Four wards established in hospital psychiatric departments to deal specifically with victims of sexual assault may be closed because there is no funding for them in the coming year’s budget, even though the cost for all of them is only 700,000 shekels ($184,500) a year.
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If the wards close, there will only be four beds in the whole country dedicated to such patients – all at Ichilov Hospital in Tel Aviv.
Over the past decade, efforts have being made by the health system to recognize the special treatment needs of victims of sexual assault admitted to psychiatric wards. An important milestone occurred a few weeks ago when the National Council for Mental Health said that asking psychiatric patients upon intake about whether they’d ever undergone sexual trauma should be part of the national quality index for evaluating hospitals.
At the same time, efforts are being made by the Health Ministry, nonprofit organizations, and hospital directors to assimilate a more updated treatment approach suited to patients whose distress is based on sexual trauma.
In 2005, the first unit dedicated to inpatient treatment of sexual assault victims was opened at the Jerusalem Mental Health Center at Kfar Shaul by Dr. Shlomit Katz and Dorit Gurani. The unit was closed in 2010 for lack of funds. In the Shaar Menashe Mental Health Center in the Sharon, a special unit for these victims was also opened that is still operating.
In 2013, under pressure from women’s organizations and mental health professionals, then-Health Minister Director General Roni Gamzu agreed to establish a dedicated ward at Ichilov. Until it opened, the ministry budgeted 700,000 shekels for units dedicated to dealing with sexual assault victims. This enabled the unit at Kfar Shaul to reopen; the funding also paid for two beds in the psychiatric departments at Rambam Medical Center in the north, and two beds in the Be’er Sheva Mental Health Center.
In January Ichilov’s new mental health department opened with 34 beds, including the unit dedicated to victims of sexual assault. The unit is four beds in two rooms, where patients, in addition to whatever psychiatric therapy they need, also get more targeted treatment.
The definition of “dedicated unit” is not consistent. Not always is it reflected in a specific number of beds, but rather in the special training staff members receive. “The budget was primarily for education and training,” Orit Sulitzeanu, director of the Association of Rape Crisis Centers in Israel, said. “In many place patients with a background of sexual assault got improper treatment and it often caused damage. For example, restraining a woman who has rape in her past could be very, very serious. Not everyone is aware of this.
“In one of the courses we gave a male nurse came over to me and said that since the course he understood why one of the patients seemed afraid of him, and that she fears male therapists because of this. These are issues that require special attention,” said Sulitzeanu.
According to Gurani, a social worker who organized the unit at Kfar Shaul, “most of the patients who come here suffer from very serious emotional problems like suicidal feelings, compulsions to hurt themselves, eating disorders, dissociative disorders and depression.”
Gurani says that since the unit was opened there has been a marked change in the approach of doctors and the nursing staff. “The nursing staff here is amazing especially because they’ve received this professional training,” she said. “There is a recognition and understanding of the therapeutic needs and emotional problems that stem from trauma, and the patients also report a substantial change in their hospital experience.”
The battle for the continued operation of these units looks insignificant when one comes up against reality. According to Health Ministry data, between 36 percent and 51 percent of adult patients treated in mental health clinics or psychiatric hospitals have been victims of sexual assault as adults or as children – in other words, one out of every two to three patients. According to Sulitzeanu, NGOs that assist victims of sexual abuse get 40,000 calls and referrals a year, some 85 percent of them women or teenage girls. The rest are boys, of whom a quarter report being abused by a close relative.
“The younger the person is when the abuse starts, the chance for serious harm due to continuing trauma is greater, and is characteristic of many clients who contact us,” Sulitzeanu said. “Even today the existing system is not desirable from a professional standpoint. We need far more ongoing training. Moreover, in the units there is no critical mass of victims who could support one another.”
Her fear, and that of many others, is that even what they’ve managed to accomplish could go down the drain.