Israel Launches Privatization of Mental Health Care

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A patient at Abarbanel Mental Health Center, Bat Yam.Credit: Alon Ron

The reform in mental health was officially launched on Wednesday. This reform was first conceived of 21 years ago and was finally ratified in 2012. Its main feature is the transfer of responsibility for mental health from the state to the health maintenance organizations. Starting today, each person requiring service will need to obtain a financial commitment from his or her HMO (form number 17), whether this service is delivered by one of the 61 HMO mental health clinics or by one of the 56 state-run clinics, or by hospital mental health wards or by mental health institutions.

The reform debuts amid concerns held by many and diverse opponents concerned about issues of privacy and confidentiality of patient information, continuity of treatment and eligibility for care, with claims being made that the reform has inadequate budgets.

The first day of the new arrangement was marked by disruptions and demonstrations held by its opponents. The association of academics in social sciences and the union of social workers will begin taking slowdown measures that include stopping cooperation with the Health Ministry in matters relating to mental health. Social worker and psychologist unions called on patients to ignore the new regulations and continue receiving treatment without obtaining the HMO forms. They also demanded that medical information not be entered into patients’ computerized files in order to protect their privacy.

The slowdown measures taken by therapists follow negotiations they have been conducting with the Health Ministry to determine their employment standing at public mental health clinics. The unions claim that “the ministry adamantly refuses to sign a collective agreement with them, is dragging its feet in its attempts to impose conditions that will soon lead to dismissal of employees and closure of these clinics.”

Yesterday morning psychologists, social workers and other opponents of the new reform gathered outside the Health Ministry in Jerusalem. Prime Minister Benjamin Netanyahu came there to deliver these words: “I’m happy that we are starting today to implement something that has been talked about for many years. This is being put in place in terms of resources and reorganization, with a blending of mental and physical health under one organizational framework, with additional funding given to this venture,” he said. “Clearly, money is easy to give out but hard to find. We’ve allocated money here knowing we’ll have to take it from somewhere else, since we can’t ignore Israel’s peripheral population or its weaker sectors.”

Among the opponents and demonstrators was MK Michal Biran (Zionist Camp), who charged, “The Health Ministry is embarking on its experiment on human beings. This awful reform in mental health is now in place and no one knows what is happening. This reform was not sufficiently thought through, with the Health Ministry pulling the rug from under thousands of patients across the country, for whom the mental health system is an island of stability. The High Court of Justice ordered the state to respond within 60 days to a petition I submitted along with patient and therapist organizations. After years in which the ministry has evaded giving clear answers, it is now giving off-the-cuff, ambiguous replies at Knesset committee meetings, trying to placate us with easy answers. We’ve forced it to deal with all the difficult issues,” said Biran.

At a press conference held two weeks ago at the Health Ministry, ahead of the reform’s launching, Deputy Health Minister Yaakov Litzman said he was “not afraid of addressing Knesset members’ claims. I’m open to making amendments which may be required in implementing this reform. We’ll study it and set out. The most important thing for me is that in outlying areas people will receive mental health services. Up to now there was inadequate accessibility there – that’s the most important part of this reform.”

Cost: 2 billion shekels

The reform will cost 2 billion shekels (just over $500 million), with an annual addition of 300 million shekels to the basic “health basket.” It is expected to double the number of people receiving help through public services, in an area that is currently the most privatized one, with two thirds of costs covered privately. So far 61 new HMO clinics have been opened, and additional new ones will soon be added, 28 of them serving minors. According to the Health Ministry, each new clinic is checked and receives clearance by its department of mental health services, after meeting required standards.

One of the concerns that have been raised is that the number of treatments patients receive under the new reform will be capped. The ministry stresses that nothing will change in this regard and that the only difference will be the identity of the insurer, namely an HMO instead of the state. Treatments will be given according to medical requirements.

Different organizations cast doubt on Health Ministry declarations. “Benafshenu,” one of the most prominent organizations opposing the reform, sees it as gravely damaging the public and its entitlement to health and to receiving adequate mental health care, with harm caused to privacy and confidentiality. Over the last few months, this organization has collected testimony by therapists in the public system, who claim that under the surface, people at the ministry and at the HMOs are acting to limit the activity of public clinics and the number of treatments given to patients. The organization promises to continue gathering data related to the damage done to the public and to follow the new reform after its implementation.

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