Psychiatrists, doctors call for immediate halt to 'disastrous' mental health services reform

Mental health professionals: Children and adolescents suffering from mental problems will suffer most from the reform.

transplant doctors 88 (photo credit: )
transplant doctors 88
(photo credit: )
The long-awaited reform of mental health services that will transfer responsibility for them from the Health Ministry to the four health funds will in fact "trigger their collapse," according to the Israel Medical Association (IMA) and the Israel Psychiatric Society. The two groups issued an emergency call on Wednesday to prevent its implementation on January 1. Representatives of the two organizations, joined by heads of the Israel Society for Pediatric and Adolescent Psychiatry, the Government Doctors Union, the Psychologists Association and Social Workers Union, called for an urgent revamping of the reform so it would not harm patients and professionals in the mental health field. The agreement reached in recent months by the Health Ministry and the Treasury for implementing the reform is a "serious perversion" of the planned reform, whose roots go back to recommendations of the 1989 State Judicial Commission on the Health System, they said. "It will cause many patients to be thrown into the street without any treatment for them," they said. Instead, they called for "a real reform, which is vital and necessary, in cooperation with the organizations of professionals who treat them." When the National Health Insurance Law went into effect in January 1995, mental health services were supposed to be transferred gradually by the ministry to the health insurers, but the Treasury opposed it on the grounds that it would cost a lot of money and it never happened. The main arguments in favor of the reform were that treating mental illness like physical illness would eliminate much of the stigma of psychiatric and psychological problems and that the ministry had an inadequate budget for services. The IMA, the psychiatric society and the other professional organizations favored the reform concept, even though it has already led to the elimination of 4,000 psychiatric hospital beds, with stress placed on treating patients with newer medications and psychiatric and psychological counselling in the community. But the Treasury, "which never supported the reform, searched for ways to make it fail, and it is carrying out only a reform of reducing services," the medical representatives said. According to an agreement signed in September by the Health and Finance Ministries, 50 community mental health clinics and stations owned and run by the Health Ministry will be closed. In addition, said opponents to the reform, the Treasury was allocating only NIS 160 million extra for implementation instead of the 300 million that is the minimum needed for the health funds to set up and provide adequate services. "What is the logic of closing facilities before new ones open in the community?" they asked. "Why close clinics that have proven themselves to be professional and beneficial?" Dr. Jacob Polakiewitz, head of the ministry's mental health services, denied the claims and charges. The ministry will transfer to the health funds the NIS 1.1 billion it has spent each year on mental health services, including NIS 760 million for hospitalization and NIS 430 million for community-based services, he said. In addition, the health funds will share an additional NIS 40 million a year over four years, for a total of NIS 160 million more. "Government psychiatric hospitals will continue to function as today, but the health funds will purchase services from them to treat their members. The health funds cannot provide community services on their own today," said Polakiewitz, "so initially they will purchase services from the existing clinics. They will then either purchase clinics or hire some or all of the professionals for their clinics or independent professionals." The ministry official said he understood the fear of cuts, but that the intention was to expand rather than shrink services. Patients who suffer from anxiety, depression or trauma from life experiences would continue to get treatment, but from the health funds rather than the ministry, he said. Only two percent of the population now receives psychiatric treatment, said opponents of the reform, while the norm in the Western world is 4% - and those countries do not suffer the stresses of war and terror and the history of suffering in the Holocaust that Israelis do. Increasingly, psychiatrists' time with patients has been limited. Under the new program, only people with diagnosed psychiatric disorders will receive help, while those who suffer from stress and trauma from life events and experiences will be ineligible. The reform would not save money, the opponents argued, as without real therapy, patients would suffer breakdowns and have to be hospitalized again. Children and adolescents suffering from mental problems, especially those in the periphery, would suffer the most from the reform, the mental health professionals charged. Rehabilitation of patients would be dealt a death blow, they continued, as hostels, protected living arrangements, clubs and sheltered workshops that employ them would be wiped out from lack of budget. The reform, they maintained, has "turned into the Treasury's reform, without any support from mental health professionals who dealt with the issues for 11 years. There is not one single factor that supports it. All think it will be a disaster." Earlier this week, at a Jerusalem public health conference, Health Minister Ya'acov Ben-Yizri said he was proud that responsibility for mental health services would finally be moved to the insurers. "One can't solve every problem in advance, but we will go ahead even if it steps on some toes and hurts the prestige and the livings of some groups," he said. "There will be special committees to monitor implementation and deal with problems. If we wait, it will never get done."