When M., a 17-year-old from the Upper Galilee in northern Israel, was only 12, she experienced severe trauma that left her to deal with anxiety and post-traumatic stress disorder. Last summer, these phenomena were re-ignited after she badly injured her leg, preventing her from walking for months. M. found herself battling with acute depression.
“With my injury, leaving the house became difficult not only emotionally but also physically,” she recalled. “I also felt that my school did not know how to deal with me.”
M. explained that she had to fight with her school to remain enrolled.
“My entire world changed, at some point, it all became too difficult and I just stopped showing up to school.”
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In the spring, M. was referred to the “greenhouse,” a unique program run by Ziv Medical Center. Located in Safed, Ziv is Israel’s utmost northern hospital, serving a population of over 300,000 people, including the residents of the Golan Heights and Upper Galilee. Regarding psychiatric services, especially for children and teenagers, Ziv provides these services for all the area northern to Haifa. The region is also home to a mosaic of communities, Jews, Arabs and Christians, Druzes and Circassians, ultra-Orthodox, religious and secular.
“We describe the ‘greenhouse’ initiative as the missing link between private therapy and hospitalization,” said Dr. Uri Yatzkar, Director of The Child And Adolescent Psychiatry Department at Ziv.
The program includes a number of clinics located in several communities in the north, not only in Safed but also in the Golan Heights, Kiryat Shmona and Maghar – where Ziv runs the largest Arabic-speaking psychiatric center in the country.
Children and teens attend the clinic closer to their home once a week, to receive the therapies and treatments they need, while they are also supported by teachers who make sure that they do not fall behind in school.
The rest of the week, the hospital’s staff and social workers work with the young patients’ regular schools to support their staff and make sure they know how to properly help the students who are struggling with mental health issues.
“Ziv trains the teachers to handle problems such as depression, anxiety and eating disorders,” Dr. Yatzkar highlighted. “This is really important because schools usually find it hard to deal with these challenges.”
The hospital has worked with some 88 schools.
“They keep us informed on how the child is doing and if they miss a day, they alert us, so that we can check what happened,” Dr. Yatzkar said. “After we work with a school on one student, if they have a second student struggling, they know what to do.”
At the same time, Ziv’s social workers remain in touch with students and families, to check that everything proceeds well and that the children and teens are also participating in the afternoon social activities they are part of.
“Each patient has to be involved in afternoon activities in their communities - programs like sports, arts, music and more – and the social workers are responsible for helping families choose the most suitable option and make sure the children attend,” Dr. Yatzkar said.
The program has been running for 13 years and has proven to be so successful that the Health Ministry is working on exporting it to the rest of the country.
“Over 50% of the children who enroll had previously attempted to commit suicide, but after a year with us, the vast majority are able to go back to a regular life,” the doctor emphasized.
“This program is what saved me from dropping out of school,” said M. “It was the first time that I felt that teachers and doctors were genuinely interested in me and my wellbeing.
Without it, no one would have woken up and realized that there was a problem and something had to be done.
“The initiative provided me with educational and emotional support and allowed me to meet other children in my situation. There was no need to explain what we were going through because everyone was on the same boat.”
In the past few years, the number of cases of young people struggling with mental health has surged - a trend that has been further exacerbated by the coronavirus pandemic, which has claimed a heavy toll on children and teenagers.
According to a survey published by Maccabi Healthcare Services at the beginning of the year, major depression diagnoses among teens aged 12-17 rose by 39% in 2021 compared to 2019. The report also highlighted an increase of 33% in diagnoses of anxiety and 56% in eating disorders - while school psychologists recorded a 43% rise in the number of students who shared suicidal thoughts.
Ziv has also been experiencing similar trends, Dr. Rasha Elias noted.
“The post-COVID mental crisis has highlighted the urgent need for specialized mental health services for children and adolescents,” she said. “The pandemic has resulted in significant disruptions to their routines, social interactions, and educational experiences. Many young individuals are dealing with feelings of isolation, anxiety, depression and suicidal thoughts. The need for hospitalization in the children and adolescent population has significantly increased.”
While in Israel in 2017 treatment for mental health was theoretically transferred from hospitals to health funds (HMOs), in some areas, the funds have struggled to provide an adequate response. The region covered by Ziv is one of those areas.
The hospital runs one of the biggest centers for youth mental health in Israel. “We are located in the most distant periphery and most of the people we serve come from a low socio-economic background,” said Dr. Yatzkar. “This makes the issue more complex, also because many of these communities live according to a very conservative lifestyle, and their members do not have access to support for mental health struggles within their communities.”
The region also suffers from a shortage of private therapists.
“Most people cannot afford private therapy, but even if they could, they would not have an easy time finding someone,” the doctor explained.
As the demand for mental health support surged, Ziv has done everything to provide an adequate answer to the need.
Currently, the hospital’s inpatient unit includes 15 beds, but lately, they have proven to be sorely insufficient to meet the demand. There have been times when up to 20 children in desperate need of hospitalization could not be accommodated.
“A lot of adolescents suffering from mental crises including many who attempted suicide had to wait weeks and even months to get the help they needed,” Dr. Elias said. “I do not have to explain how this affected their mental state.”
For this reason, the hospital is working on opening a second unit with another 15 beds in the upcoming weeks, which will be headed by Dr. Elias.
“We address a comprehensive range of psychiatric conditions, with the most frequently encountered problems being depressive disorders and anxiety disorders,” she added.
“Additionally, we frequently encounter issues such as non-suicidal self-injuries, the entire spectrum of suicidal tendencies from thoughts to actions, struggles related to identity including gender identity, and personality disorders.”
In order to treat a higher number of patients – and also to offer the best alternative to those who are good enough to be discharged but are still in need of daily support – Ziv also runs two ambulatory centers, one specialized in eating disorders and one focused on the rest of psychiatric conditions. Recently, eating disorders have become one of the most common conditions among the patients evacuated to the hospital - with children as young as eight presenting severe symptoms.
“We can say that the treatment offered by our department encompasses three levels, based on the intensity of the emergency: hospitalization, ambulatory clinics, and the ‘greenhouse’ clinics,” said Dr. Yatzkar. “In total, we treat over 2,000 children each year.”
The level of care offered by The Child And Adolescent Psychiatry Department at Ziv is recognized by the Health Ministry as the highest in Israel, attracting many patients and staff from all over the country.
Ziv Director-General Prof. Salman Zarka said that the hospital has a vision to excel in providing advanced, comprehensive and quality medical service to the northern community of Israel.
The Child and Adolescent Psychiatry Department at Ziv is already achieving this vision but it is unfortunately constrained by limited resources and less adequate infrastructure.
The Department is currently housed in a building from 1926 disconnected from Ziv’s main campus. The building is also not up to the standards required for a modern hospital, lacking adequate accessibility and infrastructure.
“We already have the project for a new building in our main campus with two inpatient units of 22 beds each and two ambulatory clinics with another 22 spots each,” Prof. Zarka said. “We know how to give every single patient the best treatment in Israel and possibly in the world, we just need to be given the tools to provide for all those in need.”
“When we have a new building for psychiatric services, we will be able to integrate these important services with the other services we offer to our patients, as well as to assist the faculty of medicine to grow so that it can train more medical students where the psychiatric services are located today.
For this purpose, Ziv is looking for donors to support its mission – matching the budget from the government - and ensure that all children and teenagers like M. can overcome their struggles.
“I think that I can say that today I got out of my depression,” M. said. “I am still in treatment but I am in a good place. I am excited about starting 12th grade, and I also found a job that I like.”
Next year, M. noted that she hoped to spend a year volunteering and then join the army, ideally in the medical corps.
Asked about what message she would like to send to other teens struggling with their mental health, she said “Don’t be afraid to ask for help.”
“For many years I did not do it,” she noted. “Only when I agreed to it, I suddenly started to see the light at the end of the tunnel - even though I knew it was still very far away.”
“It is important to remember that asking for help is not shameful,” she added. “Thanks to Ziv’s support, I found out I was not alone.”
Like M., Ziv is not afraid to ask for help. Because healing the souls of Israeli children is a responsibility for all.
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This article was written in cooperation with Ziv Medical Center.