A year and a half after the Health Ministry decided to close the country’s private psychiatric hospitals following reports of poor conditions and even abuse, it will instead issue a tender that will essentially allow them to continue functioning as “ecological rehabilitation communities.”
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According to the ministry, these institutions will be reorganized so that residents live in groups of 20, along with their caretakers and next to areas where various activities are available to them. According to the ministry, the new frameworks and professional staff will allow flexibility that “would give every resident a program adapted for him personally.”
At issue are the Ilanit and Neveh Shalva facilities, which house some of the toughest psychiatric patients – those who not only have emotional problems but cognitive deficiencies, such that doctors can’t always know for sure which problems are besetting them. Parents and guardians of these patients usually have neither the capacity nor financial resources to care for them on their own. Many are violent and must be constantly supervised.
In October 2012, dozens of staff members were arrested at a third facility, the Neveh Yaakov psychiatric hospital in Petah Tikva, on suspicion of serious patient abuse and neglect, and the hospital, which had 150 patients, was closed. In 2013, then-health minister Yael German and her director-general, Prof. Ronni Gamzu, announced a plan to close the two remaining hospitals by the end of that year. Yet both Ilanit and Neveh Shalva are still operating.
In January 2014, Gamzu informed the administrations of both hospitals that the ministry would no longer work with them. The ministry had found an alternative model of hostels and community housing that it believed would be suitable to at least some of the residents, and in March 2014 issued a tender for such operations.
That same month, however, Gamzu announced his resignation from the ministry. Since then, nothing has moved forward on any of these plans. German, it seems, had changed her mind about closing the two hospitals.
“Parents and relatives of people living there contacted me and told me heartfelt stories about [the patients’] situation,” German said. “These are people in a very difficult state, and any change would affect them badly, while those two places were home for them. They explained that moving them anywhere would cause a huge regression in their condition, and begged me not to close the institutions.”
Many of the patients have been in these facilities most of their lives, in some cases 35 years or more. It also emerged that some parents had made financial deals with the owner of Ilanit, “investing” money in the facility to guarantee their family member a permanent place there.
“I visited both places,” said German. “I found problems in both of them. In one I found physical deficiencies but excellent care, and in the second I found problems of attention, treatment and maintenance. But then the wonderful Dr. Tal Bergman became head of the [ministry’s] mental health department and she suggested an integrated approach; a tender that would allow both hospitalization and a communal framework. I also believe that there are instances where an institution is preferable to a community framework.”
Of the two facilities, Ilanit has been the target of most of the criticism. The 58-year-old facility, located in the Pardes Hannah industrial zone, was visited last week by Health Minister Yaakov Litzman, director-general Moshe Bar Siman Tov, and MK Ilan Gilon (Meretz). Last month a 52-year-old resident was taken to Hadera’s Hillel Yaffe Medical Center with a black eye and fractured eye socket. Family members said he was hit by a staff member and that it wasn’t the first time he’d been hurt. His sister reported that several months ago his hand was broken when staffers tried to restrain him.
“One of the workers said to me, ‘What do you expect? We earn 25 shekels an hour here,’” the sister said. “These are difficult patients who need professional treatment, employees who see this as a mission, and a support system for the workers themselves. That doesn’t happen in these places.”
In April 2013, the Haifa District Court sentenced two caregivers at Ilanit to four years’ imprisonment for being accessories to sodomy, sexual assault and emotional abuse of the helpless.
Health Ministry officials, however, claim that the situation at Ilanit has dramatically improved in recent years. “The case of Neveh Yaakov was unfortunate and the Health Ministry learned from it,” says Bergman. “I’m not saying these places are the pinnacle of our aspirations but our reviews in the field show that in recent years they have gotten better. In the realm of occupational therapy, for example, they have developed a whole new approach. And in general, on a professional and clinical level we’ve moved forward. We’ve come a long way in a process that also takes the families into account.”
She noted that these patients have only a limited capacity for rehabilitation and that treatment must be adapted to their abilities. “A patient who reaches a stage where he is ready to be accepted to a community framework will make it to the community,” she said. “But we have to do more than just make the community accessible.”
As for the frequency of inspections, Bergman said, “The ministry’s inspection team visits every half year, and any time there’s an incident or complaint that needs checking.”