Mental health services needed more than ever - opinion

Mental health professionals have a duty of care to reduce levels of distress and improve the functioning of society.

 HEALTH MINISTER Nitzan Horowitz visits the Abarbanel Mental Health Medical Center earlier this year. (photo credit: AVSHALOM SASSONI/FLASH90)
HEALTH MINISTER Nitzan Horowitz visits the Abarbanel Mental Health Medical Center earlier this year.
(photo credit: AVSHALOM SASSONI/FLASH90)

As we approach the start of 2022 – nearly two years since the original outbreak of COVID-19 – we find ourselves dealing with yet another iteration of the virus. Screenings, masks, quarantines, and the latest travel bans have us all feeling like we’ve seen this film before.

Mental health issues were identified as the leading global health-related burden prior to 2020 by the World Health Organization (WHO), with depression and anxiety topping the list. Add to that a never-ending pandemic and its ramifications, which wreak havoc on people’s mental health: illness, loss of life, feelings of confinement, loss of freedom, fear of the unknown, a continuing cycle of changed or canceled plans and an inability to visit or get together with family. Our state of safety has been undermined, and the world as we know it is now unfamiliar.

A newly published study in The Lancet assessed COVID-19’s impact on depression and anxiety around the world, and found a startling increase in these conditions as a direct result of the pandemic: Since 2020, there have been 53.2 million additional cases of major depressive disorder, an increase of 27.6%; and 76.2 million more cases of anxiety disorders, an increase of 25.6%. The study provides the most current and significant information on how the pandemic has affected mental health around the world.  It concludes that “the pandemic has created an increased urgency to strengthen mental healthcare services in most countries.”

The need for mental healthcare services is greater than ever before, and Israel is no exception. People are in dire need of tools to help them manage uncertainty, and the system is already running on overload.

The Challenge: Providing accessible/affordable services

How can our public health system provide basic, affordable mental health services that will be accessible to all who need it?

Teen depression (illustrative) (credit: ING IMAGE)Teen depression (illustrative) (credit: ING IMAGE)

Unfortunately, the current demand exceeds the supply, and we know there will always be a shortage and a long wait until these services are more widely available in public healthcare. There are simply not enough therapists in the system, and those who are working in the kupot are stretched to their limits.

This is not surprising. First, therapy is a time intensive, one-on-one treatment that can last months and with certain modalities it can be years. Second, therapists who work in a kupa may see around twenty individual clients a week, limiting their availability to accommodate more clients. Third, there are language and cultural barriers that make therapy inaccessible for olim. Finally, private therapy is not an affordable option for everyone and wait times are currently long, even in the private health system.

Easing the Burden ASAP

As The Lancet study indicates, there is an urgent need to strengthen mental health services, and again, Israel is no exception. We are duty-bound to bring the greatest good to the greatest number of people precisely because we have a public healthcare system. This means designating more resources within the kupot to increase the availability of mental health services. Additionally, using evidence-based, time-limited modalities in the public healthcare system should be a priority, and should begin with one or all of the following:

  1. Offer CBT (cognitive behavioral therapy), a standard intervention used in public health care systems. CBT readily lends itself to evidence-based analysis because it sets clear goals and outcomes, irrespective of the diagnosis, both in terms of the reduction of subjective emotional distress and as improvement of objective functioning. It is measurable and definable.
  2. Provide time-limited, evidence-based therapy. While there are always exceptions, in most cases a three month time frame of treatment with well-defined goals, and evidence-based protocols and skills to improve people’s mental health in the shortest period of time possible should be offered. This is advantageous both for the individual client and the public healthcare system by allowing clinicians to service more clients.
  3. Provide group therapy. Group therapy offers a unique and powerful dynamic, and it is a clinically and cost effective means of treatment. Additional groups should be established in the public and private healthcare system. We have seen this borne out at the Machon Dvir behavioral health clinic as an adjunct to private therapy and on its own.

There is no one-size-fits-all solution when it comes to mental healthcare

Critics say that CBT is too reductionist and superficial, but given the urgency of the current mental health pandemic we are obligated to find solutions that will serve the needs of as many people as quickly as possible. Employing evidence-based, time limited therapy is the best clinical and cost effective solution, and those fortunate to have additional resources at their disposal will be able to choose longer-term therapies. 

As we have seen with many aspects of this pandemic, balancing the rights and wants of the individual with the needs of the overall public is an inherent dialectic, and inevitably, there will be shortfalls and limitations. Mental health professionals have a duty of care to reduce levels of distress and improve the functioning of society. It is our responsibility to ensure that everyone who seeks out mental health services is given that opportunity on some level and in a timely manner.

The writer is a board-certified adult psychiatrist who trained at Hadassah University Hospital. He is founder and director of Machon Dvir, a clinic that specializes in DBT, and a member of the Israel Medical Association (IMA), the Israel Psychiatric Association, and is a registered medical practitioner with the Australian Health Practitioner Regulation Agency. He is co-author, with Rabbi Yoni Rosensweig, of the soon to be published volume, Nafshi B’Sheelati, a book that deals with the interface of mental health and Jewish law.