Krivoy Amir, Rosenthal Gadi
Geha Mental Health Center, Helsinki 1st, Petach-Tikva, +9729258220, Israel.
Mental Health Research Center, Clalit, Petach-Tikva, Israel.
Isr J Health Policy Res. 2025 Jan 29;14(1):6. doi: 10.1186/s13584-025-00670-y.
The events of October 7, 2023, and the subsequent war have starkly exposed the shortcoming of Israel's public mental health system. This system, already strained by years of underfunding and the COVID-19 pandemic, was unprepared for the surge in mental health needs resulting from these traumatic events. This paper outlines the systemic failures and proposes a comprehensive overhaul reform towards an integrative community-based, recovery-oriented mental health service.
Israel's mental health crisis is exacerbated by four converging vectors: a global diagnostic crisis in psychiatry, insufficient biological treatments, chronic underfunding, and a fragmented service model. Diagnostic practices, centered on outdated classifications, fail to address the complexity of severe mental illnesses, resulting in imprecise diagnoses and insufficient treatments. Despite the advent of psychopharmacology, significant advancements in drug efficacy are lacking, with recovery rates stagnating or declining. Financially, mental health in Israel receives only 5.2% of the health budget, far below the 10-16% seen in high-GDP Western countries. The community mental health services reform in 2015 lack effective oversight and incentives, leading to long wait times and inadequate care. Additionally, the fragmentation among funding entities-HMOs, Ministry of Health, and Ministry of Welfare-hampers coordinated care and comprehensive service delivery.
The proposed solution involves shifting from a hospital-biomedical -based to an integrated community-based model, emphasizing recovery over symptom management, based on regional mental health centres as hubs of services. This requires significant investment in community mental health teams, crisis intervention, home treatment, and integrated services. Early intervention, technology utilization, economic incentives for community-based care, and patient and family involvement are crucial components. This transformation aims to create a holistic, efficient, and patient-centered mental health system, better equipped to handle future challenges and reduce the societal and economic burdens of mental illness in Israel.
2023年10月7日发生的事件及随后的战争， starkly暴露了以色列公共心理健康系统的缺陷。该系统多年来一直因资金不足和新冠疫情而不堪重负，对这些创伤性事件导致的心理健康需求激增毫无准备。本文概述了系统性失败之处，并提出了一项全面的改革方案，朝着以社区为基础、以康复为导向的综合心理健康服务进行全面改革。
以色列的心理健康危机因四个相互交织的因素而加剧：精神病学领域的全球诊断危机、生物治疗不足、长期资金不足以及碎片化的服务模式。以过时分类为中心的诊断实践无法应对严重精神疾病的复杂性，导致诊断不准确和治疗不足。尽管精神药理学已经出现，但药物疗效方面缺乏重大进展，康复率停滞不前或下降。在资金方面，以色列的心理健康仅获得卫生预算的5.2%，远低于高GDP西方国家的10%-16%。2015年的社区心理健康服务改革缺乏有效的监督和激励措施，导致等待时间过长和护理不足。此外，资金实体（健康维护组织、卫生部和福利部）之间的碎片化阻碍了协调护理和综合服务的提供。
提议的解决方案包括从以医院生物医学为基础的模式转向以社区为基础的综合模式，强调康复而非症状管理，以区域心理健康中心作为服务枢纽。这需要对社区心理健康团队、危机干预、家庭治疗和综合服务进行大量投资。早期干预、技术利用、对社区护理的经济激励以及患者和家庭的参与是关键组成部分。这一转变旨在创建一个全面、高效且以患者为中心的心理健康系统，更好地应对未来挑战并减轻以色列精神疾病的社会和经济负担。
