Northern Israel's Top Mental Health Facility for Kids Faces Collapse

Since Health Ministry shifted responsibility to HMOs, Safed hospital staff have been deserting sinking ship.

The inauguration of the Child Health Center at Ziv Medical Center in Safed, attended by Health Minister Yaakov Litzman (center) as well as hospital and Safed officials, June 2016.
Gil Eliahu

The waiting list at the mental health department for children and adolescents at the Ziv Medical Center in Safed is continuing to grow as doctors, psychologists and other caregivers leave. It’s happening at the largest and most important pediatric mental health facility in northern Israel, which also operates extension facilities in the northern towns of Tiberias, Kiryat Shmona, Maghar and Majdal Shams.

The past year has seen a drastic reduction in the department’s operations. The medical center (formerly known as the Rebecca Sieff Hospital) issued a statement saying that the changes are a result of a reform in how mental health services in the country are provided, which shifted responsibility for the provision of services within the community to the country’s four health maintenance organizations.

Just recently, two doctors, five psychologists and a number of paraprofessionals have left the Child and Adolescent Mental Health Department. In addition, Haaretz has learned that the department’s director, Dr. Itzhak Vorgaft, has also announced his resignation and is expected to leave next week, before a replacement is appointed.

His departure, just a year after taking on the post, is seen as a low point in the continued decline of the mental health department, a decline that has resulted in longer waits for care. If in the past patients had to wait three months, now they have to wait for up to six months.

The department, which is run out of an old hospital building, provides a range of services for children from pre-school age to the age of 18 and sometimes even slightly older. It has facilities for 15 hospitalized patients and five beds for patients staying just for the day. Facilities also include an eating disorder clinic, a psychiatric clinic that includes individual and group therapy and treatment for other family members. The services for younger children include diagnosis of attention deficit disorders, developmental problems and autism. There is an adolescent clinic and a phobia clinic.

Over the years, the Child and Adolescent Mental Health Department gained a reputation as a place that combined a range of advanced intervention approaches and current theory, along with a commitment to both research and therapeutic practice. The department serves the Galilee and Golan Heights and also receives patients from Haifa and the Jezreel Valley.

When the question is posed as to why the clinic has taken such a sharp turn for the worse, the answers ultimately relate to funding. Some have argued that it results primarily from reforms in the country’s mental health sector, particularly when it comes to funding, for example, of eating disorder treatment, which in turn has resulted in major funding problems.

Others have suggested that the medical center’s director, Dr. Salman Zarka, who, like Vorgaft, was appointed last year, was not sufficiently aware of the crisis developing in mental health services at his hospital and the issue was not properly addressed. Zarka, who prior to taking his current position was the director of medical services in the Israel Defense Forces, succeeded Dr. Oscar Ambon, the director for 21 years. Zarka and Vorgaft repeatedly clashed over the past year, until Vorgaft decided to leave.

The Ziv Medical Center issued a statement to Haaretz, saying that it is committed to providing “inclusive and quality medical services to all residents of the north,” and to expanding services to spare residents of the region the necessity to travel elsewhere. The statement goes on to say in part that its psychiatric services are “a center of excellence.” The statement noted, however, that in the summer of last year, the reforms were introduced in the country’s mental health system that shifted responsibility for psychiatric services to the health maintenance organizations, with an emphasis on services within individual communities.

The change, the statement went on to say, required the medical center to revamp its own mental health services, but in consultation with the HMOs, the hospital decided to continue to provide services at its branch operations within the community “despite the economic implications involved.”

The medical center’s statement added that since the implementation of the reform, continued provision of psychiatric services while responsibility has been transferred to the HMOs is “complicated,” but psychiatric services for adults at the hospital remain unchanged.

The Health Ministry issued a statement saying that it is committed to providing mental health services in outlying areas of the country and the situation with respect to mental health services at the Ziv Medical Center is being examined in consultation with hospital management.