*** 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, today Matt Rann is joining the episode and we are talking about mental health. With everything that is going on in the world with the coronavirus pandemic, mental health is something that is affecting many people, including both children and adults.
We are chatting about how mental health is underwritten for things like life insurance, how the insurance sector is currently responding to mental health and our thoughts on how insurance offerings could be improved.
The key takeaways:
- Statistics regarding mental health during the coronavirus lockdown.
- Debate over the classification of mental health symptoms.
- A case study of arranging life insurance and income protection for someone living with Bipolar.
Next time, Roy McLoughlin will be back hosting with me and we will be chatting to Andrew Montlake.
Remember, if you are listening to this as part of your work, you can claim a CPD certificate on this website.
Kathryn: Hi everyone, this is episode three of season three and I have Matt Rann with me. Hi Matt!
Matt: Hi Kathryn.
Kathryn: Today on this episode we’re going to be focusing on mental health. We’re going to be chatting about mental health underwriting, how the current insurance market is working and what we could maybe be doing to offer insurance to more people. So this is the Practical Protection podcast.
Matt: How’s it going?
Kathryn: Everything is going very, very well thank you. I think last week was an absolute shocker of a week so this week can only be brighter and better. How’s everything for you?
Matt: Yeah it’s good. I think like everybody – well in the world, let’s be honest about it, it’s not just the dear old UK, is suffering in one way or the other but it gives me a chance to do other things. So the things that if life was more normal I just wouldn’t get around to doing. So positive all round, thank you very much.
Kathryn: Absolutely, lots of positives. So what I wanted to do first of all is just give a little bit of a background on some recent statistics and things that have been popping up when I’ve been looking at things in regards to mental health and I think it’s quite clear to many people that mental health is a massive topic. It has been for the last few years but I think it’s really, really – even in this last year or so, even more so because, you know, we’re talking so much about our children’s mental health with everything that’s going on – in a sense, everybody’s mental health because we’re in a situation that is very, very unique. Hopefully, touch wood, it will be over at some point this year and something that we don’t necessarily have to go obviously through again.
But it’s interesting because I was looking on the Rethink Mental Illness website and in that they have the statistic which I think has been quite standard for a while now that about one in four people will experience a mental health condition each year within the UK. Something that surprised me a little bit though was – ‘cos I was looking at the different conditions and I’ve had a look before into general suicide rates and depression rates.
Matt: Yeah, yeah.
Kathryn: But one thing that surprised me actually was that schizophrenia was one in every 100 people and, yeah, I was going to say, that shocked me ‘cos I kind of think of it as a mental health condition but I don’t think of it as one that – I mean to me, one in every 100 people actually seems like quite a lot of people actually when you think of the population in the UK but another thing that kind of led on from that, that I was again sort of looking through the website and the different information was that they were saying that sort like there was some recent conversations as well about suicide rates that have been increasing during lockdown. And I think something that’s really unfortunate and I got caught out by it actually on social media, there was a post that went out probably the middle of last year that said basically there’s evidence to say that suicide rates have significantly increased because of this lockdown and different things and so I retweeted it and, you know, I was obviously trying to give support to say, you know, we need to try and make sure that people are speaking to people, that they have avenues to chat to.
Matt: Absolutely, yeah.
Kathryn: But the problem was actually that that post – and I actually ended up having to warn other people as well ‘cos I was warned – it had actually been written by anti-lockdowners and so you then had a lot of mental health charities and the people that they’d sort of like said they’d got the statistics from then having to do disclaimers to say, “These statistics aren’t from us. There’s no evidence of this at the moment. Please stop sharing this information,” which was obviously such an incredibly sad thing to see, you know, that there was such an important connotation to it. It had kind of been hijacked for a reason that really shouldn’t ever be played about with. But I think – so I did a little bit more looking into it and there was actually a recent publication by the British Medical Journal and it showed that suicidal thoughts have actually increased within the younger generations sort of like recently so it was just about – just over 14% of 18 to 29-year olds had felt suicidal in their response group and 26% of the people had felt moderate to severe depression and I know that that’s sort of one sample group that they have but what was interesting was that if you then kind of combine that or at least – not necessarily combine it, I’m not going to sort of pretend how to combine this kind of data or anything like that.
Matt: No, no, no. No, fire away, fire away.
Kathryn: But yeah, with the Samaritans, they had done a study and they showed that the Samaritans – in the first six months of social distancing, they’d experienced 1.2 million calls for support and one in four of those were experiencing suicidal thoughts or behaviours. So if you look at it, that’s 300,000 people in the first six months alone just going to the Samaritans, not going to other groups, that were having suicidal thoughts or behaviours. Now obviously that’s an incredibly – to me that’s an incredibly shocking amount of people in the sense of, you know, this is something that really does need to be addressed, you know, we need to be aware of this but when we sort of take that back to the insurance side of things, you know, and sort of like seeing those younger generations who’ve had, you know, the suicidal thoughts and moderate or severe depression, there’s a massive sort of like want in our industry to sort of like get millennials to get insurance, to want to have insurance, to want to engage and we’re showing there that potentially a quarter of that group have had moderate to severe depression recently.
You know, 14% have had suicidal thoughts or behaviours and then you’ve got 300,000 people purely within the first six months of lockdown solely going to the Samaritans, having suicidal thoughts or behaviours and I think that that’s just a massive amount of people who are potentially going to be wanting to get insurance at some point that we’re going to have to say, “Right okay, how do we engage people in the best way possible and make sure that they get the best terms?” And I know that’s kind of like leaving sort of like a really open debate there Matt, but what’s kind of your thoughts on all of that?
Matt: My first thought is it’s an extremely sad set of data that you’ve been talking about there Kathryn. We are going through some pretty bad times to say the least. I think in terms of where I would come from with my speciality, which obviously is the underwriting insurance side, I think that the classifications – I think we’ll go onto my concerns about classifications of mental health issues, but underwriting generally, based on medical – some medical data is that people who have a reaction that could be classed as a mental health issue to a given situation come out of the – generally speaking I would have to say, this is not to belittle the situation that people find themselves in whatsoever, it’s very, very important but people who have a reaction to a given situation like lockdown and everything that goes with lockdown come out of the other side with good mental health.
Matt: And therefore from an insurance perspective, a one-off reaction to an extreme situation like lockdown and let’s be honest, it is an extreme situation particularly for youngsters I think, then there should be no repercussions for life insurance. I’ll probably leave it at that because I think when we get into suicidal thoughts or suicidal ideation, whether those ever get disclosed or not is another point.
Kathryn: Yeah I think that’s – it’s a really interesting point as well. It’s something that I’ve discussed before, I think, you know, on potentially some panels that I’ve been on.
Matt: Sure, sure.
Kathryn: Is that kind of thing of like what is a suicidal thought and I have had –
Kathryn: You know, other people have said and I do get them, they kind of say, you know, “Insurers aren’t the thought police,” and I know that’s really hard but it’s kind of like well, what is a suicidal thought? Where do you classify it? So, you know, is it a case ‘cos people individually will classify it differently, you know?
Kathryn: Is a suicidal thought, you know, sort of like, I don’t know, being stood at a train station and having remembered that somebody has maybe – or on a film or something, somebody had decided to obviously hurt themselves by, you know, jumping in front of a train. Is that – you’re stood there thinking, “Ooh, I couldn’t do that,” you know. Is that a suicidal thought because you’ve thought about it, you are thinking about suicide, you’re thinking about whether or not you could do it. You’ve decided no but some people may even class that as a suicidal thought and it’s kind of like well, is that fair because in some ways that’s just people processing information that they’ve been, you know, we’re so bombarded with different information. The amount of Netflix series and different shows now that talk about this, it’s quite hard not to think about it or to see it and think, “Ooh I couldn’t do it that way, or if I was going to do it that way, it wouldn’t be that way.”
Or to even know of people who’ve done it and think about potentially sometimes, you know, potentially really sort of like think about what emotional state they must have been in to try and sort of like think, “Wow, could I have been in that emotional state at some point? If I had something where I would have maybe, you know, could I have done something to help them?” You know, and trying to like really empathise with that person and try and understand what they’ve been through.
Or is it more sort of a case of, “Right, you know, Friday night, that’s it, I’ve got these things ready, that’s how I’m going to do it. I’m set on it.” And it’s kind of like, where do we draw the line of what a suicidal thought is and how do we make that an easy thing for somebody to disclose because that’s really hard to actually say to someone because some people will say, “Well, I thought about it after watching that TV show so I have, I need to say yes to this,” but then other people may think, well they’ve maybe even had a – maybe even a stronger one but think, “Well no, that wasn’t it because I didn’t actually like plan it.” It’s quite hard to gauge.
Matt: [Laughs] Absolutely Kathryn. You’ve hit the nail on the head completely here. One of the challenges that – bear in mind that underwriters work with doctors very closely –
Matt: In looking at risk. You hit the nail on the end in terms of how the medical profession and underwriters actually classify something – a mental health event. You’re absolutely right, you’ve just highlighted it, you know, if you went along to – let’s say a GP and you said, “Well on Netflix there was something about suicide or something and I thought, “Oh I wonder what would happen if I was in that situation?” then I don’t think a doctor, I would hope and I’m speaking as an underwriter and not a clinician by the way –
Kathryn: Yeah, of course.
Matt: A doctor would not think that in itself was a precursor of a mental health issue.
Matt: Somebody who had planned, I think they would.
Matt: And advise accordingly. I think if everybody – if you had 100 people sat down in a room then some of the – and they were completely honest about their mental health, then I would suspect that some of the data that you have mentioned already would – it would be spot on.
Matt: But from an underwriting perspective and a medical perspective, all things being equal by the way –
Matt: The mere thought – fleeting thought of committing suicide would not be an issue for an underwriter without a shadow of a doubt. What an underwriter would be more focused in on is whether that was a fleeting episode or a number of fleeting episodes, let’s be honest with you, and the circumstances in which the event took place.
Kathryn: Yeah. It’s quite hard isn’t it though as well because obviously –
Matt: Very hard. It’s the classifications thereof and of course – sorry Kathryn, I know you were probably going to say something then.
Kathryn: No go on.
Matt: But, you know, it’s very difficult for GPs who are often obviously on the frontline here.
Matt: Or mental health nurses for that matter to actually classify a situation and I know there’s the GP international classification of disease, ICD10 –
Matt: Which is used very commonly but even that is pretty vague. I don’t know if you’ve ever come across, seen it, seen the questions –
Kathryn: I’ve not come across that one.
Matt: On the internet or anything like that? But it’s very difficult and my experience of talking to doctors about it is it’s very general.
Matt: And it’s there really just to give them a guide of the next steps and where I’m kind of leading to ultimately here, particularly in the timeframes that we’re working to is that the best person to give you the information – I don’t say give you the information, the people who are making the risk management decision with the information – is to talk to the individual directly.
Matt: GPRs only give an overall big picture of a circumstance. Psychiatry – if the case goes to a psychiatrist or a psychologist, you’ll very likely get a much more detailed report.
Matt: But again, it will still be a synopsis of what that patient said over an hour.
Matt: And really the absolutely key person here is the individual and talking to that individual. That is not an easy conversation, you said yourself.
Kathryn: No, it’s not.
Matt: But you guys are the front end. Me – I haven’t done many telephone interviews, telephone conversations regarding these medical questions myself but you guys are the absolute experts on that.
Matt: It’s not a – sorry, it is a very difficult conversation to elicit. But it’s interesting in that – and I know something that we touched on historically in that people who are very well adjusted to their mental disorder – and, you know, let’s be fair, people are very, very adjusted to physical disorders as well –
Matt: And why should people differentiate between a physical disorder and a mental health disorder, let’s be honest?
Matt: People who are very well adjusted and have got their support mechanisms sorted out quite – are pretty – are quite often very open to discussing these things.
Kathryn: Yeah. Oh absolutely. I think something as well – just picking up on –
Matt: And that’s key, that’s absolutely key.
Kathryn: Something that obviously you were just sort of like saying there that stands out for me as well is that, you know, obviously it’s very, very hard for the underwriter but I think as well it’s very, very hard for the adviser. I know we said that but it’s not just a discussion for the adviser as well, it’s the risk as well as an adviser because, you know, we’ve had it before and I’ve certainly had it where somebody – I’ve been chatting to them and sort of like you say, “Have you ever had any suicidal thoughts?” and they’ll go, “Oh well I thought this but what do you think, do we say yes or no?” Now that’s really hard as an adviser because you’re just like, “Well I’m not a medical professional so I can’t determine that. I can’t determine what’s in the GP reports and obviously if I get it wrong and if I say that wrong, then that could be me doing a non-disclosure.”
Matt: Yeah, yeah.
Kathryn: And, you know, obviously that’s the compliance risk, you know, there’s obviously lots and lots of risk so it’s very, very hard. So I think again, you know, it’s kind of – whereas the underwriter errs on the side of caution, I think advisers then also probably err on the side of caution in the case of like, “Well I can’t – if I’m told something and it is in the question set,” so I think that’s probably where, you know, it would be really useful to, you know, at some point – and I don’t know how it would happen but for there to be some kind of like understanding or development of understanding between advisers, underwriters, actuaries, everybody – sort of like as to what actually – what do they want to know in a sense when it comes to a suicidal thought? What does that actually mean ‘cos it’s so hard?
Matt: I feel quite strongly on this point actually Kathryn. I am completely averse to ‘when in doubt say nought’. Completely against that.
Matt: I think – I know it was an example, you know, that you’ve mentioned but if somebody says they’ve had a suicidal thought and that’s a direct answer to a direct question –
Matt: The answer is yes.
Matt: It must be yes. What I find – and again, you know, I have had this challenge myself by the way.
Matt: But not on the same scale as you and your team. What – if that person has – so one of your team, if they have the skills and they feel comfortable in themselves and they’ve got the support networks for themselves, to delve a little bit deeper into that disclosure, then I would say try to.
Matt: If they’ve got the skills etcetera and explain it more when you submit the app.
Matt: Now, my next challenge to the industry is electronic applications do not lend themselves to mental illness case – mental challenges cases, mental health challenges –
Matt: Whatsoever because they are not tick box at all –
Matt: And, you know, asking questions which are typically seen – I think it was – one I read the other day when I was thinking about our podcast this morning was – so straight question, have you ever attempted suicide, taken an overdose, self-harmed or had any suicidal thoughts?
Matt: So that is a straight question, no build-up, no explanatory information, no anything.
Matt: What was that? That was completely lacking in empathy –
Matt: Support. What about the poor old client who has just been asked that question?
Matt: Shock? Horror? “I’m not going to say anything, I’m not going to buy life insurance.” We have to change the way that we engage on those types of questions and let’s be honest about it, honesty being the key word I suppose –
Matt: How many people in a state of shock – these are the people who are buying the insurance etcetera, will just say no?
Kathryn: Yeah, absolutely. Or not feel comfortable because as you say –
Matt: Not feel comfortable.
Kathryn: It’s so impersonal.
Matt: We have to change the way that we ask about mental health and that in itself we need to do but secondly, automated systems just do not lend themselves and I’m a huge believer in that –
Matt: To a) asking the question in a very cold way but 2) actually eliciting the answer which should actually be useful to the underwriter in the first place [laughs] and an underwriter can only really make a judgment based on the information that they’ve got.
Matt: If they’re given a cold hard yes or, you know, they need more than that to be able to give the client a fair hearing if that’s the right expression to use.
Kathryn: Yeah, I think –
Matt: So, that is gaining.
Kathryn: Yeah, I think, you know, interesting as well and I think I may have said this example before but we’ve had it before where somebody has wanted insurance and they’ve got IBS, so that’s irritable bowel syndrome.
Kathryn: And then sometimes it will say, “Is this linked to anxiety?” and you have to say – sometimes you have to say yes and then immediately you’re just like, “Right, so have you ever been an inpatient? Have you ever seen a community mental health team psychiatrist? Have you ever self-harmed?” It’s just – and you suddenly have to go into these questions and it’s just like, this person has IBS, you know [laughs]? And with a bit of a, you know, if they feel a bit anxious, their stomach plays up a little bit more and you’re just kind of like, “This feels quite excessive.” And, you know, I can understand it to an extent but it does feel excessive.
But I think what’s interesting as well just before we go onto the next question is, you know, just a couple of other things to pick up first. I know you were saying about like with training and different things and what’s interesting is that myself and Alan did mental health first aider training with MHFA England and what was interesting about that was when we did the sessions is that pretty much, you know, if somebody gives you any kind of an inkling whatsoever that there’s maybe, you know, sort of like a – that they’re not feeling okay or something, you have to assume – almost assume the worst in a sense and start, you know, being really, really supportive and making sure they’re okay, they’ve got support systems, trying to establish if they’ve maybe had the suicidal thoughts. And I always felt that when – and obviously it was brilliant training and absolutely follow it completely, but I found it quite weird because it was in the sense of, you know, in that kind of a mindset, it was a case of right, anything and everything could potentially lead to this person not being well and we need to try and intervene and make sure, you know, potentially just a very light intervention or stronger intervention to make sure that they’re okay. But then obviously with insurance, it’s kind of the case of when we’re looking at it, it’s sort of like, “Well, is a suicidal thought a suicidal thought?” but then when you – it kind of didn’t marry up in a sense as to what in my head was working because, you know, to me a suicidal thought sometimes isn’t necessarily an actual thing where somebody is maybe wanting to actually actively think of hurting themselves. They could just be thinking about the concept.
Kathryn: And then – but then – and it just – yeah, it just seemed quite unusual the way that it all kind of – I couldn’t sort of like figure out how to make the two of them mix together in my mind for a little bit, you know, I had to very much be sort of like a – and as I say, I really don’t know how advisers are meant to kind of understand and explain that to people and another thing – that was it, that just really popped into my mind as well is that I very much dislike, and I’m sure there will be reasons and again, as always, I’m more than happy for underwriters, actuaries to tell me and discuss this with me obviously completely in private but I don’t understand why with some insurers, suicidal thoughts are rated the same as an actual suicide attempt. That really doesn’t sit well with me because if you – as somebody who has mental health, having a thought compared to actively doing something, it’s – that’s a massive difference.
Kathryn: It’s a massive, massive difference, you know, it’s kind of a, you know –
Matt: It affects somebody, yeah.
Kathryn: It’s that kind of –
Kathryn: You’re basically – you’re saying to somebody, “Well you’ve had a thought so in all fairness, you know, it’s actually just as intense as if you’d actually had an attempt,” and there’s actually – there’s really not, it’s a completely different situation and I kind of feel that that really should be addressed, you know, and it’s not every insurer that does that so the ones that are doing that, I just personally really feel that that should be something that is looked at a bit further.
Matt: I would agree. It goes back to my point Kathryn I think that I made earlier in that you need to ask – somebody somewhere in the risk management process needs to ask a little bit more about that suicidal thought.
Matt: I suggest – I would think and by the way I certainly would not be an advocate of treating the two the same by the way on a personal level –
Matt: But as I say, with an underwriting hat on personal level –
Matt: That’s where we need to understand more around the suicidal thought.
Matt: What was the background to the suicidal thought or thoughts? And that includes a raft of things as in potentially the age of the individual, the social environment that they were working in, the – whether there are any physical reasons why they suddenly felt that. Maybe they had a physical disability that made them feel alone and lonely and not being able to face the world.
Matt: Or was it just something that you alluded to earlier on, you watched a programme, a suicide has occurred and you thought, “Oh, that’s interesting,” if I can use that expression –
Matt: For want of another word and it goes back to asking the questions and getting more into what that suicidal thought was all about. Now of course you’re getting into the challenge of is that person – the adviser in this circumstance, equipped with the right questioning techniques? If I can be cold about the fact –
Matt: In an interaction with that particular client and I feel pretty certain that most advisers won’t be. You said it yourself, I think – I hope I haven’t misheard you.
Kathryn: No there’s not enough training, there’s not a lot of training for advisers in that kind of area.
Matt: Absolutely and it’s a very difficult area to get into and, you know, to an extent, I think you’ll probably find that some insurers will say, “Well we’re not putting a lot of people through – they’re not going to do it, the underwriters aren’t going to do it because it can trigger all types of problems and therefore we’re going to assume the worst.”
Matt: You know, it’s a very difficult one from an insurance perspective to get into asking more information but more information would actually make things a lot better.
Kathryn: Absolutely and I think as well –
Matt: How we – sorry Kathryn, just to interrupt there.
Kathryn: Yeah, go for it.
Matt: Just for a second. It’s how we can move as an industry towards those types of conversations. Maybe it would require specialist mental health nurses to have those conversations, people who were trained. I don’t know but it’s something that we certainly need to think about.
Matt: We certainly do not want to – for our children – my children maybe, not yours at the moment but your children in the future to be denied life insurance or any type of protection insurance for that matter because of this – because of, let’s say, using a current example, having a very understandable reaction to being locked down.
Kathryn: Yeah, absolutely.
Matt: There are people – we need to move forward on those types of things and it’s an example. Being locked down is an example of many things.
Matt: You know, anyway sorry Kathryn, I interrupted you.
Kathryn: No, no. I had a random kind of offshoot thought. I don’t know why but I was thinking of Romeo and Juliet earlier, the Shakespeare play. So it’s not even just Netflix is it? You could read a play like that and get to the end and think – and obviously read about Juliet and think, “Ooh, no, not doing that.” But again, it’s kind of like still that thing of kind of like having that thought but what you were just saying there though has just led us perfectly onto the next one so what I was going to say – so at the moment with a lot of insurance questions, and I’m not saying that these questions are necessarily, you know, going to mean that people are declined or severely rated or anything like that for their life insurance but my thought is – one of the questions I have is, can we really expect anybody to truthfully be able to answer no, right now, to “Have you experienced anxiety in the last three years?” And I think for me it’s not that – as I say, I know that someone may have anxiety and, you know, it could still go through at standard but –
Matt: Yeah, yeah, absolutely.
Kathryn: To me –
Matt: Every day, yeah.
Kathryn: Exactly but to me at the moment it’s kind of like a defunct question because surely everyone’s going to say yes to that and if people aren’t saying yes, if they’re doing applications now and they’re saying they’re not feeling anxious, I think – I find it very hard to think of anybody in lockdown – I don’t think there’s anybody I know in lockdown that hasn’t experienced some form of something that would be classed as anxiety because anxiety is a normal, healthy reaction and if people aren’t anxious by the fact that we’re locked inside, that we’re doing home schooling, that, you know, there’s difficulties sometimes with trying to get to the shops to get food, you know, relatives who are maybe ill or friends who have, you know, suddenly got Covid. There is so much going on and again it comes down to that question of, what, you know, where we say what is a suicidal thought, it’s like –
Matt: What is anxiety?
Kathryn: “What is anxiety that is actually a concern to insurers?” You know, is it anxiety that’s required, you know, maybe a bit of intervention at a GP? Is it, you know, just any anxiety? But again, if it is a case of any anxiety, then at the moment this question should just automatically be ticked yes to everybody on every application for at least the next year or so. That’s my opinion. That’s probably a bit extreme but [laughs] –
Matt: Not at all, it’s a classification of anxiety. It goes back to your point about suicidal thought really. You’re absolutely right. Stress is another classic there – if people answer no to stress then I’m sorry [laughs], that’s a cold question by the way and interpreted in no other different way apart from the question is, “Have you ever suffered from stress or anxiety?” Frankly, I think the whole population would say yes.
Matt: In one way or another. It doesn’t have to be down to lockdown, it could be because your mates were taking the kids to school and, you know, whatever, it can be a whole variety of things and you’re absolutely right, handled in the right way, both of those things or certainly stress, absolutely no problem at all. With anxiety, again it’s around what constitutes anxiety and trying to better understand what the client means or what their definition in their own head of anxiety actually is. Anxiety in its own right – an anxious person so you’re talking that they are anxious on, you know, on a number of occasions during the week or during the month and as long as it doesn’t lead to depression –
Matt: Then an underwriter or an insurer will not have any problem with it as long as they can understand that the anxiety – what classification has been used for anxiety.
Matt: Anxiety – 99 times – well no, a good 90% of the time it would just go through on the nod. In other words –
Matt: It would go through on standard without the need for any further questions.
Matt: What an underwriter’s obviously concerned about whether that anxiety moves into something else as in the so-called various depression syndromes – I say syndromes, depression and then they’d be a little bit more concerned about that and then you get into mild, moderate, severe depression and then an underwriter will be looking at those cases a little bit more to see whether there are any risk factors, no two ways about it.
Kathryn: Absolutely and I think that –
Matt: I don’t know if that helps but I think, you know, there’s a message here Kathryn that what I’m hearing is the classification of some of these terms because in modern, you know, maybe 50 years ago when some of these books – the actuaries and so on and so forth and the underwriting books were written, the meaning of anxiety and depression and stress – not even sure stress was a word 50 years ago.
Matt: They are bandied around in modern parlance an awful lot and they can mean so many different things.
Matt: We as modern underwriters have got – it’s a difficult – and GPs as well and mental health nurses. When someone says they’ve got anxiety, quite what is the background to that? What are we actually talking about?
Matt: Can I just take – I know I’m probably wittering on as I normally do –
Kathryn: No, no, no.
Matt: To take just the redundant question point you made and I think you’ve got a good point. Somebody who doesn’t – everybody [laughs] is likely to answer yes, in the insurance-buying population anyway and the challenge we’ve got as underwriters is continue talking, changing the questions on an electronic format. That is actually easier than doing it in the paper format by the way.
Kathryn: Yeah, of course.
Matt: But it’s still –
Kathryn: It’s not going to happen overnight, it’s going to be something that needs a lot of research.
Matt: Certainly not going to happen overnight and of course, when this thing – when all this passes by hopefully, people will still get stressed and still have anxiety, then when do you put the question back in, if indeed you ever put it back in?
Kathryn: Yeah, no I think it’s –
Matt: But either which way, you know, it’s a kind of a very much of a side-line I think to the debate that we’re having but changes to forms, which is another podcast [laughs] –
Kathryn: Yeah, yeah of course.
Matt: Is not straightforward. Anyway, I’m sorry, I went off.
Kathryn: No, I definitely think there’s a place to ask the question in the application, you know. Obviously, you know, insurers do need to know about somebody’s mental health. I just – for me, I think it’s just that kind of blanket generalisation of – but I’ve said this way before lockdown anyway, you know, “Have you ever had anxiety? Or have you had anxiety in the last few years?” I just think it’s so broad and I think it’s so interpretable that I think there’ll be people who say yes to it who maybe don’t need to and I think there’ll be a lot of people who’ll say no to it who probably should say yes so I actually don’t think that it’s gathering the data and gathering the information as it stands, you know, and I’m not saying to necessarily remove it but I just think it needs adapting. But it all moves on again though to sort of like the next bit of sort of like what can we distinguish as kind of like perfectly normal mental health – and I say that with bunny ears around the “perfectly normal” type thing –
Matt: Yeah, absolutely.
Kathryn: Reaction to lockdown, you know, when somebody already has a mental health condition? so as an example, you know, I’ve been helping somebody. They have bipolar disorder, they’ve felt unsettled during lockdown, they’ve seen a GP ‘cos they have been feeling a little bit anxious, you know, obviously we’re in very, very difficult times. Work means that they have to still go out and they’ve had to still go out during the entire time to be able to do their job and, you know, so they’ve in a sense had to also be facing going out and putting themselves at risk due to Covid and everything and so they went and started on a sort of mild antidepressant. And that was kind of seen as almost a bit of a negative by the insurer because it was a case of, “Oh well it’s a flare-up of the bipolar.” And it was a case of, “No, it’s actually a perfectly normal reactive feeling to lockdown. There are a lot of people who –” you know, if I had an application for somebody and somebody had come to me and said, you know, “Right, okay, well before lockdown I’ve had nothing with my mental health but I’ve been feeling really anxious. I’ve gone to the GP and I’ve started, you know, I’m on 20 mg of citalopram and it’s actually made me feel really good.” You know, that will go straight through online for an insurance application. It would be instant cover, probably standard rates with quite a lot of insurers.
Kathryn: But for somebody who already has a mental health condition who is proactively taking that step, probably – I imagine there’s a lot more people who have a mental health condition who are proactively speaking to people because they recognise symptoms. I imagine – to me, again, I’m not obviously a medical professional, I don’t have all the actuarial data and underwriting history behind me but I imagine that is probably less of a risk insurance-wise than somebody who is suddenly experiencing quite marked anxiety and depression, has no idea what they’re feeling and experiencing and is just trying to keep battling on nine months down the line without seeking anybody’s kind of support.
So I think that’s an extra thing sort of like to maybe have in consideration. ‘Cos you were saying, you know, it comes back to that again, not seeing it as black and white forms, you know, to make sure that we’re capturing all those grey areas so that we’re able to say and sort of like speak to underwriters who can then obviously in turn maybe speak to different people to sort of get that second opinion to say, you know, “Is this person – is this actually a flare-up of their existing mental health or is this actually –”
Kathryn: “A positive step that they have taken?” They’re actually proactively managing their health, they’re taking steps, and in many ways, you know, we shouldn’t penalise people who already have mental health conditions because of being reactive and proactive to a global pandemic that most people or many people are already feeling unsettled by. I think that probably goes back to what you’ve been saying as well and saying about that individualisation.
Matt: Yeah, I can’t disagree with you whatsoever and certainly won’t disagree with everything you just said there. Somebody should not be penalised for seeking help –
Matt: Whatsoever. People who – in my limited experience of talking to people with mental health issues, although of course as you know Kathryn now, I’ve suffered from depression for 30 years myself but luckily very stabilised on antidepressants. I’m a very lucky man from that perspective but talking to people, the people that can talk, the people that proactively seek help are far better risks than people who bottle it up and again this is where the underwriting, actuarial – the studies themselves which were drafted years and years – they’re out of date let me put it that way.
Matt: Or the numbers are too small to make an actuarial or a medical decision. They are not seeing the positive impact of all the help that is available to people these days and all the – you have to take – you have to – obviously a person who suffers from depression has to offer help in the first place.
Matt: That’s positive.
Matt: And how many, you know, sadly over the years I’ve seen – certainly seen suicide claims. Very, very, very sad – in fact in quite a number of suicide claims and one of the features that comes out of those claims is that they had no history at all in terms of seeing a GP –
Matt: And suddenly they’ve done, you know, they’ve killed themselves.
Matt: The only person potentially who can draw a parallel but that person never sought any help.
Matt: People who ask for help and get help and there is so much help – I’d probably be put in jail by many people out there but I think there seems to be an awful lot of help out there –
Matt: That people are taking up from the statistics and that will change the data which underwriters and actuaries use in order to come up with the way that they deal with mental health cases. This really I think is – one great thing – I say great thing that has come out of lockdown, that’s maybe potentially a daft thing to say, but it’s the – so many organisations are now really coming to the forefront.
Matt: A lot on the group risk side – fantastic – all in I think the majority, you’ll know better than me, of individual insurers now offer some form of support program –
Matt: Behind their plans. Now, this wasn’t around 10 years ago in the way that it is now. Certainly they were around but not to the extent they are around now and that positive type thing will work its way through to the data which the underwriters and the actuaries use. So again, I’m going on a little bit but what I’m trying to say is I completely support the fact that if people ask for help, let’s see that as a positive thing.
Kathryn: Yeah ‘cos I think, yeah.
Matt: Not negative.
Kathryn: I was going to say, ‘cos I think as well we have to be careful not to give the impression that if people are seeking help that that will be adverse to their insurance, you know, we wouldn’t want anyone to ever have that kind of thought process to think, “Well actually, if I don’t go and see – if I’m feeling a bit ugh but I’m not going to go see my doctor because if I don’t then actually if I don’t for the next year or two then I might get better insurance.” You know, we need to make sure that that’s not the kind of impression that’s being given out and that actually, you know, there is sort of a very positive output to people and to charities and to the general public just to say, you know, “If you have been speaking to a GP or anybody, that’s, you know, we actually feel that’s a very supportive and proactive stance to take and that’s not going to be, you know, that in itself isn’t going to be something where, you know, you’re going to be penalised by.”
But coming onto the case study that I have – I do like to provide a case study where I can, especially for advisers and maybe for, I don’t know, for underwriters if they want to hear what or possibly see what we’re able to arrange and see if it’s comparable to what they’re able to offer.
Matt: Sure, oh absolutely.
Kathryn: So I do have a case study just to sort of like finish off the podcast. So I have a male in his early 30s and he’s a smoker so obviously any premiums that I’m discussing will be a bit higher than what we would usually expect because there’s obviously the smoker aspect to it but he’d had some depression in his teenage years and he’d had three suicide attempts and shortly after was diagnosed with bipolar disorder. Now that’s something that we see quite regularly for people – I’m not saying that’s everybody with bipolar disorder but for people who speak to us it is something that’s quite a – sort of like a regular feature, is the fact that they’ll have had attempts before they actually get that diagnosis. But then once they’ve had the diagnosis and they’re medicated and they’re monitored, their health obviously significantly improves and they actually are, you know, absolutely fine in many ways.
So as I say, this person I’m talking about, half of his life ago had had some attempts and had this diagnosis and he’s had a bit of a relapse about seven years before we did the application. I mean, he’d sort of like – similarly to what we’ve been speaking about, he’d felt a bit unsettled, just felt unsure. He’d had some thoughts and so he’d checked himself into hospital and just said, “I’d rather just make sure that I’m okay,” and obviously took a very proactive stance there. But he’d not been under any kind of monitoring or follow-up for quite a few years and when we’d done the application, actually within that year he’d actually had some time off work and it was due to being overworked basically. So I think it was kind of like a mixture of mental health and physical health in some ways and the GP just said, “You are being completely overworked, you need some time off and I’m signing you off.” Which, you know, I think is a very sensible reaction and the job was eventually altered slightly so that it was – obviously that wasn’t happening and I think again, it’s back to that thing of anybody who is being overworked and I think we’re probably going to see this a lot from people in lockdown and I – not in this situation but obviously in September I actually became quite ill with overworking but it’s a full combination of physical and mental health, you can’t really distinguish them.
But anyway, going back to this person. This person’s a full-time worker, had a family, had a mortgage, so – talk about the life insurance first. The first thing we were doing was decreasing life insurance to cover the mortgage and we ended up with £148,000 worth of cover over 22 years for around £32 per month. Now usually, well with some insurers, we would usually see after there being three attempts that this would be an automatic decline for life insurance regardless of when it had happened during the life and how close and recent it had been. I mean some insurers, it can be different, you know, so some of them only ask within a certain period of time, some of them will be okay – not okay, but some of them will be more open to chatting if it was all – if it all happened around one particular time and was very reactive to a certain event. But obviously at this point, we spoke to this insurer and we talked about how it was pre-diagnosis of the condition and obviously how long it had been since that had happened. We’re talking at least 15 – it was probably about 18 years at that point and how often obviously they had been very self-aware and they were – actually ended up being able to offer this insurance as I say at £32 per month. It was at a rated premium but it was a very good option for the client when he looked at the market.
The other thing that we did was some income protection and I think this is a very topical one because I know income protection as always is getting – is really being shouted from the houses and from the rooftops at the moment. So for this person, to cover what they needed obviously for their salary and everything, we were able to do a £1,200 per month benefit with a 13-week deferment. It was running to age 70. There was a maximum five-year claim period for every claimable event. There was a mental health exclusion on the policy and that came in at £14 per month. Now what I think is really interesting about that is especially the approach that you maybe take as an adviser. Now, what we tend to find and we often find with people with mental health conditions, the majority of people with mental health conditions when we speak to them – so I’m not saying everybody ‘cos we have had people say that they don’t like the exclusion and I don’t want to say that anybody likes the exclusion but the majority of people that we speak to with a mental condition will turn around and say to us when we mention this kind of a mental health exclusion in the income protection side of things, they’ll say, “I’ve never had a day off work because of my mental health so I don’t mind, you know, I want to have that. You know, if this is covering anything, if this is covering me a broken leg or cancer, anything, I’ve never had a day off work for my mental health so obviously I’d rather it not be there but I don’t see me being off work.”
This person, obviously they’d been working by that point I’d say it’s been a good – probably 10 to 15 years’ full-time work and, you know, they’ve had that month off for kind of a combination reason but yeah, I think it’s worthwhile exploring – for advisers, I just want to say, it’s worthwhile exploring, you know, it’s worthwhile even if you think there’s an exclusion there, it’s trying to tell people about the amount of positives that it would cover rather than focusing on – obviously you must make them very aware of the exclusion but don’t automatically assume that it’s going to be something that they see as a negative. Some people will do and they may not want it which obviously then you have to look at other approaches but it is worth having it there.
And the other thing I wanted to say to any – obviously underwriters who might be listening or actuaries or anybody, you know, if that’s very different to what you guys are offering then as always – assuming you’ve all obviously – not assuming but definitely being careful to data protection, more than happy to chat through some situations that maybe other insurers are offering without again going into competition laws or anything but being very, very careful about what’s on offer and what we can and can’t all discuss. More than happy to chat through those and see if it’s something that could potentially become an offering to more people.
Matt: It’s an excellent example Kathryn and, you know, more power to your elbow and the team as well for getting the protection cover in particular through with an insurer. There will be many insurers out there I think in the industry that wouldn’t be able to give cover.
Matt: So it really is an excellent example. So yeah, great. I’m really pleased as an industry person if you like and an underwriter, that somebody somewhere gave that chap cover. Great, well done.
Kathryn: It was really, really obviously brilliant to get that for them.
Kathryn: So, we are at the end of the episode Matt. Is there anything that you would like to include at all or have we covered everything do you think?
Matt: I’m not sure if we’ve covered everything, you know, I think we could be here for the whole day [laughs]. It is such a large topic but extremely topical and I would say, I think it probably builds on the case that you’ve just given, is please anybody out there, anybody who’s thinking of buying insurance who may be out there or any adviser who is thinking out there, if somebody has a history of mental illness, please don’t assume that the insurer will just say no. Go to an IFA, go to Cura and you will get a great view on what can be achieved. Please don’t assume that the insurers will say no because often I think you’ll be surprised with a positive result. Secondly, what I would say is and I hope you don’t think this is a plug Kathryn –
Kathryn: No, no of course.
Matt: I might add, but two of the most insightful articles – very short articles that I’ve seen on risk assessment of mental illness, or can I just say the underwriting of mental illness, were actually published in Cover on – I did look these up so you’ll have to excuse me, on 28th November last year so 1919 and the 17th December 1919 –
Kathryn: What 2000 – hang on, 2019 or 2020?
Matt: Sorry, 20, I do apologise.
Kathryn: It’s okay [laughs]. I’ve said before, we’ve lost this last year haven’t we ‘cos it feels like it’s still –
Matt: Absolutely, I can see a questionnaire coming my way [laughs]. They were penned by a very good friend of mine called Peter Maynard –
Matt: Who actually – he writes underwriting manuals.
Matt: So he’s not a reinsurer, he’s an independent consultant but they are absolutely superb and I recommend everybody spends five minutes on each article and they are very, very insightful. So thank you for that Kathryn.
Kathryn: No of course, thank you and thank you for bringing that to everybody’s attention. I think that’s brilliant. So fantastic, I think this has been a really great first underwriting episode with you Matt so thank you so much for coming on. I’m going to be back in two weeks chatting with Roy McLoughlin and Andrew Montlake. We’re going to be chatting about mortgages and protection mix and Matt, you are going to be joining me two weeks after so a month’s time and we’ll be chatting about a new underwriting risk area. So if you’d like a reminder of our next episode, please do drop a message on social media or visit the website www.practical-protection.co.uk and please do remember that if you have listened and it is part of your work, you can contact and claim a CPD certificate on the website too. It just takes us a couple of days to get them over to you but if you bear with us, we will get them printed and over to you. So thank you so much for joining me Matt.
Matt: It’s a pleasure and look forward to the next one. Thank you.
Kathryn: Thank you, bye.