Litzman's plan for segregated psych hospitals faces stiff opposition

Litzmans plan for segre

December 2, 2009 02:13

Deputy Health Minister Ya'acov Litzman's idea of eventually hospitalizing only women at the Eitanim Mental Health Center in the Jerusalem Corridor and only male patients at the Kfar Shaul State Mental Health Center would probably end up costing more money and be very difficult to manage, according to Dr. Yehezkel Caine, director of Herzog Hospital in Jerusalem. Caine, a modern Orthodox Jew, was reacting to the report in Ha'aretz Tuesday that Litzman wants to allow patients of only one gender in the two Jerusalem-area psychiatric hospitals - and perhaps other institutions around the country. For about a quarter of a century, Herzog's psychiatric beds have been allocated to women on one floor and men in a separate department on another. The patients never meet in the hallways, wards or dining rooms, said Caine. He recommended that model for institutions in which women have been victimized by male patients or those that suffer from problems of "immodesty." Litzman told The Jerusalem Post on Tuesday night that he is consulting with professionals in the ministry's psychiatric services department, where he "has received support" for his program. He disclosed that he intends to begin with separate departments within Eitanim and Kfar Shaul, but eventually to separate the sexes institutionally. "I will discuss the plan with the works committees as well," he said, "and I will not spend any additional money on housing the men and women patients separately." He added that the reason for his plan was "out of consideration for patients' needs and without harming their treatment." Regarding criticism by the Israel Medical Association and others over his recent decisions related to religious positions - such as personally not recognizing lower-brain death as the moment of death - Litzman said he felt his opponents, even observant Jews, are "anti-haredi." The deputy minister said he has heard from families who refuse to institutionalize relatives out of concerns over what could happen in a mixed psychiatric hospital, but he did not claim that there have been any problems at Herzog, with its completely separate departments. Caine suggested that if Litzman wanted complete separation of the sexes to ensure modesty and prevent sexual abuse of women patients, he could adopt the Herzog model. In fact, some time before Litzman - a Gur hassid from the Agudat Yisrael party - was named deputy minister, he stopped by the hospital in Jerusalem's Givat Shaul neighborhood and asked questions about the separate departments. Caine said that not only haredi and some modern Orthodox Jews want separation of the sexes within psychiatric hospitals, but also Muslims and many secular Jewish families. The Herzog director has been upset since Litzman took the helm at the ministry that due to budget cuts, his hospital has lost state financing for five of its then-75 beds. "We treat more than 70, but we don't get paid for the rest," he declared. "We are now ready to have more in the separate women's and men's department. We are building now and will have significantly more space in three years." He said that psychiatric in-patient care in the Jerusalem area is "a mess" due to ministry cutbacks, and that the shortage of beds means overcrowding or people who need care "roaming the streets" instead. "I am totally opposed to separate-sex hospitals," said Caine. "The main reason is the staff. There isn't the same number of men as women, and the ratio changes. Most hospitals have different sections for different levels of clinical severity: closed wards, semi-closed wards and the chronically ill. If sexes were completely separated, twice as many would be needed. Our sex-segregated departments have only closed wards and semi-closed wards, while other hospitals have three or four sections. "And if the ministry is considering using doctors to treat patients of the same gender, that could never happen. It would be very difficult to have only female nurses for female patients, and even more difficult to have only male nurses for all male patients, as there are very few male nurses and many more male patients." Most other Jerusalem psychiatric departments, he continued, are mixed in gender, but with men and women in different rooms. In Kfar Shaul, the closed wards are divided by gender. "In various mental hospitals around the country, there have been a few cases of rapes. Some argue that it is easier to manage patients in a single-gender environment," said Caine, "but others say the mixed departments are better. I don't know of any hard scientific evidence one way or another." But because of the largely religious patient population, Herzog has found separate departments to be best. He believes that "the separation came about long before he joined the hospital because this was considered suitable for the observant patient population we get." Herzog has not had cases of rape or other cross-sex violence because of the completely separate departments. "Modesty lies in the beholder," Caine opined. "Separation by hospital is unnatural; it would waste a lot of money. Society is mixed. It's sad when there are isolated departments, but having different planets would be very bad." A psychiatrist who directs another public psychiatric hospital, insisting on anonymity, told The Post that he regretted Litzman "did not follow the policy of former health minister Nissim Dahan," a former Shas MK who is widely regarded as having been one of the best health ministers ever. "Dahan is haredi, but he never introduced his private religious views into his decisions. Litzman has done this often, and this is not the way to set public policy. Next will he want to have only male patients treated by male doctors and nurses? Will he want separate hospitals like extreme haredim want separate buses and sidewalks?" Dr. Yitzhak Ziv-Ner, chairman of the State Physicians Union, wrote to Litzman saying that his plan was "unthinkable... illogical... and violated Basic Laws, and there is no such precedent in the Israeli health system. As it is, psychiatry has already suffered from prejudice, neglect and numerous shakeups in recent years. We worked hard, in cooperation with the Health Ministry, to stabilize the profession and have reached understandings on basic principles... Any change that would affect this is liable to damage the delicate balance we have achieved." The Movement for Quality Government demanded on Tuesday that Litzman immediately freeze his plan to separate psychiatric hospitals by gender, saying it was "unreasonable and based on non-professional considerations. In 21st-century Israel there is no room for separating men and women [by institution]. There is full sexual equality that is not dependent on the views of one man." Principles are determined by democracy, Basic Laws ensuring equality and the High Court of Justice, he added. The directors of the Eitanim or Kfar Shaul hospitals were unavailable for comment.

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