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The Day After Project Overview of the Mental Healthcare System – Civil Services and Government Policy

עודכן: 13 באוג׳

Shay Weinblum 

 

Supervision: Yoni Ben Bassat 

Chief editor: Amit Ben-Tzur 

Hebrew editing: Daphna Lev 

English translation: Dr. Carly Golodets 

Design: Adi Ramot 

December 2023 


The project was written in response to the revealed weaknesses of the government and public services during the October 7 War. 

 

 

In the last three decades the mental healthcare system has undergone three reforms, the last of which1 transferred most of the responsibility for mental healthcare services from the government to the health maintenance organizations (HMOs). Under-budgeting and understaffing, alongside slow wage growth compared to the private sector, has led to a severe labor shortage and difficulties in providing adequate therapeutic solutions during both routine times and emergencies2. Currently, the mental healthcare system suffers from three main problems: a. under-budgeting and understaffing of therapists; b. difficulty filling existing positions; c. a lack of budget stability for Resilience Centers3. To ensure that the system can fulfil its role adequately, there is a need to significantly increase its budget, ensure long-term budget certainty, adjust the number of positions to match therapy demand, and find incentives to attract professional personnel to the public system and retain it. 


How Are These Long-term Disparities Expressed? 

  1. The number of patients is higher than the estimates used to determine HMO mental health budgets 


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  1. The number of appointments given to each patient is lower than the estimates used to determine the HMO mental health budgets 


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  1. Waiting times for mental health intake assessment and psychiatric treatment are longer than the global standard 


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The Three Main Problems 

Under-budgeting and understaffing of therapists 

As of early 2023, the mental healthcare system in Israel has a budget of approximately 3.9 billion ILS. Approximately 2.4 billion ILS are transferred to the HMOs, and an additional 1.5 billion ILS are transferred to government mental health hospitals. To close the gap with the OECD, and based on current priorities in the state budget4, the mental healthcare system requires a budget of 5.5 billion ILS, in other words, an annual supplement of approximately 1.6 billion ILS. However, due to the severe crisis in this field, and its chronic under-budgeting, it is reasonable to assume that this is a significant underestimate. 

 

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Due to under-budgeting, the public mental healthcare system suffers from understaffing of therapists, making it difficult to adequately meet the needs of the community. According to estimates, there is a shortage of approximately 9,500 therapeutic positions in the public service (Lia Shachaf, 2022). 

What needs to be done?  

Gradually close the gap in public service positions, which stands at approximately. 9,500, at a total cost of approximately 2.4 billion ILS, as part of a multi-year plan5. 

Difficulty in filling existing positions 

The staff growth rate in mental health hospitals, particularly that of doctors and paramedical professionals, is lower than the general population growth rate6. 


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Similarly, the fill rate of existing positions in mental health hospitals is very low, particularly among doctors. 



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What needs to be done? 

  1. Formulate incentive plans to attract a range of therapeutic professionals to work in the public sector and remain there in the long term. The one-off cost of these steps stands at 25 million ILS (Ministry of Health, 2022). 

  1. Set up a plan to provide solutions for demographic groups and communities suffering from particularly severe labor shortages, with an emphasis on the Arab community and the ultra-Orthodox community (State Comptroller, 2020). 

Lack of budget certainty for resilience centers 

Resilience Centers are designed to provide specific solutions for the consequences of the security situation on mental health. Of the 14 centers active today, 10 were established through government resolutions, which stated that their funding will come from pooling the resources of several government ministries. This budget provides two-thirds of the total government funding of these centers. During 2018–2020 the government transferred a total budget of approximately 65.5 million ILS to these centers (Figure 7). Another approximately 24% of the centers’ budget comes from rebates awarded by the National Insurance Institute for therapeutic services that meet the organization’s “traumatic stress procedure” criteria7 and approximately 9% comes from transfers from government ministries that were not determined by government resolutions. 



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Funding the resilience centers by pooling resources, rather than by a fixed allocation from the baseline budget of the government ministries, has created a need for annual or biennial negotiations among the ministries to decide on their continued budgeting and the scope of the budget, whose outcomes are then ratified by government resolutions. As part of these negotiations, the funding ministries often ask to reduce their budgetary contribution or to completely cease funding (State Comptroller, 2021). Since this conduct means that the scope and sources of the government funding of the Resilience Centers remain uncertain on an annual or biennial basis, and since the pooled resources comprise the greatest proportion of the government funding, the centers are in a constant state of budget uncertainty. This uncertainty impacts long-term planning, poses an ongoing threat to their continued activity and makes it difficult to recruit employees (State Ombudsman, 2021; Blank, 2021; Knesset Employment, Welfare and Health Committee, 2017). 

In the two years that have passed since the State Comptroller’s recommendation to set up an annual budget framework for all the resilience centers, which is fixed in the baseline budget of one of the government ministries, a few changes have been made. In the 2022 state budget all of the government funding for the centers, for a total budget of 26.6 million ILS, was included in an ordinance in the baseline budget of the Ministry of Health. Nonetheless, in the 2023–2024 budget this same ordinance in the budget of the Ministry of Health includes only 7.35 million ILS per year8, out of a total budget of 26.01 million ILS that was pooled from the budgets of various ministries9. These significance changes in the size of the promised budget show that despite the progress in fixing the funds for operating the Resilience Centers, a level of budget uncertainty that affects their operation still remains. 

What needs to be done? 

Establish an annual budget framework for all the Resilience Centers that is fixed in the baseline budget of one of the government ministries, and set up a mechanism for updating this baseline budget (State Comptroller, 2021). 

References 

  • OECD (2021). Health at a glance 2021: OECD indicators. OECD Publishing. 

 


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