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Reforming the Mental Health Care System: Key National MJB Studies


In 2015, Israel undertook a major reform of its mental health care system. For the first time since the introduction of universal health care in 1995, mental health care was included in the basic national health insurance package available to every Israeli citizen, with this care provided through the four national health plans. 

The reform sought to strengthen the links between physical health care and mental health care, make mental health services more widely and more easily available to those in need, improve quality of care, and make the system more efficient.

Today, more people are receiving publicly funded mental health care, and the health plans are taking steps to make mental health care more culturally accessible to Arabs, the ultra-Orthodox and other groups with particular needs.

MJB's role in the reform actually began with several initial studies that helped shape the reform itself and are now serving as baselines for assessing the impact of the reform.  The initial studies were supported in part by private philanthropy, most notably by Andrea and Michael Dubroff of Massachusetts, USA.

Today, the Smokler Center continues to play a key role in evaluating the implementation of the reform, with a series of studies focusing on key issues faced by the reform.

For example, one study has looked at the shortage of Arab mental health care professionals.  The research team, led by researchers Hadar Samuel and Irit Elroy, worked with Arab professionals and community leaders to understand the barriers that are contributing to this shortage and to identify successful efforts to overcome them.

Another study is looking at the changing roles of primary care physicians. With the integration of physical and mental health care, the primary care physician's role is even more critical in identifying and, in certain cases, treating mental health and referring to a specialist if necessary.  This study, led by researcher Yael Ashkenazi, is examining what role primary care physicians are playing in this area, so as to help maximize their role in mental health care.

In 2013, on the eve of the reform, MJB examined practices of psychiatrists, psychologists, and social workers to understand the level of preparedness for the changes.  Now, two years into the reform, a new study is assessing what has changed, in order to identify any continuing gaps between the practices and attitudes of professionals on the one hand and what is still needed to achieve the reform's objectives on the other.

Finally, a particularly pressing question is the impact of the reform on persons with serious mental illness (PSMI).  The reform seeks in particular to make care more accessible to this population, since they have long-term psychiatric disorders, often have limited financial means, and suffer from stigmatization and social exclusion.  A study by Dafna Haran, a researcher from MJB's Center for Research on Disabilities, found that, as the reform was getting underway, more than a third of PSMI were unaware that new services were available to them.  Studies like these have helped to emphasize the importance of the reform, and have focused the efforts of providers to address the key challenges.

In these studies, the Smokler Center researchers are working with some of the top international experts in the field.  In fact, a special collaboration is in place with Brandeis University's Schneider Institutes for Health Policy to stimulate an exchange of ideas related to best practices in mental health care policy in Israel and the United States.  The work of the collaboration has been supported by the Bronfman Philanthropies.

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