Israel's State Comptroller Examining Forced Psychiatric Hospitalization

Panels on forced psychiatric commitment are accused of being callous and negligent

Shaar Menashe psychiatric hospital
Rami Shlush

The State Comptroller’s Office has begun examining the performance of the psychiatric hospital committees that decide on forced hospitalizations.

As part of the examination, which began a few weeks ago, auditors are attending committee sessions and have been interviewing mental health and legal professionals.

The committees determine whether patients committed to a psychiatric ward on the orders of a district psychiatrist should remain hospitalized; they meet in the psychiatric hospitals once a week. Thousands of patients are discussed by these committees annually. There are some 20,000 admissions to psychiatric wards each year in Israel, of which nearly 6,000 are cases of forced hospitalization.

The committees’ decisions can be appealed in court, but recently there has been criticism of how they operate. Dr. Zipporah Ehrman Stern, an expert in law and psychiatry, told an Israel Bar Association conference that, “Sometimes the committees are insensitive. I’ve witnessed cases of yelling at patients and families who were late to meetings. They weren’t permitted to say anything. I’ve seen committee members sitting in front of the patient and talking on their cell phones. There’s no one to complain to about such behavior.”

“Generally the committees conduct themselves properly, but there are some cases of behavior that need improvement and correcting,” says attorney Daniel Raz, who handles the area of forced hospitalizations for the legal aid department of the Justice Ministry. “The minutes of these discussions are often handwritten and totally illegible, the obligation to explain [the need for hospitalization] is not consistently observed so that sometimes a person is forcibly hospitalized and there’s no real way to have any legal oversight of the process. Still, we are getting cooperation on this issue from the Health Ministry and recently we have even had discussions about preserving a fair process with quality representation before the committee.”

The psychiatric committees enter the picture during a person’s first hospitalization when the hospital seeks to extend the patient’s hospital stay against his will. A committee comprises two psychiatrists not affiliated with the hospital – one in private practice and one in public service – and a lawyer. The committees evaluate the patient’s medical condition and hear the positions of the hospital, the patient and his family before deciding whether to extend the hospitalization.

The panel is meant to decide whether the patient is a danger to himself or his environment and whether there is justification for keeping him hospitalized against his will. During the first hearing the committee can approve continued hospitalization of up to three months, and in subsequent hearings for up to six months. The average forced hospitalization is around 30 days.

A committee’s decision can be appealed to a district court, and committed patients are entitled by law to free legal representation from the Justice Ministry’s legal aid department, which indeed represents most such patients. Ministry figures show that legal aid represents some 4,000 psychiatric patients annually in 5,400 cases, which are 90 percent of the forced hospitalization cases.

The State Comptroller’s Office said, “The comptroller’s society and welfare division examines various issues in the realm of mental health very two or three years, since we’re talking about a weak population that doesn’t know how to stand up for its rights. As part of the annual work plan, it was decided to focus this time on various issues relating to psychiatric hospitalization.”