Mental illness

People diagnosed with manic depression are known to experience severe changes in their moods. This ranges from periods of very low depressed moods to elation, or mania.

These occur almost daily but changes between highs and lows are extreme. They can result in damaged relationships, poor job performance and even suicide.

Manic depression can be treated and people who have the illness can lead a normal life but they must be medically managed throughout.

Euphoric

Mania is described as being a manic phase where the person will feel euphoric, on top of the world. People are known to lose social inhibitions and feel important. They will deny anything is wrong with them.

When they lose this feeling they will become very unhappy, see everything as a struggle and see no positives in their lives. These feelings may lead the person to contemplate suicide.

People with manic depression will first be seen by a psychiatrist who will conduct an in-depth assessment of the treatment and support needed for the individual.

These treatments help stabilise and prevent mood swings. Depending on the severity of the symptoms admission to hospital may be required to make sure that the client gets the correct supervision and treatment. Otherwise anti-psychotic drugs, anti-depressants and continual psychiatric review will be used.

Schizophrenia is a chronic, severe and disabling brain disease. Often people believe, incorrectly, that schizophrenia means having a split personality.

It is diagnosed based on positive (acute schizophrenia) and negative (chronic schizophrenia) symptoms.

Positive symptoms are delusions, hallucinations, disorganised speech and thinking, and signs of chaotic behaviour.

Negative symptoms are usually noted by family members as the sufferer tends to show subtle changes in their everyday behaviour.

These changes include a loss of energy, poor communication and loss of motivation.

Treatment for schizophrenia includes anti-psychotic drugs, which reduce the symptoms and allow the patient to lead a more normal lifestyle. Other forms of treatment include rehabilitation programmes and talking through problems with a psychiatrist.

In more severe cases hospital admission may be required and, only in exceptional circumstances, electro-convulsive therapy and brain surgery may be needed.

Manic depression affects one in every hundred people aged 18 and above each year.

It can affect anyone at any time and can occur in all types of people. Between episodes, people with manic depression are free of symptoms but up to a third will have some residual symptoms.

A tiny amount of sufferers encounter chronic continuous symptoms regardless of any treatment.

Sufferers of manic depression are more likely to die from suicide or circulatory disorders.

Evidence shows that people treated with long-term anti-depressants - on their own or combined with anti-psychotic drugs such as lithium - have lowered suicide rates even though they were more severely affected.

Suicide is a higher risk for people in an early stage of manic depression as they may not have been diagnosed as having the condition and not received any treatment.

Schizophrenia affects approximately 1% of the population during their lifetime.

Suicide

Mortality rates are two to three times higher than those of the general public and research has shown that there are higher deaths from natural and cardiovascular causes, suggesting schizophrenics are less healthy because the illness may have caused them to adopt an unhealthy lifestyle and not to seek medical help.

Between 30 and 40% of people with schizophrenia will attempt suicide at least once.

Out of this one in 10 will actually commit suicide. Young men with the chronic form are more at risk of suicide.

Schizophrenia tends to affect men and women equally. Males are mainly affected in their teens and early 20s. Females tend to suffer later, in their 20s and early 30s.

About a quarter of people who suffer from schizophrenia will recover within five years.

Around two-thirds will experience fluctuating symptoms on and off for many years and up to 15% will experience long-term incapacity.

Underwriting implications

Application forms in which the clients indicate that they have or have had a severe form of mental illness means a rated policy is inevitable from an underwriter's point of view.

In some cases terms may be delayed or not even considered.

An underwriter will always try to obtain full hospital reports from the client's doctor to assess the severity of the illness.

Additional benefits such as total and permanent disability and waiver of premium will often be declined.

For life and critical illness applications for a client with manic depression, or bipolar disorder, doctors will look at when the client's last episode was and if the symptoms are recurrent.

If symptoms are present a life office would tend to look to delay the application.

An application may be considered only when the applicant has been symptom-free for at least a year.

If the client has only had one episode an underwriter will need to know when this was.

A rating would be applied if the episode was within the last four years.

After this period an underwriter would need to assess how long ago these symptoms were and how severe they were.

Each case is assessed individually as no two cases are the same. Recurrent episodes are treated with higher ratings.

Also, declinature would be considered in severe cases with no signs of improvement.

For clients with schizophrenia the underwriting would tend to be the same as for manic depression but the ratings are much more severe, especially for clients under 30 who have had multiple episodes.

In these cases rated premiums are only available if the condition is fully controlled.

If there is also a history of drug or alcohol abuse, terms are unlikely to be offered. In cases where there have been multiple episodes which have not been successfully controlled the application will be declined.

If there is a history of suicide attempts in manic depression cases or schizophrenia an added extra rating will be applied depending on how recent the attempts were.

If it was under a year ago the firm would look to delay the application, and a rating would be applied up to five years after the occurrence.

If there has been a history of more than one episode a case may be declined.

Income protection applications from manic depression sufferers would only be considered if there were many favourable factors, such as the sufferer not having been an inpatient for more than two weeks and not within the last five years and having had no time off for the last three years.

Even with these factors there is no guarantee terms will be offered - but if they are they will be with an exclusion for all mood disorders.

For cases of schizophrenia for income protection terms are less likely to be offered than for manic depression.

For a sufferer to be considered a client must only have had one episode and it will only be considered five years after the occurrence.

Again, though, similarly to manic depression, terms are unlikely to be offered and, if they were, an exclusion of mood disorders would be placed on them.

Sources:

Swiss Re Underwriting Manual - SURE