Israel's Infamous Psychiatric Institution Annexed to Tel Aviv’s Ichilov Hospital

Abarbanel, a psychiatric hospital with a dreaded reputation, expects to see positive changes as the two hospitals embark on a journey of medical collaboration

Ido Efrati
Ido Efrati
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Tel Aviv's Ichilov Hospital last year.
Tel Aviv's Ichilov Hospital last year.Credit: RONEN ZVULUN/ REUTERS
Ido Efrati
Ido Efrati

The Abarbanel Mental Health Center in Bat Yam is set to become a branch of the Tel Aviv Sourasky Medical Center, also known as Ichilov Hospital, as part of an agreement signed Wednesday in a ceremony attended by Health Minister Nitzan Horowitz and the directors of both institutions, Prof. Yuval Melamed and Prof. Ronni Gamzu.

According to Horowitz, the merger is a first step in an ongoing effort to attach psychiatric facilities to general hospitals. Also expected to be joined are Maaleh Hacarmel Mental Health Center and Rambam Medical Center in Haifa, as well as the Be’er Yaakov-Ness Ziona Mental Health Center and Shamir Hospital (formerly Assaf Harofeh).

“Mental health is moving from the sidelines to the center stage,” Horowitz said. “As part of this reform, we've allocated hundreds of millions of shekels to mental health, and now – we're taking the first step towards integrating the mental health system into the general health system by linking Abarbanel and Ichilov Hospitals.”

Considering the two hospitals' drastically different public images, the move is a rather symbolic first step– as it represents the seemingly unbridgeable gap between attitudes towards general health care and mental health care, due in large part to the stigmas associated with mental illness.

On the one hand, there's Ichilov, a municipal hospital serving the “nonstop” city of Tel Aviv and its celebrities. Its brand-new buildings built by the country's top businessmen attest to its status among philanthropists, and it's overall positive image in Israeli society.

Just a few kilometers to the south, in Bat Yam, is Abarbanel Hospital. Viewed by the public as a dark psychiatric institution, its name is often whispered with dread. Despite some changes over the years, its reputation as the harshest psychiatric institution in the country – an emblem of the health system's backyard – went unchanged. Reports and photographs have documented the physical neglect and shameful infrastructure prevailing at Abarbanel. “Such hospitals aren’t even suitable for animals,” said former Health Minister Yaakov Litzman after visiting the premises. “The situation is reminiscent of darker periods in the nation’s history. I was shocked,” said Dr. Eitan Hai-Am, the ministry’s director-general at the time. Descriptions provided by patients, their families, and visitors painted a grim picture: overcrowding, unbearable stenches, moldy walls.

Abarbanel Hospital was built in the 1930s and is one of the biggest psychiatric institutions in the country. It has 300 beds for patients suffering from various mental conditions, including chronic patients who often spend years there. The hospital employs 400 staff members and serves one million people, including the residents of Tel Aviv, Jaffa, Holon and Bat Yam.

Criticism of the conditions at Abarbanel have been voiced for decades, shocking the public but resulting in almost no dramatic improvements. The government finally announced the decision to close Abarbanel in 2003, though it never happened. Since then, suggestions have been made to relocate the hospital, but again, none have reached fruition. To make matters worse, despite the attention the hospital has received by the public, up until 2012, it's budget only included 'maintenance,' with absolutely no funding for development.

The State Comptroller’s report from 2018 – the latest of many tasked with addressing the hospital's condition – said that in a department with 34 beds, the occupancy was, consistently, 60 patients by day and 40 by night. The overcrowding not only led to violent incidents in the department, but also left some patients bed-less, forcing them to wander into other wards at night to find a place to rest.

“This situation is intolerable and affects patients' chances of recovery, possibly exacerbating their condition. It causes great discomfort to patients and violates their dignity as human beings as well as their rights as patients,” says the report.

The comptroller added that the hospital’s future was unclear. “The decision to close the hospital was not implemented, and with its future undecided- it's difficult for responsible authorities not to take action. One cannot accept a situation in which conditions are so undignified and unsuitable for human beings,” said the report.

The hospital has also suffered from serious management problems over the years, with internal struggles impacting the quality of care and the staff's attitude towards patients. The 2018 indictment against Dr. Yehuda Baruch, the hospital’s director until the end of 2014, for having sex with a patient, certainly didn't improve the situation and only further eroded the institution's image. Since 2015, the hospital has been managed by Prof. Yuval Melamed.

In 2005, it was decided to establish a hostel in Abarbanel which would include both a youth ward and a ward for adult autism patients who don't require hospitalization. Building plans were approved by the Bat Yam Municipality in October 2017. Only now, 17 years after the initial decision, the wards are finally being completed. This consists of three buildings, a youth wing with 26 beds, an autism ward with 20 beds, and a hostel with 32 beds. Areas between these buildings have also been developed, adding space for outdoors activities, a sports field, walking paths and other features.

Management, resources, philanthropy

Will linking Ichilov and Abarbanel spell a new chapter in the life of the infamous psychiatric hospital? The prevailing spirit of optimism suggests that it might, but the proof, as always, will be in the results. Mental health officials believe this is the right move for shattering the stigma associated with mental illness, which inhibits medical personnel, researchers, decision-making officials and of course, the general public. Others are less optimistic, and see a future ridden with problems as veteran management officials are likely to be replaced.

The new agreement does not make Abarbanel Hospital subordinate to Ichilov management, as both institutions are expected to be managed separately while maintaining cooperation.

The hope is that by linking the two hospitals and calling for joint philanthropy, more money will flow in – as philanthropists are often willing to donate to hospitals like Ichilov though relatively uninterested in mental health institutions like Abarbanel. In addition, Abarbanel should benefit from better access to medical suppliers, improved computer services and digital communications.

Cooperation between the two institutions in certain clinical areas is expected, including a common center for conducting joint research on neuropsychiatric treatment. Collaboration is also expected in staff training and knowledge expansion. Specialist clinics run by Ichilov personnel will operate at Abarbanel as well, which allows Ichilov to expand its general clinical services. These changes should ideally help in diminishing the stigma associated with mental illness patients, and in doing so, open the doors to patients in need.

“All aspects of mental health care require strengthening, in community and outpatient clinics, as well as in hospitals,” said Ichilov's director general Ronni Gamzu. “We recognize the difficulties we face," he continued, referring to the joining of the two hospitals, “but we'll create more power, together. We wanted a common facility with professional and managerial links, so that we all can bring what we can to the table to help improve Abarbanel.” Gamzu promised to help in getting funds, whether through donors or other methods.

Yuval Melamed, the director of Abarbanel, seemed similarly optimistic, “By creating smaller departments with designated healthcare personnel and a larger auxiliary staff, this move is part of a vision to reform mental health services and meet the needs of every patient in both general or psychiatric care. We anticipate that this collaboration will result in the creation of centers of excellence in the brain sciences, made up of doctors from various disciplines.”

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