Context
Following the Hamas attacks on October 7th there has been a notable increase in the demand for outpatient mental health (MH) care among individuals directly and indirectly affected. Studies indicate an increase in individuals suffering from stress (from 31% of adults in August 2023 to 44% in November 2023), depression (24% of adults to 43%), and PTSD (16% of adults to 30%) (Gil-AD, 2023). Non-governmental civil organizations’ helplines report a significant increase in calls in the month following the attacks. For example, the helpline “NATAL” averages 1200 calls in a typical month. In October 2023, the helpline received 15,000 calls. “MAKSHIVIM,” which usually receives 23–35 calls a day, saw an increase to more than 200 calls per day during the same time period and the helpline “ERAN” received more than 40,000 calls, which more than one hundred percent above their average call volume (Blank, 2023).
While MH is covered by the National Health Insurance, there are significant access barriers such as long waiting times and high cost-sharing. Low availability of services is primarily attributed to psychologists preferring to work in the private sector. Additionally, there is a shortage of psychiatrists, rehabilitation psychologists, and medical psychologists in both the private and public sectors (Blank, 2023 and The State Comptroller, 2020).
Impetus
The inadequately staffed public mental healthcare system struggled to cope with the surge in demand for mental health services. This has caused the Health Plans (HPs) to voluntarily put in place several short and long term initiatives.
Main purpose of the reform
To explore innovative ways of providing MH care to meet the rising need in the population for immediate and long term.
Content of the reform
In the initial weeks following the attack, the Ministry of Health (MoH) temporarily recruited over 1000 professionals from the private sector to work voluntarily, assisting victims immediately impacted. The professionals provided immediate emergency mental health care to victims and displaced people but there is a need for a more systematic and robust response.
The HPs have implemented several initiatives to address the situation in the short and long term:
- Abolishing cost-sharing for emergency MH virtual (phone) visits: HPs offer their members up to three psychological treatment calls, free of charge (Blank, 2023), a measure similar to one enacted during COVID-19. These calls aim to provide short, focused, and practical interventions, including equipping individuals with coping tools to prevent the worsening of mental health conditions.
- Reach out by the HP: the largest HP (Clalit) covers the majority of the population in the affected areas, the south and north of the country. Clalit reached out to their members to assess MH needs to plan their service provision. It conducted a MH survey among all members through a text message containing a link to a questionnaire designed to identify emotional distress. If necessary, individuals were directed to the services offered by the HP (Yasor-Beit-Or, 2023).
- Creation of a new MH profession: To expand the cadre of MH professionals, HP “Clalit” has created a novel MH profession: resilience coach. This position is open to individuals with a bachelor’s degree in a relevant subject (e.g., psychology, social work), and the HP will provide its own training for the role (Clalit Health Services, 2024).
Implementation steps taken
Implementation was immediate due to the urgency of the situation. No formal evaluation has been conducted to date.