Last update - 00:00 03/12/2006
To help the mentally ill
By Tirza Leibowitz
The recent calls to stop the imminent changes to the mental health care system, voiced in this newspaper and other forums, recall the agreement by the false mother to King Solomon's proposal that the baby with disputed parentage be put to death.
Like the baby in the biblical story, the mental health insurance reform has many parents - all of whom are now distancing themselves from it. Some do so out of concern for the many people who need mental health services and a desire to do something about their current intolerable situation. However, the call to suspend the reform process, and begin negotiations anew even before the struggle to legislate a just reform, does not reflect genuine caring.
Human rights organizations and advocacy groups representing mental health consumers and their families support a reform of mental health services in Israel that would bring these services under the National Health Insurance Law, transfer responsibility for them to the health maintenance organizations and establish an obligatory basket of mental health services. The human rights organizations also call for removing certain riders that were attached to the bill.
It should be pointed out that at present there is no national insurance in the area of mental health. Medical services in this field remain outside the basket of health services, and outside the responsibility of the health funds. Over half the adults and about two-thirds of the children who need mental health care are rejected or their treatment is postponed due to the scarcity of services in the public health clinics. Clinic directors repeatedly warn that children and adolescents are being forced to wait between six and 12 months to receive treatment. In some cities and areas of the country, such as Ashdod, a city of 250,000, there are no government mental health clinics.
This illustrates the great importance of the reform. However, two riders that were attached to the draft law and which are preventing its enactment must be withdrawn. The first weakens the Community-Based Rehabilitation of the Mentally Disabled Act of 2000 - one of the most enlightened laws ever passed in Israel - which enabled the rehabilitation within their own communities of thousands of mentally ill and disabled persons by providing a basket of housing, vocational and leisure services. Many thousands more are waiting for rehabilitation.
Nevertheless, as a condition for carrying out the reform, the Finance Ministry is demanding changes to this law that would significantly restrict eligibility for rehabilitation. The treasury will also provide negative incentives to the HMOs to discourage them from referring individuals to rehabilitation.
The reform is expected to increase the consumption and the demand for public health services, and that is one of its benefits. But if the Finance Ministry seeks to pay for this increase by reducing rehabilitative services, this is exploitation that should not be supported.
The second rider conditions the reform on the closure of community clinics for some years after the reform is implemented. The absurdity of this cries to high heaven. How does closing the little that exists now jibe with the main goal of the reform, which is to expand clinical services? Advocacy groups for the disabled warn against closing the clinic in the interim, as do the Israel medical, psychiatric and psychological associations and the HMOs. Keeping the clinics open entails a marginal cost to the state, since once responsibility for mental health services is given over to the HMOs, the latter will pay the state for purchasing this service. The benefit, on the other hand, is enormous: It will allow the reforms to be implemented without damaging the existing situation.
The reform will shortly be submitted to the Knesset for its approval. Professionals and advocacy organizations alike are convinced that the riders to the bill are a recipe for failure of the reform on the ground. The legislature can and must save the reform. It should help in the birthing of a strong mental health reform program that can help many, but one without the destructive riders that have been attached to the draft law.
The author is a lawyer for Bizchut, the Israel Human Rights Center for People with Disabilities.