John  (00:04):

Hello, and welcome to today’s webinar, hosted by the Institute and Faculty of Actuaries mental health working party. My name is John Brazier editor of Cover magazine, and I’ll be chairing today’s discussion, which examines, where we are as an industry and how we can improve regarding mental health. This webinar forms the conclusion to the mental health in life insurance awareness week, which is featured a series of daily blocks from protection and wellbeing experts, covering topics, including groups and access to insurance, claims reports, claims, support, and underwriting and pricing as well as daily podcasts from the practical written section podcast. The aim of this awareness week has been to highlight how mental health is relevant across all sections of the customer protection journey from initial underwriting practices and applications to ongoing support. Once a claim has been made and processed today’s webinar will bring together some of the key talking points across the, across the week and features an expert panel of speakers spanning the actuarial underwriting and advisor roles.

John  (01:09):

We’ll be addressing areas such as what the industry is currently doing to incorporate better mental health practices, where further improvements can be made, examining the role of underwriting and data, and looking forward to the future of mental health in protection. The webinar will ask for approximately one hour and we encourage listeners to submit questions throughout the discussion for our speakers. We’ll address as many as we can of these towards the end of the webinar. So do please submit them using the Q and A tab on your screen. Now I’d like to ask our speakers to introduce themselves and give us a little bit background, oh, knowledge and area of expertise. Uh, and we’ll start with you, Lisa.

Lisa  (01:47):

Thanks John. Hi, everyone. Great to be with you today to see so many of you joining this session. So I’m a business development actuary at Hannover Re UK Life Branch. And my background prior to that is in health and protection insurance pricing. So as part of my current role, at Hannover Re, I work to support clients in developing insurance products in a way that can broaden the reach of protection products. And also I’m chair of the IOFA’s deputy chair, I should say, of the mental health working party. So we set that working party up to raise the level of understanding and awareness of mental health amongst actors and the broader, and also to promote the consideration of mental health in the design of life and protection insurance products and processes. So together with my, my colleagues, Kathryn, Fraser, and the working party, and everyone really that’s been involved, we’ve put this week together to reach out to actuaries and insurance professionals on this important topic.

Fraser (02:45):

Thanks Lisa. Hi everyone. Uh, so my name is Fraser Ballantine and I’m currently the underwriting quality and risk manager at Zurich. Uh, I joined the IOFA working partly after Kathryn mentioned to them that I might be interested in a topic, which I was, uh, I guess the expectation was to add some underwriting knowledge and a different perspective to the work, uh, that was being undertaken. Uh, in terms of background, I’ve got over 20 years experience in the protection industry, ranging from customer service roles to case underwriting and to building rules for medical Condit. Uh, so I’ve been able to give a holistic perspective to the working party. Uh, the work I’ve previously done with Aspen has also been helpful for this group as well.

Kathryn(03:29):

And I’m Kathryn Knowles and I’m managing director at Cura Financial Services, and we are a protection insurance broker. Uh, what I do is I do protection the personal on a group space within the UK and internationally, and I’m here. And I bring my experience as an advisor who helps people who are typically classed as being in a high risk situation, but also bringing in my own personal experiences of having tried to get insurance, having had a mental health history and, and sorry, trying to give that broad perspective. So from a, a personal point of view as an individual, whilst also mixing that in with that professional kind of perspective of things, too.

John  (04:08):

Great, thank you all for us today to share your expertise and discuss the mental health journey within insurance. So to start off, let’s take a relatively high level look at where insurance currently is in terms of his efforts to better include and adapt to mental health conditions. Um, Lisa, let’s start with you. I mean, where, where do you see that protection is currently moving the dial or has been in recent times, uh, on mental health?

Lisa  (04:35):

Yeah, thanks John. That’s a really great question. So there’s been a lot of positive efforts in recent years in this space. So like to highlight one in particular, which is the ABI mental health standards. So these were implemented at the LA at the end of last year, and really this is such a positive initiative to drive better support and outcomes for insurance customers who have a mental health condition. So the standards and also just the industry practices in general and beyond the standards, they’re really, so they really cover all that wide range of potential touch points between mental health and insurance processes. So touching on things such as accessibility, so really giving customers a choice about how they want their insurer to communicate with them, and also ensuring that insurers themselves provide their own staff with training and awareness programs can help support customers with mental health condition moving to the underwriting side.

Lisa  (05:27):

And I won’t say too much here because phrases be the expert here in this area, but really ensuring as well that questions are asked relevant and appropriately. So there’s that transparent communication with the customer to explain why the insurer needs to ask an underwriting question in the first place. Think that’s a really positive thing that we’ve seen in recent years. Um, and also just communicating that, that decision with clarity and empathy. So Kathryn, as an advisor, you’ll be really close to that as our I’m sure you’ll, you’ll share more here, but it’s really important to explain to customers in an empathetic way why they’ve been declined to cover or why there’s a loading being applied for their cover, if they have a mental health condition for on that underwriting side and then also to signpost to relevant support services and potentially even highlight providers that might be able to provide cover if a decline is given.

Lisa  (06:17):

And then the fourth bit I, that I wanted to highlight is really around transparency. And I think that’s really a place where actors can play a pivotal role, have been playing a role and, and there’s lots more to do here. So this standard is all about ensuring that the underwriting approach is reviewed regularly and using the most recent and statistically credible relevant evidence. So as actors, there’s lots we could bring here in terms of data analysis and challenging ourselves to make sure that we’re using the best data, the most recent data, also the most relevant and available data. So I think we’ve seen, you know, across all these areas, some really positive initiatives and I’m hopeful that we’ll continue to improve going forward as well in all these areas.

John  (06:59):

Thanks, Lisa and FRASER, you mentioned your work with Aspen. Can you tell us a little bit more about

Fraser (07:03):

That as well, please? Yeah, sure. So action for suicide prevention and insurance or Aspen is it is better known. Uh, it’s basically formed of a voluntary group of people from across a protection insurance industry. Uh, looking at war, if anything, we can do to help prevent suicide and support people who are affected by that. Uh, it was originally the brainchild of Jane, okay from RGA, uh, re insurer a few years ago. And I was asked to be involved in the group, uh, everybody on the group path professional, uh, and or personal experience of the impact of suicide. Uh, and we all really were wanted to do something about it within the industry. Uh, personally I learned the heartbreak and impact suicide, but my best friend took his own life in early 2018. Uh, so that was a tough time, but, you know, I think the impact suicide does it wide range it beyond just immediate family.

Fraser (07:54):

It could extend to towards friends and, and everybody else. So this led me to join Aspen in January, 2000 and a took over as chair of the group in 2020 from Jen. We’d heard anecdotally, uh, that financial advisors find themselves sometimes in the midst of difficult conversations with customers, uh, and what we wanted to help on how they could respond to these conversations in questions. So we developed some guidance, uh, and conjunction with, uh, to help advise ourselves empathetic, clear, and open conversations about mental health, uh, and suicide with our customers. This included content for the websites and digital communications, uh, the talk about suicide and also to raise awareness. Uh, there was also a suicide prevention directory, uh, which was, uh, filled with organization resources that can help as well. Uh, and the overall document was published in partnership with, uh, Sesame bank group in the protection distributor group in late last year.

John  (08:52):

Thank you. And Lisa’s also mentioned there, the, the API mental health standards and obviously several insurers within the market have, have embraced these. I mean, from your perspective, where do you think insurers are doing good work, uh, to embrace better mental health practices?

Fraser (09:08):

Yeah, I think it’s, I think it’s an ongoing discussion, uh, to be honest and something that will continue, you know, through this year and next, and be on, I think insurers have been looking for some time now at how they phrase their questions. Uh, and indeed the, the publication of the E I mental health standards really brought that under the lines even more. Uh, we, and by we, I mean, insurers and advisor, the customers, I mean, we all want to have questions that are clear and easily understood, but still being able to get accurate answers from customers. I think that’s crucial, uh, the word then, you know, it needs to be compassionate and needs to be consistent. Uh, and I think overall that will reduce the risk of misrepresentation by the customer. And that’s, that’s a really important part of the work that we need to do.

John  (09:51):

Thank you. And turn to you, Kathryn. I mean, where do you see good progress being from the advisor perspective?

Kathryn(09:59):

Um, I think there’s been a lot of, you know, really good progress. So just seen a lot of people here won’t know very much about mebecause I am in a slightly different space, but, um, just give people a bit of background. So about 10 years ago, when I went for my insurances, I was declined by all two insurers, um, due to my mental health and my mental at that time, I was generalized anxiety disorder, um, and, um, a couple of bouts of phobia, but in terms of, for people obviously who are here and I’ll be very honest, that was none of the things in terms of, I’ve never seen a psychiatrist, never been an inpatient that had been a suicidal thought self harm or any attempts. So if you look at that then, and then you look at that now in, in general, if you looked at that now, there’s probably not going to be much difficulty in getting the insurance.

Kathryn(10:43):

A lot of insurers would accept that application straight online. So that really shows the difference that we’ve made in this last 10 years. And in terms of the advisor space, I think a really big positive that we’re seeing everywhere is obviously that there is this more, much more openness for collaboration between all of us, you know, having this working group is obviously a big thing. We’ve got re insurers, we’ve got insurers, we’ve got so many different like, uh, sorry, roles within different companies together, really trying to make big change. And I think as well, um, in the actual advisor space that need for things like, um, enhanced kind of vulnerability training is really starting to come to the fore to say, well, actually we do really need to be aware of how these questions might be positioned. Obviously I will, at some point notice, wanna talk about some of the questions and some of the wording.

Kathryn(11:32):

Um, but for now, just focusing on the real positives, you know, it’s, it’s making sure that we are providing that empathetic journey that people aren’t just told that they’re declined and then just kind of left to, to their own devices. Um, making sure people have things like vulnerable climate registers and just getting people to really understand as well. Because we put people in the advisor space generally from like a compliance point of view when we talk about vulnerability or when historically when people have talked about, um, vulnerability it’s often been to do with age. So usually it was a case of right, if someone’s reached the age of 70, you know, as an advisor, you need to make sure that you get assigned letter of from that person that they are with sound minds and potentially that they do or don’t need an advocate with them, which it’s, it’s trying to get people away from that mindset to some extent, because there are some 70 year old’s who might be in that space, but you could easily have some 80 year old’s who are absolutely on top of things without any vulnerability whatsoever in terms of under in their financial circumstances.

Kathryn(12:34):

But then you might have someone in their thirties who’s incredibly vulnerable and that could be due to something such as the finances or potentially mental health. So there’s definitely lot of work going on. There’s lots of things in terms of, you know, additional training, obviously the ABI have been putting out some additional training for people to attend as well. Uh, and it’s something that we’re seeing a lot more in terms of like webinars and courses. And for myself, a lot of people are coming towards me for training, just so I can really make sure that they’re doing it right by people.

John  (13:05):

Thanks very much, Kathryn. Um, so that’s essentially where we are as an industry right now. So let’s move on and look at where we can improve further. Um, so Kathryn, I’ll, I’ll come back to you to kick us off in this area. I mean, again, from the advise perspective, uh, where do you think we can as an industry improve and, you know, maybe specifically relating to some of the topics you’ve talked about on the podcast this week around sort of support and, and claims, uh, and the, the services that goes part of those packages.

Kathryn(13:36):

Yeah, I think you, there, there’s plenty of things that need to be probably addressed. You know, we do have things like the value added benefits now that a lot of insurers offer, um, from an advisor perspective, you know, they are really important to make people aware of. And it’s really important that we have a very clear understanding of what that’s involves because one things that we talked about is impact the podcast was that obviously there is mental health support services, but they, in a sense, there’s a point where they have to kind of stop and then more professional medical interventions may be needed. So from an advice point of view, it’s making sure that advisors know that we can’t just say, oh, this is a me, you know, mental health support line. This will be all solution. Our senior dancing solution is knowing, well, actually this is here for this situation.

Kathryn(14:20):

And if you need something else, we need to go over here in terms of the actual support going through, um, the application process, um, in terms of an advisor, does that will be very different to what you would see in terms of a, like a, a comparison side potentially going direct to an insurer. And we will have lots of things in place to say for ourselves. You would have things like giving people the opportunity to be able to talk to you about their situation. Maybe do secure documents, discussions instead, maybe email, or maybe let them complete the application on their own. If they obviously do feel a bit too, too worried about being judged in terms of what they might be saying to people, um, in terms of actually self, like working with insurers and what can happen. I think obviously having that constant kind of communication, making sure that everyone knows exactly where we are.

Kathryn(15:12):

There’s, there’s clearly a lot of work that needs to be done in the uptake of like electronic GPS, which would be very helpful for all of us because something that I find quite regularly, I do look at GPS quite regularly for people is that they often either have potentially errors in them which need to be corrected. And it’s quite awkward speaking to somebody and saying, do you, did you, you might have forgotten to tell me this. And actually, you know, it is either that they’ve forgotten it or that it, it is an error and there’s, there are more errors than you would. Um, you would think, um, the other thing as well is making sure that there’s procedures in place for, for a sense, everybody, if there’s something about maybe they’re to health that has, they’ve not really understood, possibly they might think that it’s not as strong as, as what it is now as an advisor, I can really sort like step in as best as possible to help that and to try and soften what’s being said, um, in other situations where it’s, you don’t have that advisor involvement, they, and it can lead on to obviously the decline letters.

Kathryn(16:15):

Um, I know lots of work is being done in the decline letter type space. Um, one of the things that I think really just need working on, and it is something that we’re still seeing now. And, and obviously even from recent ones that I’ve seen is where people may be getting an email or a letter. And it literally, it, it, it does just say you have been declined in show because of, and it will say mental health and it’s just with that kind of information, it’s just not clear enough. And it almost feels from an advisor’s point of view. Obviously, I can’t say for definite what goes on an insurer says, systems does say that, I’m sorry, saying this is exactly how it is, but it just kind of feels sometimes as a, if it’s been like an auto generated email, or if there’s been like a little dropdown box to say, what’s the condition.

Kathryn(16:58):

That means that we’ve declined this person, rather than just going into it a little bit more in terms of saying, you know, we’ve had to decline, um, the application due to our mental health history. Um, when we, when we just something simple to say in terms of the application, and we were given some dates in terms of diagnosis, and these haven’t matched up with what the GPR has said, maybe go speak to your GP. And in the meantime, if you feel you need to speak to someone, here’s someone you can contact. And, and that in itself is kind of changing a bit of a, a template. If that’s what I’m assuming is being used. It’s changing that a little bit of a bit more information, which isn’t that big a change. Um, but just sometimes a little bit more intervention, because a, a big thing from my point of view is, is if you are declining somebody due to their mental health, then to put it quite bluntly, because we’re in obviously a very professional forum here, it means that you think that person is at heightened risk of suicide. So to just simply give them a letter that says we can’t cover you because of that people aren’t DED. They know what that means. They know what that’s saying, and that in itself could be trigger enough for somebody to then take an action that none of us would obviously hope that they would take.

John  (18:08):

Thank you, Kathryn. Um, and so FRA, I’m going to come back to you, because you’ve sort of mentioned stuff around the underwriting rules a bit earlier on. So from your perspective, where do you think insurers or indeed the entire industry can better adapt and improve underwriting rules or, or practices around standard rates? And I’m sure Lisa, you probably have some thoughts in this area to share as Weller come to you first on this, where do you think we can you as an industry do better?

Fraser (18:33):

Uh, I think, I think to start with think it’s, it’s fair to say. I think Lisa will touch on this as well. Is that mild anxiety, stress or depression is usually catered for within the base premium set by the, a rates? Uh, we, you know, we acknowledge that a sizeable portion of the population, uh, will have be in some element of maleness or stress, particularly during the last couple years with the COVID 19 pandemic. You know, I think most people will have been affected to some degree, uh, whether it’s some nervousness around going out or worrying about loved ones. Uh, so, you know, and this is unlikely to really have impacted on their ability to carry out with daily duties such as work or socializing when it was available. Uh, and by mild, really what we’re saying is we’re talking about customers who have required improve from primary care, such as GP or a nurse, uh, haven’t really required any or very little time of work, uh, treatment may or may not have been prescribed.

Fraser (19:28):

Uh, but we do know that, you know, antidepressant usually to be taken for one, two weeks without missing any doses for actually have any benefit to be felt by an individual. Uh, so we need to be looking at that. However, I do feel that, you know, if we probed a little deeper with questions that are statistically quantified, then we might see more moderate conditions receive terms within the American information. I know that’s something Kathryn I’d like to see. Uh, the online application journey should also have a sense of, you know, easing the customer into it, you know, and by this, you know, we should start with some basic questions. Uh, you know, when they were diagnosed, who they’ve seen, you know, the type of treatment of using some time off work and only once we’ve went into those basic kind of structural questions, you know, should we really move on to asking customers about the most sensitive issues such as self harm or, or thoughts of suicide?

Fraser (20:19):

Cause these are really a mode topics to, to be discussing. Uh, they, it can be generally a motivators to discuss and we need to tread sensitively, but we also need to ensure that we obtain enough information to allow underwrite ours, to make an accurate and fair decision. And that the customer is aware of what we need to know, uh, to make a decision, uh, by doing this, you know, we should be able to make the customer journey simpler and more welcome in, uh, none of us want the customer journey to be, you know, overwhelming or a stressful process. Uh, and I think we can definitely do some work in that area.

John  (20:58):

Thanks FRA. Um, and Lisa, we, any thoughts there on, on what phrases just sort of outlined in terms of underwriting and standard rates, that kind of thing.

Lisa  (21:06):

Yeah. Thanks John. So Fraser did emphasize, you know, the wide reaching nature of mental health care. So statistically about one in four people would experience some form of mental health condition at some point in their lives. So that’s a really high prevalence. So of course you can expect that that will already be included in the I insurer’s based price for life insurance, for those lower severity, higher frequent conditions, such as the mild to moderate anxiety, the mild depression, that phrase of words mentioning, and, you know, Kathryn, thanks for sharing your, your personal story there, applying for life insurance and the progress that’s been made in recent years here, and really, you know, highlighting how for life insurance. Now, there usually is no change in underwriting decision for a customer disclosing these lower severity conditions. Um, and they do receive standard terms. And no, we’ve had a question in the chat on that.

Lisa  (21:55):

So I really didn’t want to clarify that we have had a huge progress in terms of that in recent years. I think where it gets more complicated though, is where a person has what we call comorbidities. So that’s where a person might have a mental health condition, either a low or, or high severity one. And they might have more than one mental health condition. They might have several mental health and physical health conditions. So really what I’d like to see is improve as an industry is to build up the more granular data to help model the relative risks for these more complex comorbid cases. So although there are some studies out there showing how mental health conditions impacts mortality and mobility, when it comes to these overlapping mental and physical health conditions or overlapping mental health conditions, they’re often limited to specific conditions and they don’t always do a deep dive into the severity of those conditions.

Lisa  (22:46):

So at the moment to ensure fair outcomes for customers, um, underwriters such as Fraser would typically review the information provided for these individuals, look at their individual circumstances, the wider biosocial context of that individual, the comorbidities themselves, other lifestyle and social factors, and then present that underwriting decision to the customer. So that’s really an absence of that hard statistical population data, the approach that’s being taken. But I think if we could have continued medical research that can allow increased granularity, um, when it comes to these comorbid conditions, then there could be potential to further refine that underwriting philosophy and more formally quantify the impacts of even things like the latest treatment approaches and, and how that’s going to impact the future looking view of mortality. So I really think that’s a great opportunity for keeping up collaboration across the industry, deepen it further so that perhaps we could anonymize mortality data, but a range of those mental health conditions at differing levels of severity to help get insights there, or potentially explore partnering with research institutions, to commission, a dedicated population study to really do a deep dive into these aspects. So, you know, I think this sort of data, it could have a lot of potential to do even more than what we’ve done so far, keep making progress and really refine that underwriting so that we can have richer insights into these more lower frequency, high severity, mental health conditions, and also those mental health conditions that when individual has a mental health condition and also perhaps an another mental health condition together with, or just mental health condition with a physical health condition. And I think lots of potential further progress in the space.

John  (24:30):

Thanks, Lisa. And I’ll come back to you Fred, to touch on this severity topic in terms of, uh, rates and rules. I mean, what, what do you think we can be doing better when it comes to condition severity and, and being perhaps, um, more flexible, I suppose, when it comes to our definitions, how we deal with them?

Fraser (24:47):

Yeah. So I think when we’re talking about, you know, more severe mental illness, I think it’s probably worth clarifying exactly what we mean by severe mental illness. So what we’re mean here is we’re referring to individuals with, you know, psychological problems that are likely to be so debilitate in that their ability to engage in or functional events is severely impaired. Uh, so schizophrenia and bipolar disorder are often referred as severe mental illnesses. And we know where a lot of other conditions and mental health is no different that every individual will follow a slightly different path with their condition. Uh, but as insurers, you know, we are in the, the business is pulling risk together. So we have to use that to determine the underwriting outcomes, I think within underwriting guidelines and the questions that we are looking to identify customers with a stable condition and a reasonable period between significant symptoms or hospital admissions when it comes to severe mental illness.

Fraser (25:45):

Uh, we are also interested in any thoughts of taking their own life or attempted to do so, and we know it’s a sensitive subject, but it is a really important factor for us through the underwriting process. You know, we, we do ask about thoughts of taking their own life or attempting to do so because multiple sources tell us that, you know, the instant rates of taking their life being somewhere between eight to 15% higher than knows without a severe mental. So this is a realbecause for concern from an underwriting angle, uh, and something that is incorporated into the underwriting outcomes. Uh, an interesting report was the NHS right care toolkit, uh, amongst other sources and this highlights some other very important future risk associated with severe mentalness. So Lisa had touched on Nicole morbid factor earlier, for example, people with severe mental illness, you know, they, they have a 53% higher risk of developing cardiovascular disease.

Fraser (26:37):

So that’s heart attack stroke amongst others. And that is a significant increase that, you know, must be factored into underwriting outcomes. It’s also noted within the same study, uh, that people with severe mental illness, you know, they have a 85% higher risk of death from cardiovascular disease. Uh, these are both quite startling statistics, uh, and display why this condition does require us to obtain medical information, to, to assess ’em correctly. Uh, you know, it’s, it wouldn’t really be fair to make these decisions through an online, an online process. One of the, one of the other parts within the study, uh, and this has been quoted in other places as well, is that, you know, we are told that life expectancy between 15 to 20 years lower than a general population. And for those with us severe mental illness illness such as S your bipolar disorder.

Fraser (27:24):

So these are all, you know, important and significant statistics for us and demonstrates why, you know, some customers with severe mental illnesses will have to pay an extra premium to obtain cover, or unfortunately in some ES are actually unable to obtain the cover. I think when you look through that study with NHS, there are some subsequent plans that are set out, which I think are really important. Uh, so the, the list really four things, and one of them is early detection, which really means that the GP should be monitoring blood pressure, lipid smoking status, alongside fair illness illness, and also primary prevention. So possibly starting, you know, blood pressure, lip procurement early in the process to have some protective factors. Uh, the last couple are a couple of long term management of modifiable risks and also a personal care and support plan, uh, that is shared throughout all the healthcare professionals that are involved with that individual. Uh, and I think once you see that coming through, then you can understand that the NHS are taking these, you know, mid jump to longer term potential re illness. Seriously,

John  (28:29):

Thanks. And Kathryn, again, from your perspective as the advisor, I mean, can you share some insights from your experiences of, of discussing and, uh, dealing with underwriting for consumers, especially as an advisor who, you know, is, is not necessarily a medical expert, you know, obviously you have to know your stuff, but I think we discussed this in a recent webinar as well, that, you know, you are a financial advisor at the end of the day, not, uh, a medical expert in this area.

Kathryn(28:57):

Absolutely. And I think this is the time where we would absolutely especially mean phrase, have a good debate debate with any underwriter. And actually, obviously, um, so in terms of asking the questions, obviously it has to be asked very sensitively. And I think sometimes, you know, there’s almost part of me that kind of wonders, you know, sometimes could maybe an underwriter and actually in a sense kind of try this, you know, in a sense and try, actually asking these questions for someone and see how it feels, um, a big one for me, which I, I always talk about though. And it goes on to just a little bit of phrase are saying, is this thing about suicidal thoughts now? Not all in shows, ask about suicidal thoughts. And some of them have also started to bring in kind of a right to forget in that if anything’s happened outside the last 10 years, a big thing for me is that as far as I’m aware, actress, underwriters, you’re wanting that really kind of, you’re wanting the information.

Kathryn(29:46):

That’s going to kind of answer that risk depending upon the data. Now, the question is, is there’s, how can you define what a suicidal thought is? Because there’s, you know, there’s a forwards on this call and we might be similar, but I imagine that we would possibly have views about what a suicidal thought is. And for me, I think that some people answer yes to that question when probably they don’t really need to. And some people will say no, when they probably really should do. And ultimately as with anything, unless it’s written down on a GP report, none of us would be able to know anywise or if there was a claim we just wouldn’t know, but it does come out like, is it actually a useful question? I’m sure that phrase are based upon saying about that data and everything thinks it is a very useful question.

Kathryn(30:32):

Um, but I don’t know, because I’ve spoken to one, I fine. I’ll said like what defines a suicidal thought? Because again, like you said, John, I know a loss about medical conditions, but I am not a medical professional. I’m not allowed to do anything where I’m bordering into any kind of medical advice of assessments and I’ll say it to an underwriter, right? So what’s a suicidal thoughts. And the answer always is, well, it, it depends upon what the person feels as if it was a suicidal thought. And that’s really hard to speak to someone about, because then it’s a case of, you’ve got someone asking you, obviously a client saying to you, is that a suicidal thought? And then you’re like, well, as an advisor, you’re like, well obviously my sense to protect my back, I’m pretty much going to have to say yes, because I’m not a medical professional.

Kathryn(31:18):

So I can’t say if you have or happen and the insurer isn’t giving me a of what a suicidal thought is. So I can’t risk my compliance, my livelihood, everything by saying, no, if you are questioning, if you ever have, and that can be really, really difficult because there is such a range in term of suicidal thoughts. You know, as, as examples I say to people, you know, there’s times when my husband’s in London and unfortunately maybe been somebody who has decided to end their life and his train has been delayed and immediately I think, oh, if I was going to do it, I don’t think I would do it that way. Now, does that mean I’ve had a suicidal thought, some people would say yes, that is. And you know, for them personally, they would classify that as having had it because they’ve classified how they would maybe do that method of in their life.

Kathryn(32:04):

But other people would just say, well, no, that was just a, a fleeting thought to, to a situation. What if you see, there was obviously a big, um, TV show in America where pretty much the entire show was all about teen suicides. And it’s like, well, watching that and thinking about it, contemplating it again, kind of like the methods, is that a suicidal thought? I think we probably all agree that if someone has decided that it’s going to happen on Friday, that they’re going to be taking some kind of medication and some certain processes, and they are really planned on taking their life. That that would be plus as that. But it’s so, so far ranging that I just don’t really feel that it’s necessarily. I know what other people, I know what the underwriters are wanting, but I don’t think the question at the moment is actually achieving what they’re wanting.

Kathryn(32:48):

And I think some people are being called in it that shouldn’t be, and some people are being missed in it that maybe should be. And then the other thing is just quickly say,because I don’t want to talk too long is that we do, you need to be on top of how things are changing and the times to say you tend to find, um, quite a lot of people now are taking part in talking therapies. So just like people go to the gym to look after their physical health, people are taking part in talking therapies to look after their mental health. Now that in itself could potentially be to an exclusion on say maybe an income protect action policy. And I think we need to sort of, I, I really don’t know how an actual underwriter would in any way kind of factor that in. But I think we do need to be really careful about making sure that we’re not again, possibly doing exclusions and making things worse for people who are really trying very, very hard to, to actually look after that health before anything happens.

John  (33:42):

Thanks, Kathryn and Fraser I’ll turn that, um, element of dealing with considerations for those who are seeking treatment, who are seeking support over into that underwriting consideration. I mean, how, how can we better go about thinking about those that are actively and proactively seeking to a better improve their mental health?

Fraser (34:02):

Yeah, I think this is something that’s come up a bit more in recent times, I think in terms of protective factors, uh, for, for individuals. And I think first of all, it’s vital that customers engage with primary healthcare on their condition, uh, is that does allow, you know, any deterioration or improvement de to be identified quickly by their health professional. Uh, and it’s important to ensure anyone’s mental health treatment or support, or is supported as adequate and appropriate, uh, from an underwriting angle. It, ING is a positive that customers are in dialogue with doctors. Uh, but we also appreciate that if you’ve got a stable condition, regular contact may also not be necessary. So you can kind of follow the 2, 2, 2 parts for this. It’s a fine balance we under it. But we always look at at the information holistically. I think if we look at the, the protective factors, you know, I think, I think we’d also say that it would be good to see the questions set, expanded to include protective factors sort is, are you exercising to, you know, improve your mental health?

Fraser (35:05):

Are you, uh, you know, talking to friends, are you doing things like yoga, you know, or other activities that actually help customers deal with their condition? Uh, I think the only hesitation at the moment with this is, and Lisa, I’ll probably say this as well is the actual lack of data that shows the impact that, that has on individuals, because there isn’t really much data on that at the moment in a big enough scale for us. And if we have no data to determine how that information can be accurately used, then we can’t really relate it in turn underwriting decision. Uh, so I’m sure Lisa touched on that on the like type of data on the podcast on Wednesday. Uh, and I think we’d all be hopeful that we can see that improve in the future.

John  (35:45):

Thanks for, yeah. This is a, a good opportunity then to move onto the data sort of angle Lisa. I mean, what, what do you think there, what’s your thoughts on how we can better account for that lack of data, so to speak or, or take that into account in terms of actuarial and underwriting processes.

Lisa  (36:01):

Yeah. Thanks, John. And yeah, I think we’ve had some, some really important discussions and just the, the discussions we’ve been having in, in the last few minutes, I think they really do highlight the importance of that cross collaboration and, and making sure we can bring the different perspectives here. You know, the advisor perspective, the medical perspective, the underwriting perspective, the actual perspective, and, and bring that together to think about the customer journey, um, you know, right from that data analysis all the way to the question that we’re going to be asking that the end customer. So I think when it comes to the data, first of all, it’s really important to, to make clear that mental health data, you know, together with all health data, it’s, it’s sensitive personal data. So got to be really important when it comes to data that, you know, insurers of course have these strong data protection protocols in place.

Lisa  (36:44):

Um, so that’s, that’s the first thing to, to highlight here. And, you know, I, I was reading the, the money in mental health time to act report that came out, um, earlier this week. And, you know, it really highlights that despite progress in recent years in reducing that stigma of mental health, can we still have a long way to go? So I think only 15% of, of customers disclose a mental health condition when they were asked if they had a relevant mental health condition that they would like to disclose them, you know, at the point of applying for, well, in this case, it was quite broad financial services, also electricity, really, you know, those essential services that the customers value. So yeah, first of why think if we’re going to try and pull that anonymized industry data to get more data there, we do really need to be mindful of that, that data privacy concern, and that will need to be thought through by the industry, but assuming we can, we can overcome that and safeguard the, the personal data there.

Lisa  (37:33):

I think more granular data and more recent data on outcomes for a wider range of mental health conditions across the severity spectrum would be really helpful. And, you know, thinking act here, there’s an important balance that needs to be struck between the granularity credibility and recency of that data. So just, uh, focusing in on the life and protection insurance space, our products are a long term products. So that, that research that needs to be done has to, has to be a longer term study, has to look at those outcomes for study participants over the course of many years, to assess the long term mortality and mobility outcomes or to pick up on Katherine’s point when it comes to the impact of something like talking therapy and potential positive impact that could have in terms of reducing, um, mortality and mobility risks. You know, that data is going to take a long time to emerge.

Lisa  (38:23):

So really I think the medical profession, especially when it comes to newer treatments, that’s where nitrogen and underwriters can lean on the medical profession to take a future looking view and really understand these newer treatments, some of these newer lifestyle interventions and the positive effect they could be having in, in terms of reducing that long term mortality and mobility. And so I guess I’ll, I’ll also just touch on, um, you know, that, that challenge there, in terms of this unstructured, you know, potentially unstructured data when it comes to those lifestyle factors. So we, we have of, for example, wearable technology, now that could record someone’s sleep or physical activity, um, let’s say, but really, you know, that that’s unstructured data. So that needs to be thought through in terms of how an insurer would gather that data. Again, it’s very sensitive data. So it needs to gather that data build up enough data there to then actually do a study in terms of the impact act of, for example, claims risk of that individual.

Lisa  (39:18):

So, you know, I think that’s a really longer term aim to find ways where we can actually use that data from, for example, wearable technology, someone’s engagement in a telehealth service, um, and really other positive lifestyle behaviors in a way that can provide more opportunities for those of mental health conditions to be recognized for positive lifestyle choices, to be recognized for their proactive engagement in managing their mental health. So there’s, there’s lots to be thought through. And I think, you know, before we get there, underwriters do do a fantastic job of, you know, that case based underwriting. If they get a, a case that comes across their desk, they will look at that bio psychosocial component and the lifestyle component and really dig into that case, but for providing that underwriting decision.

John  (39:59):

Thank you, Lisa. Um, so moving on, um, before we go to our next question, just want to remind our audience to submit any questions as we’re coming up to the Q and a portion of the webinar scene. So if you do have any follow ups or questions for our speakers, please do submit them through the Q and a tab, uh, on your screen. Um, so looking forward then at the opportunities that we have, uh, uh, in the future to, to better improve mental health and tackle some of the challenges our speakers have raised in the discussion so far, um, Lisa, I’d like to ask you what the, if O mental health working party, uh, is working towards, you know, what, what plans do you have for the future in this regard?

Lisa  (40:39):

Yeah, thanks, John. So the, I O a mental health working party. We’ve been working really hard, um, over really the past year and a half since we’ve been set up, um, firstly to pull together this, this week that we’ve had this week really spanning the, the insurance value chain there and exploring all those touch points for, for mental health. So I’d encourage, um, everyone on this call to really, um, look at those as podcasts and blogs that we’ve put out those, those articles, um, that have come out there, um, but going forward. So one of the pieces of work that I’m very close to is the data and modeling side. So we are planning to release the paper in the next few months, hopefully present it at, at the conference soon as well. So this is really exploring the data analysis. That’s underpinning the underwriting of mental health conditions in life insurance products. And then also considering the possibilities that, that improved data availability could open up in terms of pricing granularity and newer underwriting designs. So really we’re hoping this paper will be the starting point for more conversations here. So really for insurers, um, and others within the industry to take that paper away and then reflect and think, how can we further improve access to insurance products for those with mental health conditions.

John  (41:46):

Thank you, Lisa, and phrase that, and Kathryn, I’ll, I’ll open this one up to you. Um, both where do you see there is a really good opportunity right now for even collab, better collaboration or individual players, for example, to make positive change or at least start the industry down that road?

Fraser (42:06):

Yeah, I think, I think in terms of industry, I think there’s been a, there’s been a huge focus on mental health for the last 82 or three years, really. And I think that, you know, we’ve all been working particularly towards the ABM AB mental health standards that were be implemented by the end of last year. But I think the main thing John is that, that doesn’t mean that we, you know, we now stop reviewing this area, you know, I think, I think as we should be constantly reviewing and, and updating application journeys and questions and underwriting outcomes to, you know, to make sure that we are actually always moving towards the fairest outcome for customers with mental health conditions. Uh, I just go back slightly to the data that Lisa was talking about. You know, if you look at there’s a NHS report, which is quite interesting called preventing illness and improving health for all, and that talks about moving to a more holistic view of the healthy individuals, uh, meaning that doctors really consider addressing the risk of common mental health conditions through their NHS health checks.

Fraser (43:02):

Uh, so it’s clear that the NHS are concerned that mental and pH and muscle skeletal health makes up a large part of preventable disability in the UK that they aren’t addressed by the current NHS health check. So if that does change, then that could be a new source of data that comes out, which would allow more opportunities to understand how mental health impacts on people’s overall health and life expectancy. And I think that’s the type of things that we, we want to see. So we can actually use that information to, to provide better outcomes for customers as we move forward.

Kathryn(43:34):

Yeah. And I think, um, for me, it’s, it’s probably a lot around what we do in terms of if somebody isn’t able to get the insurances. So it is so like a bit more being open about those. Um, if, if there was a decline or if terms are very different to what we initially expected, um, something along the lines of trying to build, maybe even if it’s just with certain advisors or certain broker firms of some sorts, you know, some kind of processes where, you know, so with the client’s permission and things like that, Dean insurer can speak quite openly to the advisor to be able to really explain what’s happened and, and resent, you know, we always talk about it as well, the, the role of sign posting. So whether or not that is a case of, you know, advisors finding other advisors that they can sign post to, if they’ve got some more specialist policies or whether it not it’s people looking towards BS find a broker service so they can get to specific firms that they know can certainly step in and help a bit more.

Kathryn(44:31):

Um, I think it sort of like a lot of it sort like sitting down, making sure, and obviously each, each firm is obviously has to be individual and it wouldn’t be a case of an advisor coming into an insurance firm and saying, you need to do this and you need to do that though. I’m sure some advices you’d like to, but I think just sitting down is going right. Practically advisors, what is it that you need? And then for us all to then just like work out and go like, well, realistically, this is what we can and can’t do. And this is the resources we have and just try and have that conversation to try and make it as seamless as possible to make it as really efficient. Um, and so that people aren’t walking away just kind of lost as to, as to where to go.

John  (45:11):

All right. Thank you. You both. So now we’ve come to the audience question section of today’s webinar. Um, so I’m just going to kind of pick out some of the best questions we’ve had from our delegates, uh, today. And Lisa, I’m going to come back to you when you’re talking about data. Um, and someone’s asked what are the data sets that are currently being used. So can you offer any insights there?

Lisa  (45:31):

Yeah. Great question. Um, so there are a wide range of different data sets that that can be used. So one big data set, um, would be, you know, the, in insurers own internal data being mindful obviously of, of the sensitive nature of that. And, and you couldn’t disclose that wider. So you could use that data set to really make sure that, you know, the underwriting outcomes that, that you’ve put in place are, are being fair, that those claims ratios off of that, that underwriting decision are looking appropriate. So that would be one data set, um, a really important source of data as well, still remains population based study and medical research. So, you know, within, within insurance, um, each insurer would have their own data set there. Um, but really got to think broader. And if you want to wide access to insurance, you really do need, need to look at those population studies because the insurer will only have data on those people that they’ve accepted for insurance in the past. So I think those population studies and they could be long, you know, longer term longitudinal population studies within the UK population. They, they can be a really key source there. Um, there could be, yeah, really a whole wide range of, of data sets within that field. When, um, for example, underwriters will actually go and look at that literature pick out the most appropriate, relevant, um, recent credible studies that they can then use to inform that underwriting philosophy.

John  (46:47):

Um, so our next question is regarding the inclusion of mental health cover within health and protection policies and what impact that might have to improve treatment, seeking behaviors of policy holders. Uh, if anyone wants to share some insights on, on how they think that might work

Lisa  (47:04):

Bit of a tricky one, I’m happy to jump in. And so I guess from the private medical angle, um, so I know some providers in, in the industry, um, they have a, an exclusion on what they would call chronic conditions. So someone’s had a mental of condition for, um, for a few years. They wouldn’t be able to get that, that private, um, treatment for their mental health conditions covered as part of their, their private medical insurance. I know they were provided out there that have weighed that excluded specifically for mental health. And I think that’s a, a fantastic initiative that can wide up access. But what I would also say is as, as life and protection insurers, if we can offer support services or even assist with triage to, and signposting to relevant mental health support services and care, um, not, not just at point of claim, which is of course important, but also during the policy lifetime itself or, or even before that the application process, um, to touch on, um, you know, the point that Kathryn was raising earlier about the suicidal thought, that could be again, another opportunity for insurers to step in and actually signpost people to relevant support services at that stage.

Lisa  (48:05):

Think about product design and embedding, um, mental health support services within that as well throughout the lifetime of the policy. And then of course at that, that claim event, having mental health support services there, I think that, you know, that is really important, um, to have those support services. Um, I, I think, you know, we, a lot of us would’ve read recently that the NHS is very under pressure when it comes to, to mental health services right now. So I think the more that the insurance industry can do to step up here and provide some additional options for people when it comes to mental health treatment and, and support, I think that would be a really positive thing that we could potentially be thinking about as an industry. And I know there’s already been some really positive progress there, and I’d highly recommend the day four yesterday’s blogs and podcasts, um, from, from Monica Garcia and necessary there as well.

John  (48:52):

Thanks, Lisa. Um, so our next question does again, sort of touch on, uh, the, the sort of the treatment and the, the proactivity when it comes to mental health. And again, I’ll, I’ll open this one up to anyone who wants to take this, um, which is about that the, um, disclosing mental health conditions, um, can possibly represent a, a better, a risk, um, because of increased awareness of what this condition means and how it impacts on say physical health, um, in terms of, you know, the, the, the mental and physical wellbeing side of things. So, I mean, any thoughts on that sort of how that can be adapted and, and better at processed by the industry?

Fraser (49:29):

Yeah, I mean, I think, I think it’s always good to see, you know, customers that have an insight to their condition and are actually, you know, genuinely taking an interest in understanding their condition, how that progresses and, and trigger factors that, you know, just not just for mental health, but other conditions as well. So I think when it comes to the mental health angle, you know, we are looking to, to see customers that, you know, can maybe understand the trigger points where their mental health may be dips, uh, that could be difficult through some of the online journeys because, you know, you can’t get so as much necessarily granular information through some of the online journeys. But I think what we do look at is once we get to those moderate to severe conditions, you know, we do see, uh, individuals engaging with our, their healthcare professionals and, and talking through those kind of situations. So I think it’s good, useful for us to, to see that, uh, I don’t know, we would, I think it’d be a longer term approach could be moved into the actual question set. Uh, I don’t know what Kathryn thinks about that from an advisor perspective. I’m sure she’ll have a view.

Kathryn(50:34):

I always have a view. Um, yeah, sorry. If you saw jumping there, my dog started barking. The background on mute just terrified me. Um, so no, I think it depends. I think it’s really useful, but I think as a long as it actually makes a difference, so we, there are certain applications where we can put in that somebody is going, you know, they decide to take the dog for a walk. You know, they do certain things that exercise a certain amount and things like that. Um, the problem is, is that I have done. And so I tested those applications sometimes, and it actually didn’t make any difference to the end outcome. So if it’s going to be there, it needs something that makes an end outcome, but I do appreciate how hard this is as well, because we will sometimes find a site, the income protection space that those kind of questions can sometimes end up being in quite a favorable outcome.

Kathryn(51:19):

But then on the flip side of it, in some ways, um, it is just because it’s popped into my mind. Then you kind of then have the questions similarly on the physical side of the, so like you might get in a sense income protection, almost a bit of a reward in terms of the, the terms that you offer, because you are taking steps to protect your mental health, but say I have high mobility syndrome and I actively take the step of not going skydiving, a bungee jumping because I know I break a lot of bones in my body, but I don’t get that taken into consideration. So there’s so, you know, it’s so many intricacies to it often, but you know, I really hope, and I do think that there are very positive things that people should be taking into accounts. Sorry about this. My husband’s shutting him in the background, but you know, in terms of talking therapies, as I say, there does need to have be the data there to make it really possible of insurer are taken into account. But to me that is, that is almost the equivalent as say, going to the gym and if we can reward people for being healthy and looking after the help that way, then there needs to be at some point, I think some kind of consideration up to the mental health space too.

John  (52:23):

Thanks, Kathryn. And, well, probably we’ve got time for just one more question before we come towards the end section of today’s webinar. Um, so what I’ll ask, we’ve got a question here about accessibility, which again has been one of the topics, um, from our, uh, bog authors and our podcast, uh, earlier this week. And the question is, is there more we can do as an industry to make protection more accessible for people who have experienced financial difficulties that have arisen as a consequence of mental conditions that may have. So again, I will open it up to whoever wants to provide an answer to that one.

Lisa  (52:58):

I’m sure there is more like if we, if we reflect as an industry with, with cross collaboration and effort, I think that is a really important question. So, so one of the things I noted down that we were talking today that we haven’t yet touched on is that really strong link between financial health, mental health physical, and I think as financial services providers with insurance, you know, we, we really in the center there of one of those links. So I think, yeah, definitely a, a great question. I don’t have an immediate answer, but I would say, you know, going forward, let’s, let’s take that as a way this, this group altogether, everyone start onto the webinar and think around that question and challenge ourselves to think what more we can do to really, you know, make sure that we are, we’re getting, um, good support and good outcomes for, for all customers, particularly when it comes to mental health and, you know, even perhaps even more so when it comes to the, the interlink between financial health and mental health as well,

Kathryn(53:44):

I was going to say, it’s not an exact answer, but we did have a little bit of this, um, sort of popup during COVID, um, as a bit of a reaction, obviously to a lot of people who are maybe losing their jobs or maybe, you know, unable to go out due to their mental health and specific concerns and worries. And what we found was that, you know, insurers are trying to do things like, um, premium payments holidays, so to try and help people, um, there will have obviously been some people in that, um, amount of people who would’ve been unable to work due to their mental health. So there have been some steps in terms of trying to really support people with mental health to, to maintain and continue these policies if they are facing financial difficulties. Um, but in terms of actually sort like that access in terms of trying to get something it’s, it probably comes down to, um, that awareness raising and the education of, you know, especially as well, someone’s really in that position, possibly speaking to an advisor rather than just trying to go through it on their own, and then maybe not picking the right insurer at the first instance, or maybe ending up with a policy that they, that isn’t in a sense of long term.

Kathryn(54:48):

Great, because obviously you can get some insurances that are incredibly cheap at the start, which for some people might work quite well, but they either have a very short term or they will suddenly start to significantly increase as they get, um, as people get older. And that’s something that I’m seeing quite a lot at the moment in terms of people who, and now maybe it’s getting towards their fifties and sixties, who’ve been given possibly like reviewable age banded type hold of life policies that are now starting to get to the point where things are massively becoming financially, you know, it’s impossible for ’em to continue them. And then that knock on mental health effect that they’re then feeling,

John  (55:25):

Thank you, Kathryn. Um, so now we are going to come towards the end portion of two day’s webinar and just with one eye on the time I’d like to ask each of our speakers to highlight one key takeaway from this week’s content that they believe is incredibly valuable for today’s listeners to take away and consider going forward in terms of making positive change happen, um, regarding mental health. Um, so Kathryn, I’m going to come to you first. Um, so what would be your one highlight from this week?

Kathryn (55:53):

I think, uh, a big thing for me is the fact that there’s just, there’s no Mon right way, you know, especially if we go back to Tuesday’s podcast where we talk about the comparison site, the advised and the non-ad advised boots then needs to be multiple boots for people to take. We can’t just box people with mental health Condit into one kind of area and say, well, this is probably the best way for all of them people, insurers, advisors, we all need to be to adapt and, you know, be able to really help people based upon their specific individual needs to access the insurance.

John  (56:24):

Thanks, Katherine and Fraser, what’s your highlight from, from this week?

Fraser (56:27):

Yeah, I think for me having listening to the other podcasts this week, you know, I’ve, I’ve generally been intrigued by the advise versus non-ad advised conversation on Tuesday. Uh, there was a similar topic at the cover protection summit, uh, and I generally find a fascinating subject, uh, when you get them on this team room. Uh, I think what’s stood out for me this week though, is everybody involved, uh, genuinely wants to make a tangible difference when it comes to mental health, uh, whether that’s advisor actually business development, you know, underwriting, uh, you know, we know that there’s different route for customers to take cover. You know, we’re also addressing the actual data gathering pro, uh, and we are also all interested in generating the right underwriting outcomes, uh, for some or supporting customer should need to make a claim. I think for me, it’s just been really, you know, great to see such a wide spectrum of topics being discussed and, you know, the collaboration is, is really important as we progress us.

John  (57:21):

Thanks. And finally, Lisa, what’s your key takeaway away from this week for our audience?

Lisa  (57:25):

Yeah, my, my key takeaway really build on what Fraser was saying. So having been involved so far with the IFOA mental health working party, um, really getting those cross-industry viewpoints that, you know, as an act wouldn’t necessarily normally be as close to. So I hope this week that we really highlighted the wide range of touchpoints between mental health. And so I’d really strongly encourage us all to build on and strengthen the cross industry collaboration so that we can really continue to work together to further improve the insurance experience for people with mental health conditions.

John  (57:58):

So Lisa, Fraser and Kathryn, thank you very much for joining us today and sharing your insights on this week’s content and this important subject as we go forwards. So as we come towards the end of today’s webinar and indeed the mental health in life insurance awareness week, we’d like to finish on a positive message. The protection industry has in recent years taken great strides to breaking down the stigmas attached to mental health conditions and adapting processes. To ensure more people are able to secure both the cover and the support they need. Mental health touches upon every facet of protection insurance. And as we’ve heard throughout the podcast and the blogs this week in order to achieve the industry’s overall objectives of closing the protection gap and providing people with the right cover and the right support at the right time, keeping that dialogue going is crucial.

John  (58:47):

We also want to encourage actuaries to begin making a positive change within their own working environments, by reaching out to colleagues across your organization and the wider industry, focusing on even small things that can be done that will make a vastly positive difference further down the line because after all great endeavors do not happen overnight, they are offered incremental and require constant efforts to maintain. But the industry has already started along this journey. And it’s now up to all of us to make sure that we keep the momentum going to quote the late Ruth Bader Ginsburg real change. Enduring change happens one step at a time on behalf of the IOFA mental health working party in today’s speakers. Thank you for listening. And remember that you can find all of these sweet content online to read and share as much as you like goodbye.