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The Director of Mental Health Services in the Ministry of Health, Dr. Gadi Lubin, on Sunday ticked off a series of failures in Israel's mental health system, some of which were reflected in the supervision of Itai Ben Dror, who confessed to murdering his three children in Netanya this weekend. According to Lubin, one of the most fundamental problems is that "by law, no one can be forced to continue to receive psychological aid after being released from hospitalization."

Health Ministry Director General Dr. Ronni Gamzu Sunday asked the Social Affairs Ministry to appoint Lubin to its inquiry committee into the care received by Ben Dror. The committee's brief will include the interface between these ministries in handling psychiatric patients after their discharge from hospital. It is also likely to have some questions for the physicians of the Lev Hasharon Psychiatric Hospital in Pardesiya. Ben Dror was hospitalized at the facility several times in the past and was discharged from his last stay a few months ago.

The Health Ministry and Lev Hasharon, which it operates, have cited patient confidentiality in their refusals to discuss Ben Dror's case with the media.

Lubin seeks to dispel the "mistaken assumption that if someone was admitted to a psychiatric hospital in the past he is necessarily mentally ill," noting that hospitalization can be the result of a suicidal or other crisis with no mental illness. In addition, he stressed, "most hospitalized mental patients are neither criminals nor murderers."

He said there is no uniform procedure in place for evaluating the danger posed by psychiatric patients after their discharge. "Every discharge is preceded by a decision on the departmental level, including a summary and evaluation, but each case is examined individually. The risk assessment of a psychiatric patient never yields a 'yes' or 'no' answer, and it can never be categorically determined that an individual is not dangerous or that there is an immediate risk. In recent years the goal has been to hospitalize the most seriously ill patients, to treat them and release them into the community," Lubin said.

The inquiry committee will also examine the care received by Ben Dror after his last hospital stay. He was recommended to receive mental health treatment in the community, but it is not clear whether he did so.

Currently, the treating physician signs the hospital discharge, or a committee headed by a jurist in the case of a court-ordered hospitalization, but in neither case can the patient be forced to receive treatment after release. A number of legislative proposals seek to do just that.

Last week MK Miri Regev (Likud ) tabled an amendment to the 1991 Treatment of Mental Patients Law that would modify the discharge approval procedure for patients whose hospitalization was court-ordered. These include requiring the committee to evaluate the risk posed by the patient to the public, including his family, and the likelihood of his integration into the community. In cases where the involuntary hospitalization resulted from violent acts by the patient, the committee would be required to assess the likelihood of recidivism and to consider measures to protect the public.