(photo credit: Judy Siegel)
For the first time in the state's history and 13 years after it was supposed to have been enacted and after six delays in implementation, responsibility for mental health services will be transferred from the Health Ministry to the four health funds starting in January. According to international statistics, one in four will suffer from emotional disturbance at some time in their lives.
The revolutionary program, which has overcome opposition from the Treasury, most staffers in the psychiatric services and patient groups, is due to be approved Monday morning by the Ministerial Committee on Legislation. From there, it is due to be sent to the Knesset for plenary and committee discussions and, when passed as expected later this year, implementation will proceed gradually over the next four years with added funding from the Finance Ministry.
Health Minister Ya'acov Ben-Yizri, who had held several previous press conferences on the subject during his 13 months in office, presented the program in a press briefing at his Jerusalem office on Sunday. At his side were ministry director-general Prof. Avi Yisraeli, mental health services director Dr. Jacob Polakiewitz, ministry deputy director-general for manpower Dov Fast, National Mental Health Council chairman Prof. Moshe Kotler and representatives of patients and their families.
Agreements have been reached for implementation with representatives of the psychiatrists, psychologists, nurses, social workers, occupational therapists and others who work in inpatient and outpatient psychiatric facilities, but the Israel Medical Association - which has long opposed it - has not voiced its support yet. The last deadline for implementation was last January 1, but it was postponed due to the lack of a Knesset bill to regulate the transfer and set down the responsibilities of the insurers.
The minister promised that not a single mental health worker would be dismissed because of the plan and that no community facilities would be closed - at least until a comparable facility supplied by the health funds would replace it in the same neighborhood, with the same accessibility and same high quality. The health funds would be allowed to provide psychiatric services with their own staffs (either existing or those to be hired); offer independent specialists who would work on a contractual basis; or contract a non-profit or for-profit organization to supply them under supervision of the ministry, which will receive 15 additional manpower slots over the next few years to ensure quality and accessibility.
The health funds will provide not only outpatient services but also rehabilitation instead of the ministry, but drug addiction and alcoholism treatment will remain in government hands.
There are now 13,000 patients who require rehabilitation, compared to about 3,500 people some six years ago, due to the release of many psychiatric patients from hospitals; improved medications and outpatient care; the growth of the population; and traumatic events such as terror and war.
Ben-Yizri and Yisraeli conceded that the program was not perfect but that it would be monitored continuously by three committees to ensure that it was carried out according to plan. The number of therapists and rehabilitation workers in the community would be multiplied by 2.5, and queues for treatment will be shortened, especially for children and youth, for whom the queue has been the longest.
"No future government will be able to ignore this agreement between the Health and Finance Ministries," Ben-Yizri asserted.
The agreed-upon basket of mental health services will be about NIS 1.241 billion a year, including NIS 763 million for hospitalization, NIS 63 million for day care and NIS 414 million for ambulatory care. About NIS 960 million will come from the ministry, and the rest will be split up by the health funds and the Treasury.
Kotler explained that the mental health system has become "ripe" for the reform, now that only the "actively ill" in 3,150 available beds need hospitalization, and the rest are being cared for in hostels and in government community clinics whose ownership will gradually be transferred to the health funds. He said that in the US, for example, psychiatric rehabilitation amounts to giving a railway ticket to another state for treatment, while in Israel, such care is "serious and professional."
Per-diem hospitalization rates paid by the health funds will be uniform in all the hospitals, whether they are general or psychiatric.
Fast said that in any location where there are not enough patients for the four health funds to treat, a single insurer will supply services to members of all the health funds on a contractual basis. In the future, Fast predicted, psychiatric hospitals would probably be integrated with general hospitals.
Although patient groups had opposed the reform out of fear that people suffering from life crises - such as divorce, cancer or unemployment - would not get the psychiatric services they needed, ministry officials said that while the clinics would "not give divorce advice, anybody who suffers from depression or other emotional problems would be entitled to treatment."