Managing Israel’s psychiatric hospitals

Along with Israelis across our nation, I was stunned and deeply disturbed by the news that last week law enforcement raided a psychiatric hospital in Petah Tikva and detained for questioning 75 staff members as part of a year-long investigation that uncovered widespread sexual and physical abuse at the facility.

Two days after the raid, the hospital – which had a patient population of about 150 – was shut down, and patients were transferred to other facilities throughout our country.

This is not the first case of abuse at an institution. Sadly, there have been many. As unsettling as these reports are, the investigation also showed that there were others who did not directly participate in the abuse, but knew it was happening, and did not speak up.

So much about the institutional environment and the way it operates – with its impersonal procedures, its creation of dependence on the part of those it serves, its separation from society, and its dearth of community – enables and supports a culture where abuse can be practiced with impunity.

In Israel we need to pick up the pace and dedicate far more emotion, focus and resources to creating more options for care in the community. It is in this model and paradigm in which individuals are afforded the best opportunities for growth and independence.

More than 40 years ago the United States faced its own Neve Ya’akov scandal – one that resulted when the young investigative reporter Geraldo Rivera exposed physical and sexual abuse at the Willowbrook State School, a New York state-run residential facility located in New York City.

The 28-minute video documentary – Willowbrook: The Last Great Disgrace – led to massive policy reform and, ultimately, government funding policies that promoted and supported community-based services for people with disabilities.

In my native Massachusetts in 1972, a lawsuit was filed in federal court by parents of children with developmental disabilities living in state “schools.” Judge Joseph L. Tauro made an unannounced visit to the Belchertown State School and found appalling conditions.

Under Judge Tauro’s supervision, which lasted for many years, these institutions were cleaned up and ultimately closed.

Massachusetts has one remaining institution that serves a very small number of adults with developmental disabilities, and it is expected to close very soon. It does still have state-run psychiatric hospitals.

A more recent federal lawsuit in the US, called the Olmstead case, has led to a massive shift to community care across the US. Individuals who had lived in facilities for decades have now been given the proper support for community living and for the first time are enjoying their independence in the community.

The arguments about why we must keep institutions open ring hollow. Some people insist there are “difficult cases” that require institutionalization. But the fact is that countries around the world – with the US leading in this area – are closing institutions and more and more are caring in the community for those with even the most significant disabilities.

Indeed, in the US, there are 13 states, plus the District of Columbia, which have eliminated all public institutions for people with developmental disabilities.

I am not suggesting that transitioning away from institutional care will eliminate all abuse. But it is harder to commit such acts, and harder to hide them, when people leave home every day to work, participate in day habilitation, or to go to school in the community.

It’s harder to commit and hide abuse when people with disabilities are treated by doctors and therapists with offices in the community. It’s harder to commit and hide abuse when local police and safety officials protect people with disabilities along with all other members of their community.

The media reports that Dalia, the mother of a 24-year-old man who was a patient at Neve Ya’akov, told investigating authorities “we complained to the administrator... we live in fear that tonight he will be hit or they will inject him. We don’t sleep.”

We trust that the authorities will conduct a thorough investigation of what occurred at the hospital, will uncover the truth, will identify the guilty, and will make sure justice is done.

But until Israel takes its place alongside other progressive countries and commits to a national policy of community-based living for everyone, we should – like Dalia, the mother of the patient at Neve Ya’akov – all have a hard time sleeping.

The writer is president of the Ruderman Family Foundation.