The ultra-Orthodox community and its rabbis have been negative about using mainstream psychotherapy and counseling services. Many mental health professionals are of the opinion that it is essential that Orthodox and haredi patients with psychiatric and psychological disturbances be treated only by professionals from a similar cultural background, since the behavior and feelings of Orthodox patients cannot be understood by others and appropriate help and treatment can be developed only by those with a full immersion in the cultural and religious values and practices of the community.
The Chiba Community Mental Health Clinic, Ma’ayenei Hayeshua Medical Center, was established in January 2004 by Dr. Moshe Rothschild, who in 1990 established the Ma’ayenei Hayeshua Medical Center in Bnei Brak.
The clinic, joined by the Health Ministry, provides proper care in the field of mental health within the community with special religious needs and demands. It has succeeded in raising awareness to mental health within this special community, as well as reducing stigma and prejudice that prevented many haredi (ultra-Orthodox) patients from seeking psychiatric and psychological help in the past. Statistics show that 65 percent of adults as well as 70 percent of children would not have gone to seek help in other clinics, which are not suitable to their special needs and unique lifestyle.
The clinic provides free psychiatric and psychological assessment and treatment, as well as social services to adults and children, and has separate day treatment programs for men and women.
The professional and administrative staff as well as the clinical psychology interns, social workers and other allied mental health students are from the haredi and national-religious communities and are attired modestly as expected.
Male and female employees sit separately in staff meetings and in the lunchroom.
Psychological treatment includes individual, couple, family and group therapy.
Because of halachic considerations, separate treatment groups are held for women and for men. However, an exception was made when the co-leader of a parents’ group of schizophrenic children explained to the most eminent Israeli arbiter that the presence of both parents in these group meetings was essential and was given permission to permit both parents of the children to participate in the group meetings, with the proviso that they were over the age of 45, refrained from discussing intimate matters, and that there was no mixed-gender seating.
The Day Hospital Treatment Center provides a facility for more seriously disturbed patients who require more intense treatment than the clinic can provide. The patients spend five hours a day at the center, five days a week, and receive individual and group therapy, psychopharmacological treatment and adjunctive therapies. They also receive free breakfasts and lunches. A rabbi who acts as a “house father” teaches religious subjects throughout the week to male and female patients. Receiving psychiatric and psychological care in this supportive and caring environment, which is consistent with their religious values and lifestyles, frequently prevents psychiatric hospitalization.
A psychiatric in-patient hospital consisting of eight floors with separate facilities for men and women is being built and will be ready for occupancy in the near future. This will be the first in-patient psychiatric hospital under haredi auspices in the world.
Although in recent years the haredi community has become more open to seeking mental-health treatment in times of need, stigmas still remain regarding mental disorders, especially in relation to shidduchim (matchmaking).
Though there exists a tendency, in religious and even secular communities, to direct young men and women who suffer from physical defects and/or psychiatric disorders not to disclose them, this tendency is particularly prevalent in the haredi community. Revealing their personal defects and disorders before marriage may result in a drastic decrease in the number and quality of “offers” they receive.
Young haredi men and women in the “shidduchim phase” come for treatment in a state of great distress, as they are concerned what will happen after they get married and their “terrible secret” becomes known. Treatment in such cases is very difficult because revealing the “secret” before marriage, thereby enabling the patient to lessen his/her anxiety, is frequently not a viable option.
Symptoms that often bring haredi men and women to the clinic are obsessional fears, thoughts and preoccupation regarding religious rituals and behavior, and corresponding compulsive behavior on their part to deal with this.
Generally, the religious content concerns issues related to cleanliness, tasks involving ritual immersion, separation of meat and milk products and utensils, and various aspects of prayer.
These symptoms frequently require the close cooperation of religious authorities and, at times, their direct intervention.
Decisions that have religious ramifications pass through a “halachic prism” before being acted upon.
A study by Prof. Eliezer Schnall of Yeshiva University concluded that the mental health needs of the Orthodox community are not being sufficiently addressed. The service gaps were particularly pronounced in the haredi and hassidic communities. Schnall called the results a “wake-up call” and said there is still a stigma in the Orthodox community attached to mental illness that prevents people from seeking help. An additional factor impeding good mental health services is their cost, he said.
I have been employed at the Chiba Community Mental Health Clinic as a supervising psychologist for the last seven years, and I have witnessed an impressive increase in the number of haredim seeking psychiatric and psychological help and, as a result, a large increase in professional staff members.
Though there are people who are against providing special services for communities with special religious needs, I believe that the establishment of a clinic under ultra-Orthodox sponsorship is a bold and pioneering step that should be applauded, as it facilitates and encourages those members of the Orthodox and ultra-Orthodox communities that are in need of psychiatric and psychological treatment to obtain help in a “religious-friendly” environment, where their religious values, needs and customs are respected and accommodated.
In addition, a haredi-sponsored mental health facility enables observant and haredi mental health professionals, trainees and students to work, train and gain clinical experience in an environment that is consistent with their value system and way of life.
The author is a supervising psychologist at the Chiba Community Mental Health Clinic. He authored Mental Health, Psychotherapy and Judaism, edited Reader for the Orthodox Jewish Psychotherapist: Issues, Case Studies and Contemporary Responsa and co-edited Psychotherapy and the Ultra-Orthodox Community: Issues and Treatment.