Towards parity in mental health insurance coverage

Out-of-Pocket payments are the most inequitable way to finance health care, especially mental health. Yet, it remains one of the main mental health financing methods in Lebanon. In addition to fear of stigma, individuals with mental disorders commonly suffer from unemployment and poverty. Therefore, OOP payments can be more of a severe obstacle for them than it is for physically ill patients. It is imperative to find more equitable ways of financing mental health that will decrease the OOP share.

As a joint effort among the Department of Psychiatry at the American University of Beirut Medical Center (AUBMC), Lebanese Psychiatric Society (LPS), Lebanese Psychological Association (LPA) and Issam Fares Institute (IFI), a national roundtable discussion was held on April 22nd, 2013 under the title “Parity in Mental Health Financing for Lebanon”.

This event set the stage for a policymaking initiative that aims at establishing more equitable mental health coverage in Lebanon. The roundtable discussion aimed at: 1) exploring how mental health is currently financed, 2) identifying options for achieving parity, and 3) prioritizing the proposed options for future implementation. It grouped key stakeholders from different domains: governmental agencies, professional associations representing providers and insurers, experts in health care finance, NGOs, ethicists and lawyers along with consumer and advocacy groups.

Two discussion sessions tackled: 1) the question of how to improve the current public financing schemes and eliminate the present disparities in coverage, and 2) how to partner with the private insurance sector to achieve more comprehensive mental health coverage. The priorities arrived at during the discussion will inform future steps of this initiative which will be followed up on by Embrace and the Department of Psychiatry at AUBMC.

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  • Unlike public funds in Lebanon, private insurance companies and mutual funds, which collectively cover 315,000 individuals, exclude mental health services from their policies.
Mental health and primary care

In April 2014, the Lebanese Ministry of Public Health launched the National Mental Health Program. The pillars of the program are:

  • Pillar 1: Integration of Mental Health services within Primary Health Care
  • Pillar 2: Community mobilization
  • Pillar 3: Access to advanced care
  • Pillar 4: Rights of the vulnerable groups

One main priority of the program is the integration of mental health into primary care, linkage with the secondary level and referral to tertiary care. To support this priority, Embrace participated in a national policy dialogue organized by the Knowledge-to-Policy (K2P) Center entitled “Securing access to quality mental health services in primary health care in Lebanon.” Through its participation in the dialogue, Embrace represented the patient and patient advocate’s voices. Many of the deliberations that took place during the dialogue will inform the work of the National Mental Health Program.

Currently, the Embrace Lifeline, the National Emotional Support and Suicide Prevention Helpline of Lebanon is in collaboration with the National Mental Health Program (NMHP) and serves under the national strategy for Suicide Prevention set by the program.

Ministry of Public Health (2014). National Mental Health Program Newsletter. (2nd issue). Beirut: Lebanon. 
Yehia, F., El-Jardali, F. K2P Dialogue Summary: Securing Access to Quality Mental Health Services in Primary Health Care in Lebanon. Knowledge to Policy (K2P) Center, Beirut, Lebanon, May 2014.

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  • Integrating mental health into primary care is a priority for the Lebanese Ministry of Public Health.
Mental health act

In 2013, the Lebanese Ministry of Public Health in collaboration with the National Committee for Ethics and the Institute for Development Research Advocacy and Applied Care (IDRAAC) have drafted a mental health law for the protection of persons with mental illnesses. This law tackles several aspects such as:

  • The right for care in the least constrictive manner
  • The right for community care
  • The right for protection from abuse
  • The right for protection by the judicial system when involuntary admissions to psychiatric wards or hospitals.

The draft law was discussed in a public debate organized by The Legal Agenda on September 23rd, 2014 and attended by mental health specialists, activists, NGOs, universities, and civil society representatives including Embrace. Several amendments were proposed to ensure an up-to-date mental health law in line with human rights and relevant international conventions. A final draft with all the suggestions by stakeholders incorporated will be given to the Ministry of Public Health who will in turn submit it to the Parliament as soon as possible.

Find out more here:

Ministry of Public Health (2014). National Mental Health Program Newsletter. (2nd issue). Beirut: Lebanon.

  • Civil society organizations are lobbying for new mental health legislation that protects the rights of persons with mental illnesses.