Since the "mental health reform" law passed the waiting times for mental health care have only lengthened and no one is supervising the provision of services and the quality treatments. What awaits those who need help or emotional support in Israel? You don’t want to know.
Who doesn’t know someone like Ruthie?
Ruthie (pseudonym), 32, grew up in a home where she was exposed to mental, verbal and financial violence by her father. Her childhood and young adult years were fraught with social difficulties, attention and concentration problems and low self-esteem.
After the army, she sought psychological treatment through her health fund. Despite the obvious need, there were no available appointments. Ruthie waited for more than a year, and then she gave up.
With impressive inner strength she studied for a bachelor’s degree and graduated with honors, then began working with at-risk youth. Yet due to the low salary and financial difficulties she ran into, she was forced to leave the field she loved.
Since then, and over the past five years, her mental state has deteriorated.
She switches jobs, occasionally signs up for unemployment and experiences anxiety attacks with increasing frequency. She recently became pregnant and this motivated her to try again "for the future of her children," she said.
Ruthie went to her local health clinic in Holon and was told that there was a wait of a year and a half. The clerk was shocked when Ruthie nevertheless asked to be put on the waiting list. Ruthie did not give up and also turned to the independent therapists that the fund offers, with a deductible of NIS 130 per session. She too has repeatedly heard that they have no place and she is expected to wait many months.
And so, we see an endless cycle. Ruthie has no money for a private psychologist and meanwhile her mental state is deteriorating, her employment situation is affected, and the hope of breaking this cycle dwindles.
Less than one-fifth of those in need of mental health care through their health funds receive it, and the waiting time can range from a year and a half to two years. More than six years ago, the "Mental Health Reform" act passed with great fanfare. One of its key points was increasing availability and shortening waiting times for care. Six years have gone by, yet the lines are getting longer and longer.
The committee chair has had six years to reduce waiting times
The answer is very simple and therefore also very frustrating. When the "mental health reform" passed, the Health Ministry removed the small amount of regulations for the mental health field that allowed the health funds to do what they wanted for mental health, which was practically nothing. Past dictates from the director-general which regulated what a mental health clinic is, who the staff is, how it’s built, etc., have been canceled and new procedures weren’t established. For more than six years the draft of the reform protocols has been floating around the offices of the chair of the Mental Health Committee, and again and again it hasn’t been approved.
And the truth? Maybe it's good that it’s not approved, because this is not the reform that will save mental health care. Although the draft lists binding waiting times - three weeks for initial receipt and one month for treatment - these regulations are full of loopholes.
1 - Treatment is defined as at least two sessions.
In such a situation, where the health funds are required to meet a set waiting times for an undefined service, what prevents them from giving hundreds of people only two to three sessions and show a drastic improvement in the "waiting time for treatment" index?
2 - The services that every clinic must provide aren’t defined, even though a state health law does define services, which are regulated by licensing and supervision by the state.
A medical department memo from last month, for example, also sharpens the need enshrined in state health law to provide a clinical psychological service in mental health (individual, couple, systemic and group therapy, use of psychological tests, staff training and preventive interventions). However, there is no similar reference at the level of a mental health clinic in the proposed draft. If so, lines for which service will be enforced?
A few weeks ago, Mark Musfir, a clinical psychologist and attorney, filed a petition in the Supreme Court against the health minister and director-general of the Health Ministry demanding that this draft, which was never published or implemented, be published and anchor standards for the treatment of mental health for the Israeli population. The health minister is expected to give an answer soon.
He has two options: To continue declaring the importance of mental health, when in practice, apart from directing local budgets to psychiatry alone, there is no real work to change the system, or to return to the table, convene all relevant professionals, exercise real regulation on the funds and issue firm protocols for three things:
1 - wait times for treatment
2 - professional level of treatment and
3 - professional judgment in the manner of treatment.
What is right for the health of the body should be right for the health of the mind. As the title of the mental health reform states: body and mind are one.
Dr. Yarden Mendelson is an expert clinical psychologist, coordinator of the field of public service in the Israel Psychological Association and a leader in the Clinical Psychology Forum. This article was first published on The Jerusalem Post's sister website, Walla!