Twenty-six years after a state commission proposed it and two decades following the launch of the National Health Insurance Law that was supposed to implement it, responsibility for mental health care is being transferred from the Health Ministry to the four public health funds.
The shift, to be carried out starting on July 1, was announced Monday at the ministry’s Jerusalem headquarters by Deputy Health Minister MK Ya’acov Litzman, who opposed the reform during his previous tenure in the ministry until 2011. Then, at a health conference at the Dead Sea, he announced that he had decided to back the reform, because “the situation is not good and the alternatives are worse.”
The press conference was attended by Litzman, outgoing ministry director-general Prof. Arnon Afek, incoming director- general Moshe Bar Siman Tov, and ministry psychiatry chief Dr. Tal Bergman-Levy.
Although the Histadrut labor federation has declared a work dispute over the reform and various mental-health professional groups have objected to the way the ministry is carrying it out, Litzman declared that “there will be no delays” and that various changes in the new system would probably be carried out as lessons are learned during implementation.
The purpose of the mental health reform, he said, is to significantly improve the quality, accessibility, and availability of mental health services. Mental health therapy will be recognized as part of medical treatment.
The family physician (or pediatrician for minors) will probably refer people in need of care to existing or new mental health clinics, or patients with acute conditions can go directly to outpatient clinics and emergency rooms in psychiatric hospitals if needed.
The State Commission to Improve the Health System, headed in 1989 by then-Supreme Court justice Shoshana Netanyahu, recommended such a change, and the National Health Insurance Law of 1994 was originally meant to add both psychiatric and geriatric care to the basket of health services in addition to regular medical care. But it was considered too complicated or expensive to implement all three, and only general medical care was included.
Under the aegis of the budget-constrained ministry, many facilities seriously declined, and Litzman saw on surprise visits that some were especially shoddy and shameful.
So far, the four health funds have opened 61 new clinics, 28 of them for children and teens.
Many of the new facilities, said Afek, are in the periphery of the country, where patients queued up too long to see a psychiatrist, psychologist, or other mental health professional.
When care was offered by the Health Ministry, he said, and when its budgets ran out before the end of December, patients waited for their turn for months. In 2012, when the order was signed, there were 52,000 patients treated, but in the past year, almost 120,000 are under treatment at health fund mental health facilities.
The reform will especially benefit not only the poor but also ultra-Orthodox Jews and Arabs who used mental health services much less than they were entitled to.
The health funds will offer mental health diagnostic services, psychiatric assessment, counseling, psychotherapy, crisis intervention, individual, family and group care, and home visits.
The goal is to increase the proportion of treatment from 0.8 percent of minors to 2% of this age group and from 1.8% of all adults to 4%. The number of treatments patients will receive will be at the discretion of therapists based on needs and the situation. Family members will be entitled to sessions on how to cope with their mentally disturbed relatives.
Bergman-Levy said that there is no need to be diagnosed with a serious psychiatric illness to get treatment. Most patients suffer from ordinary stresses of daily life or from light or moderate psychiatric disorders and can be treated in the community, she added. Asked about the effects on mental health of last year’s Operation Protective Edge campaign in Gaza, that involved constant sirens and rocket attacks, she said that although statistics have not yet been finalized, there were signs that more people, especially in settlements near Gaza, needed mental health treatment than before the war.
As part of the transfer of responsibility, the health funds will have a NIS 1.9 billion annually at their disposal for mental health care, including some NIS 420 million more than the ministry previously had for these services. Patients will pay only the small quarter charge for seeing a specialist physician. If an individual prefers to go to a private mental health professional, he will pay NIS 130 per visit.
Litzman and Afek said that the ministry and an external body will supervise implementation of the reform and that dissatisfied customers may complain to the Health System Ombudsman or to the *5400 Kol Habriut number to file a complaint.
A media campaign will soon be launched by the ministry to inform the public about the reform and how to use its services.
In addition, a public conference planned in cooperation with Lishma, which represents individuals with emotional disabilities, will be held. Mental health teams will be invited to informational meetings, and the ministry and the health funds will publish details of the reform on their websites.
The insurers will keep basic information on the patient’s treatment history and condition in secure conditions, but if a patient does not want information released, it can request this.