Psychiatrists told not to cooperate with Health Min. over new guidelines

There's a big debate about isolating and restraining psychiatric patients.

December 31, 2017 18:32
2 minute read.
mental health

A team of doctors discuss mental health (Illustrative). (photo credit: INGIMAGE)


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The Israel Medical Association has forbidden its member psychiatrists from participating in committees and other discussions aimed at implementing a circular issued by Health Ministry Director-General Moshe Bar Siman Tov regarding the reduction in restraining and isolating psychiatric patients.

The IMA charged that not only were the proposed changes impossible to carry out given the reality in psychiatric wards, but Bar Siman Tov’s circular used “disparaging language” relating to psychiatrists, their professional activities and their intentions.

“The circular must be fundamentally changed in accordance with the recommendations and conclusions reached by the IMA,” said association chairman Prof. Leonid Eidelman. Until the implementation of changes approved by the IMA, it will bar participation of psychiatrists in any meetings that do not involve ongoing work or committees or discussions that have existed for many years.
Last week, an urgent discussion was held at the IMA’s headquarters, attended by directors of the psychiatric hospitals and the chairmen of the physicians’ committees and the Israel Psychiatric Association. During the course of the discussion, the existing situation was examined and recommendations were formulated, which were agreed upon by all those present from the field of psychiatry in all its aspects, at all levels – management, scientific and professional decision-making and daily work in the field, the IMA said.

“The goal of all the psychiatrists is to reduce the number of cases and duration of mechanical restraining and isolation of patients during psychiatric hospitalization, however, in some cases and in exceptional circumstances, there is no choice but to use these measures to make treatment possible,” the IMA said, adding that there has been a decline in the use of these measures in recent years. The IMA insisted that the circular issued by Bar Siman Tov – an economist and not a physician – could not be applied in its current version and under the existing conditions.

For psychiatric treatment around the country to be improved, said the IMA, 100 additional isolation rooms must be constructed, and additional psychiatrists and nurses must be added.

The IMA noted that a hospital psychiatrist is responsible for several departments (sometimes five or six), with 300 to 360 patients in them. Considerable walking is often needed to reach them all. Some of the director-general’s requirements were impossible to carry out because of the shortage of psychiatrists in the institutions, the IMA said, calling on the ministry to renew bonuses for hospital residents that agreed to specialize in psychiatry and to give extra-risk pay to all psychiatrists.

Asked to comment, the ministry spokesman said that “After thorough staff work, plus activity of a public committee, the director-general issued a draft circular that sets guidelines for reducing restraining and isolation of patients in the mental health system.” He added: “The ministry recognizes the shortage of resources and is constantly working on the issue. Funds were allocated to psychiatric hospitals during the year, including designated standards for reducing tying of patients, and additional resources will be allocated later.”

The spokesman continued that, already in 2017, “hospitals curtailed the restraining of patients, but the necessary changes in the psychiatric system are required, and we are determined to continue reducing restraining of patients.”

The ministry said it is willing to hear suggestions from the hospital psychiatrists but would not be dictated to or negotiate on the issue.

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