Context
For decades, the supply of publicly funded mental health services did not meet the demand. The COVID-19 pandemic increased the need for mental health services significantly, resulting in longer waiting times. In addition, professionals prefer to work with privately funded patients, exacerbating the gaps between demand and supply in the public system.
Impetus for the reform
Israel entered the “Swords of Iron” war that stated on 7 October 2023 with a stretched and underfunded mental health system. The war has had a dramatic impact on the populations’ need for acute and long-term mental health needs. As per mid-August 2024, and before the intensification of the conflict against the Hezbollah, the MoH estimated that over 300,000 people need mental health care as a result of the conflict so far. Other estimates range between 80,000 and 500,000 people.
Main purpose
The mental health plan aims at increasing the availability of mental health workers to improve access to mental health services, and expand the types of care offered, with an emphasis on shifting care from inpatient to outpatient settings.
Content/characteristics
Medium-term responses → Diversification of mental health outpatient service delivery:
- Expanding community “resilience centres” and opening new ones: a joint program between the Ministry of Health, Welfare, Education, the Interior, the IDF, and municipalities.
- Expanding “balancing homes” to prevent psychiatric hospitalization → Patients stay in “collective houses” and receive mental health care from various professionals (for example, psychiatrists, psychologists, social workers); aim for 100 new homes in 4 years.
- Creating a new profession: mental health resilience coach → helping public facing professionals (for example, Social workers; Art therapists; Educational consultants; Medical student during the clinical years; Psychologists before their internship; teachers) to improve their mental health resilience.
- Creating more mental health clinics with diverse options of care: (intensive) day-care, crisis teams that provide care at the patient’s home.
- Training health professionals from various fields, particularly primary care, to provide different levels of mental health care
Long-term responses → Plan to expand mental health workforce and availability of services:
- Shifting workers from the private to the public system by raising the payments for psychologists who contract with the health plans
- Raising the salary of psychotherapists employed by HPs by up to 38%
- Increasing the payments for self-employed professionals treating patients funded by the health plans
- Training more psychiatrists: increasing specialty training from 80 to 150 graduates/year
- Grants (NIS 500–300K) for physicians who choose to specialize in psychiatry
- Extra grants for those working in underserved areas (the north and south districts)
- Increasing the budget and staff positions for outpatient mental health and resilience centres
- Adding 200 staff positions and improving the infrastructure of psychiatric hospitals
- Creating a new nursing specialization: specialist nurses in psychiatry, who will provide primary mental health care.
Implementation
Implementation of some of these initiatives started in October 2023, while this plan was being consolidated in parallel. Funding has incrementally been allocated since November 2023. Funding relies on a dedicated budget that partially comes from general government funds and partially comes from an increase in the earmarked mandatory health insurance contributions (the health tax).
Outcomes and evaluation
There has been no evaluation so far.