Three years after it was approved and eight months after its implementation, the High Court of Justice will discuss a basic question at the end of the month: whether the reform in mental health services is even legal. The discussion will take place at a time when mental health services have already been transferred from the state to the health maintenance organizations. The court’s decision is likely to have far-reaching implications.
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A petition filed against the finance and health ministries, the Knesset and the HMOs claims that the reform in mental health services constitutes a reduction of the health services basket in Israel and therefore was approved illegally. The reform was introduced in the mid-1990s to complement the National Health Insurance Law, but was approved only in May 2012 and was launched last July.
In June 2015, before the start of the reform, a petition was filed on behalf of several organizations and individuals by attorney Hagai Kalai. The petition claims that because the right to mental health care, according to the reform, is conditional on a psychiatric diagnosis - a condition that did not exist previously - it excludes a population that prior to the reform had a right to such care.
“The National Health Insurance Law states that health services that are transferred from the state to the HMOs must provide at least the same services,” said Kalai. “Therefore when something is removed from the basket such a change can be passed only by changing the law or by the Knesset Health Committee.”
The Health Ministry presented the reform as a means of upgrading mental health services, noting that the opening of over 60 new HMO clinics, in addition to the 56 government mental health centers, provides greater access to care. The reform is designed to expand the provision of mental health care from about 80,000 patients to 200,000, a target of 2 percent of all children and 4 percent of all adults. In social terms, the reform is designed to shatter the negative stigma of mental illness in Israel and to merge physical and mental health care under the umbrella of the HMO clinics in the community. In order to promote the reform the state invested 2 billion shekels (about $500 million), with an additional 300 million shekels each year.
Prior to the implementation of the reform various groups expressed a fear that the agreement between the Health Ministry and the HMOs would end up excluding some patients. On the other hand, mental health workers in the Health Ministry and the HMOs claimed that “anyone in need of treatment will receive treatment.” In effect, it turned out that that is not the case and that there is more than one answer to the question of “who needs mental health care?” The health system and the HMOs chose a very narrow definition.
In December Haaretz reported that the Clalit HMO, which insures about half of all Israelis, told the Health Ministry that the reform fails to provide a solution for many patients. The HMO asked the ministry to approve a private mental health care track for patients with complementary insurance. The ministry refused.
The state does not deny that services must not be removed from the basket, but claims that this is not the case here. “We aren’t asking to turn back the wheel and cancel the reform. We’re only asking that the government provide what it gave previously,” says Kalai.