people like you.  

If there was, you know, if there was to – if there was a case study as to when and why then I think this pretty much must be it.

Kathryn: Yeah.  I was going to say, the guidance in regards to the coronavirus and income protection providers, it’s changing almost I think probably almost every few hours or so.  It’s completely –

Andrew: Yeah, I think, I won’t name check it because it will reveal when we’re recording this but I think another one’s come through in the last sort of half hour and so –

Kathryn: Yeah, I think so.

Andrew: So yeah it is – And it will.  I think the confident thing we can say is it will continue to change.

Kathryn: Yes.

Andrew: But, yeah.

Kathryn: I think as well there’s going to be, from recent things I’m hearing as well, there seems to be – well because it’s not just – previously it was just more sort of the shorter deferred periods so maybe the providers who offer maybe a one day or one week deferment so that is the amount of time you need to wait from being ill and unable to work before the claim kind of kicks in.  And that’s now being extended with some insurers to even include four-week and eight-week options. And some recent kind of chatter that I’m hearing – so not saying for definite but some recent chatter that I’m hearing is that some occupations are now being declined access to the insurances.  

So it is really important for people to just be really reactive and to not obviously get frustrated with any advisors when we’re trying to sort of give advice and for advisors not to get frustrated too much with underwriters.  I’ve said too much, a little bitter maybe. But too much with underwriters because we are in completely unprecedented times and I think everybody is scared and we just – none of us know what’s going to happen. I mean, I don’t think anybody has any idea what’s going to happen to the economy for any country in this world right now and, you know, we’re all going to have to make some kind of adaptations.  And it’s just trying to figure out how we can do it as smoothly as possible.

Andrew: Yeah, and again, I think, I guess sticking – I’m wary of going away from insurance because I’d just become another anxious human being but I think within insurance as well, the other thing to flag is GP reports which wouldn’t just be for income protection, for life, critical illness and which are still obtained on a minority of cases.  It is reasonable to assume that those are going to take longer to get back at the moment given pressures on staff and that no one is going to pretend that getting a GP report back is more important. I would hope that insurers find ways to kind of get around that, you know, and get around that even more than they have already tried to. But I think that’s kind of almost probably in the second wave as we get over this initial – however we ringfence the risk.

Kathryn: Yeah.

Andrew: And then I think, you know, I hope that – sort of in the weeks and dare I say it, in months ahead that insurers can have the time to consider things like that.

Kathryn: Absolutely.  Well everybody, we’re getting towards the end of the show now.  We usually do a truth or lie feature but to be honest with the seriousness of the topic and we knew how much we were probably going to go over time because we both have a lot to say on this, we decided not to do it on this episode.  Just it didn’t feel right. But thank you all for listening and I am thrilled to say that the next episode, if all goes to plan and the coronavirus behaves itself for a little bit longer, we will feature a mystery guest and we really hope that you’ve found this useful.  If you do have any questions or if you want to ask us any more about any stuff like certain things we’ve mentioned in this, please do send us a message.

Andrew: Yeah.  So we’ll be back in two weeks and if you’d like a reminder of the next episode, please do drop us a line.  The plan is to talk about access to insurance as Kathryn’s teased with a special guest from outside the industry.  So yeah, please do drop us a social – a message on social media or visit our website which is www.practical-protection.co.uk.  Thanks very much for listening and speak soon.  Bye.

Kathryn: Thank you everyone, bye.

 

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Episode 4 | Mental Health

*** Disclaimer: In this episode we are going to be talking about mental health conditions and in particular suicidal thoughts and attempts. Please be aware that some people may find some of the content upsetting.***

Hi Everyone,

We had a really insightful time at last week's Cover Mental Health conference. It was great to hear from our peers and new friends, about how we are all taking every step that we can to support people living with mental health conditions.

Kathryn is not one to shy away from saying that she has had generalised anxiety disorder for many years, and experienced agoraphobia a couple of times. She is incredibly passionate about people living with mental health conditions, getting fair access to insurance.

Andrew has been working alongside insurers to determine the best ways to develop current medical underwriting stances, especially the language used, when it comes to mental health. He is currently developing a mental health training programme for advisers, so that they can support their clients fully.

Our 3 key takeaways,

1. 26.8% of 16-24 year olds have had suicidal thoughts.

2. Example Vulnerable Customer policy.

3. Case study client that was able to have life insurance after a suicide attempt, without a permanent suicide or self-harm exclusion.

We always love to hear from you, please do let us know your thoughts of the podcast and if you think that our ramblings are good, bad or simply not your cup of tea.

 

Kathryn: Hi everyone, this is episode four and it’s all about mental health.  I’m Kathryn.

Andrew: And I’m Andrew.  This is the Practical Protection podcast.

Kathryn: Right Andrew, I know you’ve got some really, really important things to be discussing today and whilst we want to keep it obviously serious and not make light of any kind of the topics, we do still have our truth or lie to go through from last – last time that we had an episode.  And I think I’m going to blow your mind away a little bit by the way on the Twitter poll.

Andrew: Oh God.  Go on.

Kathryn: We’ve had our highest number of people voting this time and I’m really happy we got into double figures.  Ten people – 10 people voted as to whether or not – which one of us was telling a truth or lie. So would you like to reveal if you were being truthful or lying please Andrew?

Andrew: So my claim was that I have one piercing and that is a lie.  And unlike you I don’t kind of do half-lies. So I don’t have seven piercings or ten piercings, I have no piercings.  I was out-and-out lying, which I guess means –

Kathryn: I’m being out-and-out truthful.  I have seven tattoos.

Andrew: Wow.

Kathryn: And they’re all in places where none of you will ever see because the only time you would see them is if I was in a bikini and none of you are ever seeing me in a bikini because I would be mortified!  So there we go. We’re all sorted. So today is all about mental health and I’m sure that everybody listening to this is very, very aware that both of us are very passionate about this. I – for anybody who doesn’t really know me too well, I’ve had generalised anxiety disorder since the age of 20 so that’s 14 years ago.  I had two very, very nasty bouts of agoraphobia. It’s interesting to know how many people – so I’ve been looking at some statistics and one of the things is that – that come through with Mind – is that one in four people will experience a mental health condition each year in the UK.  

So one in four people.  So that’s quite a high amount of people.  And then they’ve got a few other statistics which – there was – the first ones I don’t find like massively shocking in a sense.  So it was saying that generalised anxiety disorder, that 5.9 people out of every 100 have it, which, it doesn’t sound like a lot but really when you take this to how many hundreds of people we have in the UK, that is a good amount of people.  Depression was 3.3 people per 100 but the one that really, really stood out for me was suicidal thoughts and that was 20.6 people per 100 people have suicidal thoughts. And I found that really, really quite surprising.  

So I know suicidal thoughts, it’s something that we’re going to chat about later – it’s quite a contentious issue when it comes to say like life insurance applications.  But that’s a pretty significant – that’s a fifth of people that should be saying really, on these applications, that ‘Yeah, I’ve had a suicidal thought.’

Andrew: Yes, yeah and it’s – well I – I think all of that, as you say, that – as someone who knows and loves people with mental health conditions, then those numbers almost instinctively seem low to me.  As with anything, you’re in your bubble and I think probably both of us are in bubbles where we – we would expect, if anything, certainly in those numbers for anxiety and depression to be higher. I still do the school playground test because I’m not imaginative.  And to be clear that on average means that, you know, one parent has depression in every class and a couple, sorry, yeah, and a couple have anxiety and, you know, as with always as with the theme of these being kind and understanding when you’re speaking to those people who – you probably won’t know which one it is, is a key thing.  

The suicidal thoughts I know we’ll come back to so I’ll hold fire on that but I, yeah, I agree.  It’s an amazingly high number.

Kathryn: There’s a thing as well, because I did some mental health first aid training recently with Alan and we did it in York with a person from Mind at York and it was the one that is offered by Mental Health First Aid England and again they have some statistics which I think are something that is really going to come into play a lot more with all the social media and everything else.  All the pressures that young people have at the moment. It’s going to have quite an impact I think when people are starting to go through their insurance. So like the next generation start going for their insurances. With them they had the – obviously 26.8 percent of 16 to 24-year olds have had suicidal thoughts and 18 percent of students between the ages of 12 and 17 have self-harmed.  

So that’s a fifth of teenagers have self-harmed and you kind of think, well at some point there’s going to have to be some kind of reaction to – I know that means also that four fifths haven’t.  Just in case any underwriters are wondering if I don’t realise the other side of it, that there’s going to be four fifths of people who don’t have that. But it is such a significant amount and – and I think we’re seeing more and more that what people are going through and potentially the bullying and the different things and sometimes the glorification of self-harm and things on social media, on TV shows, is kind of – it seems – it’s almost sort of like normalising it in a lot of places.  

And I kind of think that there’s going to be more and more instances where insurers are maybe going to have to be adaptive to – and being more reactive to how long it was or the age that person was when that was happening.

Andrew: Yeah, absolutely.  And I think almost a first check for insurers is to go and check your stats and see how often people are disclosing those things, if you’re asking about them on an application form.  And if, as for most, the numbers are much lower then you – then you have to kind of challenge yourselves as to why that is and is that because – is that because these people are simply not applying to life insurance?  It seems unlikely in the long term. Or is it that people are – I guess interpreting questions in a different way because we can’t possibly mean that or they can’t possibly mean that.  

I think that’s, you know, some of that honesty about the whole process is probably needed to move us forwards in some of this because, yes, as you get older, then those numbers start to decline and in some instances – in some instances – but the rate of disclosure while increasing for mental health is still much lower than any of these kind of independent stats that you get from charities.  And I think being able to explain that or otherwise risk being told at claim stage that ‘Well you knew you weren’t getting honest answers to these questions and you continued to process,’ is frankly, from a risk perspective, why insurers need to treat this seriously.  

There’s lots of other reasons why they need to treat this seriously but from a risk perspective there’s, you know, there’s potentially a big underlying issue here.

Kathryn: Well I want to reflect as well a little bit as well on us having the Mental Health conference with Cover last week.  It was lovely to be on panel with you. It was really, really – it was quite surreal and actually quite anxious for me to come down to London because I was getting – obviously we do have everything with the coronavirus and we’d planned on staying on for two nights.  The night before and the night of Mental Health and then as soon as the session was over, I have to say, we just immediately packed up and headed home because I’ve got three kids. Obviously one of them was with me but the other two were at home. My dad’s ill with Parkinson’s and I just had this awful feeling and anxiety that they were just going to shut the walls and the roads to London.  

So I do apologise that I didn’t stay for the full thing but our session went really well and we’ve had some lovely feedback.  I think some of – there were some really good key takeaways from that and I think one of the big things for me was that everybody there – you know, there was this clear passion and unity to try and be better and support people more and that was really, really lovely to see.

Andrew: Yeah I agree and I think it – it’s a different community.  I mean, don’t get me wrong, I guess the 10 – the 10 people I always sit with at a conference I still sat with at a conference but – going and do the circuit – so it’s lovely to see Johnny and other people.

Kathryn: Yes.

Andrew: But it is just kind of I think – where it becomes really interesting is those different perspectives.  Whether it’s charities, whether it’s some of the other mental health kind of first aider trainers, whether it’s some other, I guess, support services or value add services and things like that.  Looking at the corporate wellbeing side as well, which –

Kathryn: Yeah.

Andrew: Yeah, as you know, I think that’s where you get good ideas from, and not necessarily a clumsy kind of corporate links up with one of those companies but just in the conversations and in the stuff in between.  So I thought it was a really good day. I think personal highlights for me were probably two talks close to our hearts. So Mental Health UK, Sarah from Mental Health UK – they’ve done a really interesting survey of – of people who have applied for life insurance with mental health backgrounds, with mental health disclosures and some really interesting insights coming out of that.  And then almost the other side of the fence was Keith Robertson from the Holloway –

Kathryn: I think you mean Keith Richardson.

Andrew: Yes sorry.  Keith –

Kathryn: That is a joke for the people –

Andrew: Yes.

Kathryn: Who were there.

Andrew: Who just, you know, who I guess embodied the –

Kathryn: He was amazing.

Andrew: He embodied the everyman underwriter, you know, of kind of – he’s been around a bit.  He’s seen a few things and he is that person who sits in the middle of many underwriting teams unheralded, trying to do a good job and finding it quite difficult at times but doing his best to find a way through it.  And I know, from a personal perspective, he shared some of his story on the day –

Kathryn: Yes.

Andrew: But I know within, you know, within Holloway he has been instrumental in kind of pushing that forward.  So it was really, really good to see him have that opportunity and, as I say, just so powerful when you actually get people who really make change, talking and opening up rather than it being, dare I say it, the typical person three levels up who’s kind of been briefed as to what they should say.

Kathryn: Yeah.  He was absolutely – the presentation he did was brilliant.  It was the perfect level of seriousness with comic timing, information and, as you say, the personal aspects of it that he brought to it was just absolutely, you know, it was really, really touching.  And it was really nice because I think we do see it as advisors as well sometimes and I’m not saying this is of Keith, but you know, anything before I’m – but we do sometimes see it with underwriters where they can sometimes seem like these distant, grey kind of walls that aren’t listening to anybody or anything.  Sorry underwriters. But that is kind of what it feels like sometimes. You just feel like a barrier, you know? It’s just kind of like the riot police, you know, kind of coming up.  

It’s the underwriters there with the barriers and the batons going ‘No, no, no.  They’re not going to let you pass,’ kind of thing. And it’s really nice when we do meet an underwriter and you see them there and, as you said before, you know, underwriters are human too – and you are.  You know, it’s nice to see the human behind it and to see that it’s not somebody who is deliberately trying not to cover people. You know, it’s – you know, there is rules that they have to go by but they are also trying really hard to constantly evolve and change things and to – you know, they’re proud of what they – what they’re doing and they want to make it as best as possible.

Andrew: Yeah.  No, absolutely and I think – I mean, so much of that is culture and I think, you know, anyone in any place would – or who’s moved companies a few times would go ‘Well at some places I was more able to be myself than others,’ and I definitely think underwriting is quite an extreme example of that.  There would be places where you go and it’s – you do just have to follow rules and that becomes your job. Some – from an underwriting perspective – a willingness from different companies to try different approaches and to ask different questions and I think, again, an honesty that it’s very unlikely that they will suddenly have come up with the perfect new set of questions for everyone.  And I guess again that’s – that’s to be encouraged albeit that, you know, you want improvement and you want things to get better quickly.  

I think – I think that engagement and that willingness to try and ask different questions which may be more applicable, even for some clients and others or for some advisors to use than others, will become probably an increasing theme in this area, I think, in the next couple of years.

Kathryn: Yeah, I think so.  So, suicidal thoughts.  You’re going to let me loose with this, aren’t you?

Andrew: Go on.

Kathryn: So, I will – like, so for any underwriters or any actuaries or anybody who’s listening, I’m possibly going to say some things that you may not like or may make you wince a little bit.  But there’s reasons, so bear with me. So obviously we chatted a little bit with Sarah Murphy from Mental Health UK and one of the things that I asked her at the event was basically, what is a suicidal thought?  Now this is the thing that is so hard for clients and it’s so hard for advisors and it – you know, it’s – in fairness it may be hard for underwriters too but we don’t know because we don’t really get kind of that – there’s just not that kind of transparency about what a suicidal thought is.  So like I’ve said to quite a few different underwriters, you know, what is a suicidal thought? And I’ve never had a clear answer to be honest.  

So it’s kind of a thing of I have to say to people – and they say ‘Well what is a suicidal thought?’  Well it’s like, well I have to say ‘Well I don’t really know to be honest because is it that, you know, you’ve seen one of shows – like that 13 Reasons Why show, which is all about suicide.’  You’ve watched it and you’ve thought ‘Ooh that’s all about suicide, ooh,’ and then later on you’re thinking about the show. Well hang on a minute, does that mean that you’re thinking about suicide because you’re thinking about a show about suicide?  

Is it that you have been, you know, this has happened to Alan quite a few times when he’s coming back from Kings Cross.  Is it that you’ve been somewhere and your train’s been delayed because unfortunately someone has decided to take their life in that sort of area and you sort of, you know, I know that it’s probably quite natural to think ‘Oh, well I don’t know if I was going to do that I don’t know if I’d do it that way.  I’d probably –’ You know, again, is that a suicidal thought? Is it the point where you’re sort of going ‘Oh well the world would just be better off without me,’ but then there’s different levels of saying that. There’s saying that in the sense of ‘I’m frustrated with the world and, you know, everything’s getting me down and that’s it,’ and then there’s actually it being much, much more of an actual statement.  

And then there’s the people who have had the suicidal thought where they’ve gone ‘Right, I’ve got the – I’ve got the paracetamol, I’ve got my favourite gin.  Friday night, I’m doing it.’ There is such a range there of what a suicidal thought is and the difficulty is – is that it can be such a change as well in what the insurance underwriting will be.  So, you know, especially when it comes to self-harm and the suicide types of things, I know some insurers they class them as the same thing and I have to say, it’s incredibly – as an advisor I find it incredibly insulting sometimes if someone says to me ‘Well I’ve been declined because I’ve self-harmed,’ and stuff like that and it’s insulting for me to have to say to them ‘Well I’m really sorry but it could be – I’m not saying for definite, but it could be that some insurers treat a self-harm as the same as a suicide attempt.’  

That is a huge difference in between those two things.  And I’d – I’ll argue for a while with anybody who would like to argue with me that that is not right at the moment that people are doing that.  But I think there’s – I mean it’s such a huge thing that we can’t possibly cover it all in one podcast, but with the suicidal thoughts, with Sarah Murphy when I asked her, she turned around and said – it’s something I’ve heard – it was from Karen Lloyd as well, basically said “Insurers aren’t the thought police.”  And it’s true. I mean, what – and so can you explain to me, because it would really help me, what is a suicidal thought and why is it that it is so, so important in these applications?

Andrew: I can try and I can, you know, in the spirit of this I can do – do my very best because I recognise all of those issues.  To start at the end, insurers aren’t the thought police but disclosure is important. And because otherwise you risk the claim not being paid and, you know, big and heavy as it sounds, that is what we’re up against here.  And I think a common theme is ‘Well insurers don’t know what I’m thinking,’ and they don’t today but if in – let’s run a scenario forward where in six months’ time you go and – someone goes and seeks help and says ‘I’ve had these thoughts for 12 months,’ i.e. before the application.  ‘I’ve never taken any actions but these thoughts have been going on for 12 months,’ and then another 12 months the worst happens –

Kathryn: Yeah.

Andrew: You commit suicide then, you know, then probably that claim won’t be paid because you – you’ve misrepresented, you’ve lied on your application form.  So I think that’s – that heightens the need to get clarity on what insurers actually mean when they ask this question. And we’ve talked before about the importance of answering questions and not – not doing anything more or less than that.  And I think, almost the insurers’ deal on that is the wording they use must be very carefully considered in order to allow people to do that. And to that extent, I think, you kind of – you go through it logically and say insurers have the opportunity to ask “Have you ever made plans to commit suicide?” or “Have you ever taken physical steps to do that?”  

That’s a question I’m much more comfortable with from both an evidence perspective and a – and a way of measuring the severity.  And I think there are some insurers who have done that but most insurers, you therefore have to conclude, consciously decide to throw the net wider than just that.  

Kathryn: Yeah.

Andrew: Because they’re not asking that.  And they’re certainly not asking ‘Have you seen a doctor or have you had medical support around this?’  Which does then lead us into this, yeah, very grey area as to – I – an acknowledgement that anyone listening to this now is thinking about suicide.

Kathryn: Yeah.

Andrew: So, you know, to all of your examples given, add that one and say, ‘Right, so if you’ve listened to this podcast, you now have to say yes.  You now have to say yes to that application question.’ We can’t possibly mean that. I would say that a well-structured application would then ask other questions that would reveal the lack of severity, should reveal that but as you say, I – I can’t hand on heart say that that does – that that always happens.  And especially in an automated world. So, so I guess long answer coming to a close, it does become back to the exact wording used and I think you do end up having to take some responsibility for – for saying “This is something where you have personally thought about suicide for yourself.” Rather than this kind of – in the more abstract concept.  

I – I think – I think I have heard and I guess the consensus ends up being this mix of saying ‘If you have thought about, you know, how you would do it.’  Or ‘If you have thought about what physical actions you would take.’ I think that seems to be this, where a lot of underwriters would begin to draw the grey line.  But I can’t help but thinking we could and should do better. Bluntly, because otherwise it does just leave –

Kathryn: It’s –

Andrew: So much uncertainty –

Kathryn: It’s so open.  And I think as well, sometimes in some ways – and I know that this probably goes against it, you know, what I’m saying – but you know, we can’t control our thoughts sometimes.  You know, if you are watching something and if you – if you are seeing something, you know, say if you see someone actually, you know, do that, maybe when they step out in front of some kind of public transport or something and you’ve witnessed that.  One, you’re going to obviously mentally – obviously need a lot of support mental health-wise and emotional support – but also I don’t think that you could really – I don’t think you could ever blame someone for kind of going ‘Well I couldn’t ever do that.’  And that would naturally maybe go to ‘Well, if I was going to do it I’d maybe do –’  

You know, and it’s kind of a natural kind of progression I think but I understand though that that’s not easy for either an underwriter or the person or the advisor or the person applying to handle but –

Andrew: Yeah.

Kathryn: I do think that at the moment, like you say, that thing of maybe saying ‘Have you, you know, have your purposefully taken steps, you know, or thought – have you purposefully planned your own, you know, suicide?’ in a sense.  So ‘How were you planning on taking your own life?’ Then that’s different. It’s still the thought. They’ve not necessarily gone through it but it does just feel like it could be – at the moment it does just seem a bit too much of a catch-all.  It kind of feels like it’s deliberately catching as many people as possible.

Andrew: Yeah and the challenge – so there is data that links suicidal ideation.

Kathryn: Yeah.

Andrew: [inaudible] ideation which in essence is the grand word for suicidal thoughts with an increased chance of suicide and that makes sense.

Kathryn: Yes.

Andrew: But it still doesn’t help you understand that when people answer that question, where on the spectrum they were, what had caused those etcetera?  And still, as you say, the – I do think this is one where mental health is different, where – and this kind of ‘throw the net wide’ – you then – you then, even if then the next three questions you ask are very reasonable, because potentially the next question could be, you know, ‘Have you only thought about it when listening to podcasts when waiting for a train?’  You know, you could try and then kind of build it back up from there to become more inclusive but –

Kathryn: Yeah.

Andrew: A) that’s not what people do – that’s not honestly what insurers are doing today.

Kathryn: Yes.

Andrew: And B) it would be a very odd and intrusive way to go about it.  So – so for me, insurers need to look harder to try and change. I think this is one way that you and I need to call out – Kathryn – you’ve – we have tried to engage people on this both publicly –

Kathryn: Yeah.

Andrew: Privately and struggled.

Kathryn: Absolutely.

Andrew: And I think that probably does say that actually people are kind of doing their head in sand a bit on it and going ‘Well it’s not – it’s not right – it’s not perfect but as we can’t think of anything better, we’ll keep leaving it to the advisors and the customer to deal with rather than us.’

Kathryn: Yeah.

Andrew: And that’s not – that’s not right.

Kathryn: I think a big thing would be engaging with charities, I have to say.  You know, I think there’s so many consultations and everything that are done kind of within our industry and I know there’s a lot of stuff going outside to different people as well.  But, you know, really sitting down with, you know, lots of different mental health organisations and saying ‘Right, tell us what we need to do.’ You know, that would really help. And I have to say, I’m going to be – need to do this for fairness as well – is that I have spoken to many underwriters who have been absolutely incredible with mental health and they have sat and they’ve listened and, you know, there’s somewhere – you know, so I say “Look, you know, there’s – this just puts it way out of our acceptance.”  

So it’s just a case of ‘Okay, you know, we’ve tried and thank –’ but they’ve took the time to listen to the person and I have to say that I do have some, you know, really, really incredible conversations with people where they are supportive.

Andrew: Yeah, I think – I guess for me on that Kathryn it’s the theme though of going, you know, overall – and we both acknowledge this right?  I guess anyone who’s trying to move things forward does that in the short-term there are – there are heroes throughout and whether that’s heroic advisors as many at Cura will be on these cases or –

Kathryn: Ah, thank you.

Andrew: Or heroic underwriters but –

Kathryn: Oh yeah, who win awards at the CII – what was it the other day?  Yeah? Yeah, yeah.

Andrew: But that – fundamentally, fundamentally we shouldn’t need heroes in this and so often where these wordings – where question word – I think there’s a – it’s shifting the focus right, from outcomes to actually what’s – how you got there and it would have turned so many people off along the way, either to not complete the application or, you know, or to then not take up the policy because maybe they didn’t quite answer it as they maybe should have and they know that but they don’t want to tell the advisor.  So I think – I think kind of giving ourselves pats on the back either for high acceptance rates or for ‘Oh but there’s this great case where we went extra and did this’ kind of misses the point on this – on this specifically for me.

Kathryn: Yes.

Andrew: But I know you –

Kathryn: No, it does.  No, it should be for everybody but, you know, it’s just for the time being, you know –

Andrew: Yeah.

Kathryn: We’re slowly I think making those changes but another things in regards again to suicide – so it’s slightly different.  So I’m going to just mention one more thing on suicide and then I was going to go on to vulnerable customer policies. Just potentially some tips to give out to other organisations as well.  Not saying that ours is perfect but I put it together so it’s pretty perfect! So the other one is that the thing of ‘Have you tried to commit suicide?’ And there was something that just popped into my head when we were on panel last week and it just sort of stood out for me.  You know, we were saying, you know, we need to ask if people have tried to commit suicide if they want life insurance. And, you know, I imagine that there’s maybe some people who say ‘No, not if it’s after a certain amount of time.’ 

I’m kind of in that thing of thinking ‘Well actually if I was the insurer, I’d want to know that.’  You know, that kind of thing. So I get why they’re asking and I’m not advocating for advisors to start sort of like going out and asking all these additional questions but part of my process, obviously in the specialist way that I do it, is that it’s – there’s a very, very different set – you know, getting somebody – getting an insurer to consider somebody who’s had a suicide attempt is one thing.  But that is just one thing. There’s so much more to the suicide attempt than just that. So, you know, we all know if you say you’ve had a suicide attempt then immediately that application is going to be going for a doctor’s report. There’s no other way about it in a sense at the moment.

And so basically you could put anything else on the rest of it.  Everything else could be absolutely – no, that is going to go for a GP report.  But then the problem is, is that’s not all the information that you need to be able to give your client an accurate quotation and to do your research.  So one of the big things is obviously a trigger. Now this is very, very difficult and a very sensitive thing to bring up with somebody when you’re speaking to them because they may not be in a position to be able to talk about the trigger.  Or they may be – and then you may find it actually triggers something in yourself. It depends on how open they are, whether or not this is something that you’ve experienced yourself or sometimes potentially how detailed they go into the information.  It can be very, very harrowing some of the things that you can hear.  

The other thing is the method of how they tried to harm themselves.  So insurers, as I believe it’s right for me to say that some insurers class suicides in a sense as one thing but then there’s violent suicides that take it all into a completely different ball game when it comes to the underwriting side of things.  I believe, you can obviously correct me if I’m wrong. So it’s very important to know the method. So if somebody has in a sense – if you’ve got somebody who has decided to take some tablets, that’s treated differently than somebody who’s maybe decided to do more of like a physical self-harm.  

What we would class something as violently and obviously not wanting to do anything – kind of trigger anybody who’s listening – but it would somebody who’s maybe tried to hang themselves or possibly cut themselves and tried to commit suicide that way.  Now – so it’s quite hard because I wouldn’t advocate advisors to suddenly start going off and willy-nilly asking this of people and adding that on to the question set when they’re doing these applications but it’s really hard because we still – in these applications, I don’t know what the answer is but we’re only capturing like a third of the information we need.  We need to know the method that they used and the trigger for it before we can actually still know whether or not that client’s going to be able to go forward with that insurer.

Because that insurer may be able to accept somebody who’s had a suicide attempt but then by the time they’ve got the GP report, if it’s been a violent attempt, if the trigger was something that they don’t necessarily think was a significant trigger maybe?  Then that could be that person’s out. You know, and they’ve maybe gone months down the line for a GP report and then you’ve got somebody who, rightly so, has had previous suicide attempts being told that ‘We’re not going to insure you for life insurance,’ which is inherently because you think they’re a higher suicide risk and that could potentially be triggering to that person.

And I know that there’s no answer to it and I’ve no idea what you’re going to take from that Andrew.  I don’t even think there’s anything – I’m just kind of going off on one here.

Andrew: No, no.

Kathryn: And I say, you know, it’s so hard.  For everybody involved it’s so hard.

Andrew: Yeah.  I think – I think the two most – the two most important things for underwriters about – if we’re talking about suicide attempts specifically, are how many suicide attempts a person has had and when the last one was but, as you’ve described there, there are a whole load of other factors that then kick in.  And I mean on those two most important, I think it’s pretty obvious that, yeah, longer ago is better and only one is a lot better than two or more.

Kathryn: Yeah.

Andrew: And then you kind of – then you build the picture around that.  I think – I think all the rest that you said is kind of – encapsulates this challenge that underwriters have in going ‘Well, do I want to – do I want to force the advisor to ask these extra questions when potentially I’m not going to be able to get them cover anyway?’  And depending on the advisor and the relationship and so on then there may be – again, there may – it may be exactly the right person to have that conversation with.

Kathryn: Yeah.

Andrew: Or exactly the wrong person to have that conversation.  But – and I think therefore that’s kind of why you end up with this.  Unlike, frankly, for probably more physical conditions, let’s say diabetes where there’s kind of a ‘Oh well we’ll throw – we’ll ask as many questions as we can think of that could possibly be useful.’  Where lots of insurers would be, to hear where it’s ‘Well we’ll – we’ll stop asking once we’ve got that core information and then we’ll, you know, don’t you worry yourself about it.’

Kathryn: Yeah.

Andrew: And that’s kind of where the group thing’s taken us to and I think it’s – hopefully that gives a, you know, some explanation as to why but what it doesn’t do is help out for – for the many people, whether it’s advisors or applicants, customers, who go ‘Well actually I’m, yeah I’m quite comfortable talking about this.  You know, I’ve got good understanding of it. I’d rather tell you it than, again, than have someone else tell you about it. Obviously you can go and check that.’ But yeah, I think those questions you’ve gone down would be valid and again I guess for insurers almost to produce their own, I guess, best advice questions where there is that good relationship.

Kathryn: Yes.

Andrew: Or good understanding would definitely be helpful.  And I suspect that they’re not really out there at the moment other than in a scrawled-on Post-It note in advisor offices across the land, from some of those more helpful underwriters within teams.

Kathryn: Yeah.  And one of the things I wanted to talk about now is vulnerable client – customer policies.  So just as an idea because I know some people will be listening to this and there will be plenty of advisors who are doing very, very well supporting people with mental health conditions.  But I know there will be some who aren’t massively sure what to do. So we put in a process in Cura and it – actually we got quite a lot of inspiration because we visited RedArc Nurses last summer.  We went over in the summertime, it was lovely. We went into their offices and they had this brilliant system where – I can’t remember the exact reason that they used it for, but they had basically these little red flags on everyone’s desk.  

And if there was a problem they would, you know, they’d wave their little red flag and the others would know to support.  And we thought that this was a brilliant idea so what I did is I built a customer – a vulnerable customer policy kind of system in – within Cura.  And we are very much a technological company so there’s – a lot of it is kind of automated as well but basically everyone at work now has a red flag on their desk.  And there has been incredible warnings if they are used in any way other than what they are intended to be used for. So essentially – what it is, is that anybody – that’s admin, it’s, you know, advisors, it’s managers, it’s anybody – if they are on the phone and they think that a customer is potentially at risk to themself or others, they simply raise their arm with the red flag and wave it.  

We’re in an open-plan office so this works for us.  At this point, everybody who’s not engaged say on the phone immediately stops what they are doing and pays full attention to that employee.  What we would then do is we have an internal messaging system. At that point, managers would immediately – and everyone else needs to monitor as well – we immediately contact that person through the messaging system to find out what’s going on.  Is it that they think that the person is at risk of self-harm, they’re saying that they’re going to harm others, so that we can provide some initial guidance and that person can then be – you know, in a sense we can try and talk to them to say ‘Are you happy to speak to a mental health first aider that we have?  Are we, you know, are you prepared for us to at some point – if you think that there’s a significant situation going on –’  

You can start to progress to sort of like say ‘Do you have somebody nearby?  Do you have a family or friend we can contact for you? Can we potentially contact your GP?’  And in very, very extreme circumstances it would be potentially calling the – sort of like the ambulance services.  So with all that’s happening, there’s also another thing – aspect to that – is that as well as that, anybody who sort of like contacts and has that situation, there’s that kind of like automated systems where the – you know, whoever’s in contact with them can press a button on their computer and it immediately sends – and it sends a message to the managers so that we know to go in to sort of like listen to call recordings, to find out what’s going on, to record everything down so that we can say ‘Right, well this is what’s happening, this is how we’ve followed things up to make sure that that person is getting the support that they need.’

There’s another aspect to it though as well.  So people in our team can also use the red flag if they themselves are struggling.  So if they’ve been on a phone call that has been maybe triggering for themselves, they’ve maybe heard things that are just far, far too upsetting and – or the person that they’ve spoken to has gotten very upset because of the conversation and it’s just been hard for them emotionally to support the person, then again they can raise the red flag.  Again, we all do that thing of stopping and it could just be that they message us all and say ‘I need a cuppa and a cuddle after the end of this phone call.’  

At which point we’re all ready, you know, it will be there ready for them and, you know, we can go – and we’ve also got support systems and follow-up systems for them to have some specific, dedicated support to help them through anything that they’ve – that they’ve experienced.  So I think that’s kind of a – it’s a good way I think, at least as a starting point. And I’m not saying it’s perfect but it’s a good starting point to have in place. You know, have the systems, you know, have the process in place within your internal systems to in a sense flag if you think that somebody is potentially at risk.  And that’s not just a case as well, you know, sort of like people who are maybe, you know, people who are outwardly, you know, sort of like saying to you something that you think that they are at risk of self-harm to themselves or to others.  

It could be that you think that the person is maybe not comprehending what you’re saying properly.  If you think they’re maybe sounding a bit confused. Maybe sort of like more significantly agitated, not following the conversation.  It could be, you know, if somebody even indicates to you that they’re maybe quite an impulsive, compulsive person and that they sort of like get their mind into something and then they just must have it immediately.  It could be that they are maybe sort of more like a compulsive buyer so you need to be careful as well in that kind of a situation. So have that kind of system in place in your internal systems but then have something as well where it’s easy for team members to be able to signal to each other that something isn’t right and that they can then, you know, carry on.  

You can contact them and carry them easily without it maybe being obvious to the person who’s maybe on the other end of the phone or the person who’s also – who is there in person so that they can try and keep that conversation going and keep everything as calm as possible.  But I think they’re sort of like my main tips, initial tips anyway for anybody. Please, if I’ve said anything wrong, anybody from any mental health charity or anything like that listening, please do let me know if you – if anything I’ve said is wrong and I will correct it on a later podcast.

Andrew: Yeah that’s really interesting and I think, just to give it a scale, so last summer I did a survey with Protection Review for a session that you chaired, Kathryn.

Kathryn: Me?

Andrew: And helped promote.  But just – just one – just – let me just kind of find this.  One question and answer specifically on that. So we asked advisors and insurers – but we’re looking at advisors.  We asked advisors ‘In what proportion of cases has the person responsible for communicating a decision around mental health had appropriate training with regards to managing potentially sensitive areas around mental health?’  And for advisors, the answers were Never – 27 percent, Sometimes – 37 percent, Mostly – 27 percent and Always – eight percent. So I know that’s a lot of numbers and a lot of words but –

Kathryn: Yeah.

Andrew: Suffice to say, only in eight percent of advisors would say that someone talking about decision, in this instance around mental health, would the advisor always have had training.  Which kind of feels – I’m trying to find a polite word for it and I – and obviously, much of today has been focused on underwriters and finding the write words but I – I just – I mean –

Kathryn: There’s a responsibility with advisors as well, you know?

Andrew: Yeah.

Kathryn: And we need to make sure the advisors are trained well.

Andrew: There’s a responsibility for the advisors in terms of how that customer feels but – and equally for whoever is running that advice firm that, you know, if you’re paying people, if you’re asking your employees or whatever the set up is to kind of have that call with someone, to potentially go back and, you know, go through the at-a-distance conversations you and I have had today about suicide and suicidal attempts and things like that.

Kathryn: Yeah.

Andrew: But with someone who’s actually got their own story to tell.  I just think it’s – yeah, I mean it’s –

Kathryn: Yeah.

Andrew: It’s bordering on negligence to put someone in that position and, you know, I think you need to be very aware of the potential consequences of doing that.

Kathryn: Yeah.  I agree.  And I would say in – completely agree with that.  I would also say advisors could be supported more with insurers if they didn’t send out decline letters.

Andrew: Yes.

Kathryn: That said ‘You’ve been declined because of your mental health history or previous –’ you know, ‘You’ve been declined because you’ve had cancer.’  It’s just like wow.

Andrew: Yeah.

Kathryn: Slap in the face.  Wow that’s wonderful, thank you.  You know, that just doesn’t help a situation at all and it actually makes it seem – and I know – and I know so many insurers and I know the people there are so lovely but it’s stuff like that.  It’s those letters that don’t help that kind of negative perception that people have where they’re basically – they think of insurers purely as businesses. You either suit them or you don’t and if you don’t suit them then they’re just going to cut their losses with you.

Andrew: Yeah.

Kathryn: So – so I do have a case study about – have you got other stuff that you wanted to chat about?

Andrew: No, let’s – no.  Let’s move on today – just to flag at this point – so I mean it won’t surprise anyone who knows us, to know Kathryn and I – we’ll keep coming back to the theme of mental health and the plan is in future podcasts to do that.  I guess today we’ve ended up focusing on suicide attempts and I think that is a good kind of single subject to talk about. So we’ll do a couple of case studies on that but just to flag, there’s obviously loads of other areas, issues, challenges within mental health as a whole and we will come back to those.  So if you have specific – if you want to sort of direct us towards the next time we come back to this, any questions you have on that broader subject, please do get in touch through the usual ways.

Kathryn: Absolutely.  Yes there is – it’s kind of an endless amount of mental health conditions really, to discuss them.

Andrew: It’s like trying to do a podcast on physical health, right?

Kathryn: Yeah.

Andrew: Or, you know –

Kathryn: Yes, it’s just like a – yeah.  Absolutely.

Andrew: So – but yeah, go on.  Let’s do case – let’s do a couple of case studies.

Kathryn: So, so my case study is one that I’m incredibly proud of and this is one where our team member – so Alan’s executive assistant Victoria, she won the latest Legal & General Hero in the Middle Award for this one.  So basically, they had a woman that had come to us. She had a history of eating disorders, alcoholism that had caused her a bit of liver cirrhosis and the suicide attempts. Now, she’d come to us – and this had been – she’d been teetotal for nine years and she’d been declined before seeing us and we were seeing quite a lot of declines with the insurers that we were approaching as well.  And in all fairness, on the face of it, I’m sure most people have just heard those things that I’ve said and probably thought ‘That’s going to be a difficult one to get, you know, get arranged.’  

And it really, really was but something that Victoria – she took that time to listen to her and to really go through everything and something that just absolutely got Victoria by the heart strings was that basically this woman – her suicide attempt had been because her children had been kidnapped.  Now, I don’t know how I would react if my children were kidnapped. I’m pretty sure – I’m going to say it, I’m pretty sure I’d go batshit crazy, let’s put it that way. You know, I would absolutely flip and I would – I’m the kind of person where I would tear down everybody’s front doors everywhere that I could go to find them.  Well I think that would be my reaction.  

But I’ve – touch wood – I’ve not been anywhere near that situation and I can’t, you know, I can’t possibly rule out that that would be my reaction, you know, it would be – I really don’t know and it isn’t – I can’t even think about it, let’s just put it like that.  I just can’t even think about it. And so it just really got to Victoria and she just basically said – she goes ‘I’m not having this. I’m not having this at all.’ And what we’d ended up finding out was she – so she obviously – she scoured through this lady’s medical reports and everything and she’d found out that basically the liver cirrhosis, that was the thing that was causing the massive issue actually.  And there’d been no follow-up scans to show that her liver had returned to normal. 

So she spoke to the insurers and she basically said ‘Look, the suicide attempt, you tell me that you could say without a shadow of a doubt in an extreme circumstance that you wouldn’t do that.  And also, you tell me that it’s feasible that she would be in that situation again. How about if we –’ And obviously she basically said ‘So with all that to the side and the fact that she’s not had this follow-up on her liver, if we get her to get a follow-up on her liver and it’s all fine, will you look at it?’  And amazingly, yes, an insurer turned round and said ‘You know what, actually, yeah we can’t – you know, in that situation you can’t hold really anyone to account for what they do in many ways.’  

And so we managed – took a few months but we managed to get her to have another CT scan and her liver was normal and so we went from – we went from declines everywhere to 150 percent increase in the life insurance premium.  So that means, again, for anybody who’s not familiar with those kinds of ratings, just in case you don’t have them quite often. It’s if you take the base premium and generally if you take the base premium and times it by 2.5 that will be your 150 percent increase on the monthly premium.  There is things that – with plan fees as well, but we won’t go into that.  

But that is our – sort of like of our most probably recent shining example and I really wanted to – to sort of like get Victoria’s achievement out there with that as well because it was incredible what she – and how obviously she spoke to this lady a lot and she talked through the situations she had been in and Victoria is currently 20 weeks’ pregnant now and just – it absolutely – it floored her and it was – I think there was plenty of times that she had a little cry over that one as well, at just what that woman had been through.  But yes, that’s my case study for it. So even though you may be getting declines everywhere, sometimes – as I’ve said plenty of times before to different people – there is sometimes something hidden in the GP report that can be causing that. And it – don’t always assume that they are absolutely never going to be able to get the cover. Sometimes it just needs a bit more digging.

Andrew: Yeah.  And I’m going to go off piste here briefly.  So I think – so rather than doing a case study, maybe it’s time to talk about extra mortalities and per milles because for suicide and mental health this is where you’ll sometimes find very similar cases get very, very different ratings, very, very different premiums charged sorry, which can be confusing to advisors and end customers.  So just listening as you’re going through that case Kathryn, obviously the first decision any underwriter has to make is, ‘Is it a decline or is it – or can we accept it?’ The second is ‘Well if we’re going to accept it then what’s the right premium to charge?’

And there’s two entirely different ways an underwriter can go about that.  One is the extra mortality which you’ve just very well described Kathryn, which is – in essence kind of adds to that premium that was based on the age of the person.

Kathryn: Yeah.

Andrew: So that’s extra mortality.  Whereas per mille ratings are based on the sum assured and in essence – so the per mille should be applied where the increase in risk is not related to the age of the applicant.

Kathryn: Yeah.

Andrew: So the fact that they are 45 rather than 25 makes no difference.

Kathryn: So your offshore workers would be a really good example of that.

Andrew: Yeah absolutely.  So traditionally, mainly used for occupations and things.  Suicide historically would always have been – suicide attempts would always have been one where you’d say ‘This is independent of age.’  So, you know, it comes back to this, the primary things that go into ratings around recent suicide attempts are when it was and have you only had one?  But, but what you can see kind of is this flip between almost what’s the more important thing? What’s going on here? Are we – are we – is the underwriter mainly assessing the suicide risk or are they assessing the overall depression or anxiety or whatever the mental health disorder is?

It – as I say, it does mean in practice you sometimes get wildly different decisions coming out which I think almost comes as a surprise to an underwriter as much as anything.  Because the underwriters – the underwriter – and this is a problem in modern day underwriting, says Old Man Wibberley, but that you kind of – the underwriter – the last thing they see of the decision is ‘This is seven per mille for five years,’ which means nothing.  None of those numbers are very big but potentially, you know, goes and puts on £140 per month to the premium whereas the plus 100 might put on £10 per month to their premium. So you suddenly get wildly different decisions.

So I think that’s just pretty unique to these kind of case studies and these kind of areas.  As I say, when we talk about occupations they’re all per mille. When we talk most medical conditions, they’re all extra mortality.  But along with the whole issue we have in society around mental health and the focus on it, it is this I guess odd place within underwriting as well where you have that extra bit of confusion.  So probably worth just pulling out and again I’m sure we’ll come up with other examples in future podcasts of some other things like that.

Kathryn: Yeah, and are you going to be testing me on a case study?  Was that – were you – 

Andrew: No I’m not.  I’m going to leave that one.  Looking at what we’ve ended up talking about, I think that’s more at the – I guess more minor end of stuff.

Kathryn: Okay.

Andrew: So I’m going to leave that for a future podcast.

Kathryn: Is that like mental health podcast two?

Andrew: Yeah, I think so.  So I’ll leave that.

Kathryn: Okay.  Well we’re getting towards the end of the podcast.  So one of the things that we both wanted to talk about as well was the whole thing around coronavirus right now.  So there are, I imagine – I think there’s a lot of people with some heightened anxiety at the moment with coronavirus and we are seeing that quite a bit as well at Cura.  So a lot of the time, people are starting to try and contact us about income protection and I think there’s quite a few things about the income protection that need to, sorry, be made clear a little bit.  And it’s – it is horrible as an advisor because people are coming to us and wanting in a sense what’s known more sort of like a continuation of business kind of insurance.  

So they’re basically saying ‘I’m not worried about getting coronavirus, however if, you know, if my work hours reduce, can I get some kind of income protection for me not working as many hours?’  And it’s really hard and you feel horrible because we’re having to say to people ‘Well I’m sorry that’s not what it does. I can give you something that will help you if you get coronavirus,’ but people are so worried about this lack of hours and rightly so.  We’ve had quite a few airline pilots contacting us. We’ve had quite a few medical professionals, so people who may be self-employed but are hired into the NHS. They’re getting quite concerned because obviously for them especially, if there’s any kind of symptoms, they’re being told to self-isolate, potentially for even longer than other people, from what I’m hearing when I’m speaking to people.  Potentially even longer because there’s just that absolute risk of they cannot be anywhere near other people.

So it’s really – it’s just really, really hard at the moment because people are really wanting insurances and it doesn’t feel right, I have to say, to sort of turn round to someone and go ‘Oh, well I’m sorry, that’s not going to, you know, obviously the income protection isn’t going to do what you want it to.  However, you probably do need life insurance. Have you thought about that?’ You know, there isn’t just that natural kind of flow of things and I think it’s really important, as I’m sure that the advisors who are listening to us, I’m sure that the ones that listen to us are actually going to be thinking – doing exactly what needs to be done and really being very, very clear with people as to what it does and doesn’t cover.

There’s also been that very quick reaction by a lot of income protection providers where they are now putting on either full coronavirus exclusions or at least partial ones for the time being, possibly likely to become 4(1)’s, probably imminently in a sense.  I think some people may, not everybody, but I think some people may think that’s quite harsh of them, Andrew. I mean I understand it from a business point of view but can you sort of maybe explain to people from a business point of view why these exclusions right now, while people are kind of en masse wanting the insurances, make sense from business point of – from an insurer point of view?

Andrew: Yeah, it’s frustrating.  I mean, I understand – on the one hand this is the moment for the insurance industry to step forward and say ‘This is what we do, you know, this is exactly what we do.’  And I think people are doing that where there are claims on – for existing policyholders or members in the case of mutuals. The complicating factor there is around self-isolation and kind of the half-way house of some government advice and recognising it’s changing every day but I think – I think every provider that I’ve seen is very clear that if there’s a valid claim for coronavirus on an existing policyholder it will be treated in exactly the same way as an existing claim for any other condition.

Yeah, as you say Kathryn, the – for new policyholders or members there are an increasing number of insurers who are putting exclusions on and that really is just down to the fact that this kind of en masse anti-selection and risk of early lapse after – so risk of someone taking out a policy for 25 years but only having it for one is just too great to ignore.  So I think so far all of the exclusions I’ve seen are quite tightly worded and so everyone would still be able to claim for other medical conditions for example and that kind of thing but frankly this is absolutely a case for advice and a case for speaking to someone who knows what they’re talking about at that moment on that day for your circumstances. And I, you know, that’s not a plug just for you and people like you.  

If there was, you know, if there was to – if there was a case study as to when and why then I think this pretty much must be it.

Kathryn: Yeah.  I was going to say, the guidance in regards to the coronavirus and income protection providers, it’s changing almost I think probably almost every few hours or so.  It’s completely –

Andrew: Yeah, I think, I won’t name check it because it will reveal when we’re recording this but I think another one’s come through in the last sort of half hour and so –

Kathryn: Yeah, I think so.

Andrew: So yeah it is – And it will.  I think the confident thing we can say is it will continue to change.

Kathryn: Yes.

Andrew: But, yeah.

Kathryn: I think as well there’s going to be, from recent things I’m hearing as well, there seems to be – well because it’s not just – previously it was just more sort of the shorter deferred periods so maybe the providers who offer maybe a one day or one week deferment so that is the amount of time you need to wait from being ill and unable to work before the claim kind of kicks in.  And that’s now being extended with some insurers to even include four-week and eight-week options. And some recent kind of chatter that I’m hearing – so not saying for definite but some recent chatter that I’m hearing is that some occupations are now being declined access to the insurances.  

So it is really important for people to just be really reactive and to not obviously get frustrated with any advisors when we’re trying to sort of give advice and for advisors not to get frustrated too much with underwriters.  I’ve said too much, a little bitter maybe. But too much with underwriters because we are in completely unprecedented times and I think everybody is scared and we just – none of us know what’s going to happen. I mean, I don’t think anybody has any idea what’s going to happen to the economy for any country in this world right now and, you know, we’re all going to have to make some kind of adaptations.  And it’s just trying to figure out how we can do it as smoothly as possible.

Andrew: Yeah, and again, I think, I guess sticking – I’m wary of going away from insurance because I’d just become another anxious human being but I think within insurance as well, the other thing to flag is GP reports which wouldn’t just be for income protection, for life, critical illness and which are still obtained on a minority of cases.  It is reasonable to assume that those are going to take longer to get back at the moment given pressures on staff and that no one is going to pretend that getting a GP report back is more important. I would hope that insurers find ways to kind of get around that, you know, and get around that even more than they have already tried to. But I think that’s kind of almost probably in the second wave as we get over this initial – however we ringfence the risk.

Kathryn: Yeah.

Andrew: And then I think, you know, I hope that – sort of in the weeks and dare I say it, in months ahead that insurers can have the time to consider things like that.

Kathryn: Absolutely.  Well everybody, we’re getting towards the end of the show now.  We usually do a truth or lie feature but to be honest with the seriousness of the topic and we knew how much we were probably going to go over time because we both have a lot to say on this, we decided not to do it on this episode.  Just it didn’t feel right. But thank you all for listening and I am thrilled to say that the next episode, if all goes to plan and the coronavirus behaves itself for a little bit longer, we will feature a mystery guest and we really hope that you’ve found this useful.  If you do have any questions or if you want to ask us any more about any stuff like certain things we’ve mentioned in this, please do send us a message.

Andrew: Yeah.  So we’ll be back in two weeks and if you’d like a reminder of the next episode, please do drop us a line.  The plan is to talk about access to insurance as Kathryn’s teased with a special guest from outside the industry.  So yeah, please do drop us a social – a message on social media or visit our website which is www.practical-protection.co.uk.  Thanks very much for listening and speak soon.  Bye.

Kathryn: Thank you everyone, bye.

 

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