Mental health reform bill faces many challenges

Medical community opposes decades-old proposal recently championed by Health Ministry.

homeless religious man 311 (photo credit: Marc Israel Sellem)
homeless religious man 311
(photo credit: Marc Israel Sellem)
The Knesset Labor, Social Affairs and Health Committee will not approve the proposed major reform in mental health services – first recommended two decades ago and only recently endorsed by the Health Ministry – “if it is not good,” said committee chairman MK Haim Katz (Likud) on Wednesday.
The reform, first proposed in 1990 by the Shoshana Netanyahu State Judicial Commission on the Health System, would remove responsibility for psychiatric services from the ministry and transfer it to the four public health funds. Thus, people with psychiatric disorders would be regarded like any other patient with a physical ailment and receive treatment from the basket of health services, rather than from state services – when the ministry still has a budget for treatment.
The Israel Medical Association (IMA) and a selfstyled forum of psychologists, psychiatrists and other professionals in the field have issued strong statements against the proposal and were present at the committee session. Meanwhile, ministry officials held a briefing to defend it.
Although Deputy Health Minister Ya’acov Litzman (UTJ) was strongly opposed to the bill for various reasons when he was chairman of the Knesset Finance Committee, a few months ago he came out saying he was in favor of it now, even though he had some reservations.
His views were changed, he said, by the realization that not making adjustments would only make the situation worse. Many patients, especially children, have to wait months or even more than a year to be received in a public psychiatric clinic.
Ministry director-general Dr. Ronni Gamzu warned opponents to the bill that “if the price tag for implementing the reform becomes too expensive, the government will stop promoting it.”
He added that there are 100,000 Israelis with serious mental health problems. One out of five residents will need mental health treatment at some time in his lifetime.
“This bill underwent changes since it was last discussed in 2007. It will get top priority from the ministry, and we are working hard to make it possible,” Gamzu said. “[Now] the ministry gives services, pays itself and supervises itself. This doesn’t work. The right way is to separate between the service provider and the regulator, and that means to give responsibility to the health funds.”
Asked by Katz what he would still change in the bill, Gamzu said that “the existing rights of the patient will not worsen. The ministry must carry out quality control, and the reform would begin only when the four health funds feel comfortable with the added budget for supplying the services.”
Katz said that his committee would carefully examine all sections of the bill from all aspects to make sure that it would be beneficial to the patients.
IMA chairman Dr. Leonid Eidelman called on committee members not to allow the “defective bill” to be passed, as “it is liable to come at the expense of patients and put extra burdens on general practitioners, who would be trained to treat some emotional conditions.”
He claimed that there would be quotas on the number of sessions and treatments for psychiatric patients instead of according to need; that the reform would “eat into” budgets for rehabilitation of patients in the community; would lead to the closing of 50 existing state mental health clinics around the country; that all patients would have to get a printed approval form from their insurer before being allowed to get treatment; and that it would blur the lines between the psychiatrists and general practitioners who would be involved in patients’ care.
The IMA chairman also charged that patients’ medical files would have psychiatric care listed and that this would constitute an invasion of privacy, since all physicians they consult would have access to the files.
In addition, not enough money would be allocated by the Treasury to cover the costs of psychiatric services, said Eidelman.
The doctors’ association said it wanted “real mental health reform” without all of these problems.
Meanwhile, the “forum” of mental health professionals opposed to the bill, headed by clinical psychologist Hanna Strum-Cohen, wrote a letter to Prof. Mordechai Shani, a former ministry directorgeneral who is volunteering to coordinate formulation of the bill, explaining that it strongly opposes the current format.
She said she has headed the forum, representing 1,000 people, for over 10 years. The bill, if passed, would “harm the weakest elements in the population,” she wrote to Shani, who chairs the Gertner Center for Health Policy Research of Tel Aviv University and Sheba Medical Center.
She said that even though the health funds are due to implement the reform, “not all of them are in favor of it.”
The ministry has not explained why it did not wait to present the reform to the Knesset committee until it had reached agreement with the bill’s opponents.
Kadima MK Rachel Adatto, a physician and lawyer by profession, and MK Orly Levi-Abacassis of Israel Beiteinu said it was unfortunate that those with eating disorders and those who had undergone sexual abuse would not be included. Social workers at the session said that drug addicts would also not be entitled to get psychiatric treatment.
Adatto added that while the subject was very important, she did not think the Treasury would allocate enough money for the bill’s implementation.