In July 2015, the mental health (MH) insurance reform was introduced, transferring responsibility for the provision of MH services from the Ministry of Health to the health plans. One of the main target groups of the reform, which is the focus of this study, is the population of persons with severe mental illness (PSMI), who, due to their MH condition, receive a general disability allowance from the National Insurance Institute (NII). This population numbers 75,000, about a third of whom have another disability for which they are entitled to the NII allowance (multiple disabilities). PSMI have varied, complex needs, and thus they require voluminous, coordinated services.
The study examined the extent and patterns of MH service utilization by the PSMI and their experience using these services at the outset of the reform. The services examined were psychiatric hospitalization, psychiatric rehabilitation and community-based MH treatment. The study sought to identify the factors that promote or impede service utilization, both at the individual level (e.g., socio-demographic characteristics, health status and attitudes in the area of MH) and at the system level (availability, accessibility and continuity of care).
The data were collected in a telephone survey conducted between December 2015 and April 2016 among a representative sample of 350 PSMI. The data were analyzed for the whole population of PSMI, and then separately – for those with a MH disability alone and for those with multiple disabilities.
90% of the PSMI received community-based MH treatment during the year prior to the survey, and 30% had been hospitalized in a psychiatric facility during the previous five years.
Although all PSMI who are recognized in the NII system are entitled to psychiatric rehabilitation services by law, only 32% were utilizing any kind of these services at the time of the survey. This discrepancy indicates a substantial accessibility problem of psychiatric rehabilitation services.
PSMI with multiple disabilities utilized each service to a lesser extent that those with a MH disability alone: community-based MH treatment – 79% vs. 93%, psychiatric hospitalization – 23% vs. 33%, and psychiatric rehabilitation – 22% vs. 37%, although the severity of the MH disability was similar for both groups.
The main barriers to utilization of services, particularly of psychiatric rehabilitation, include lack of relevant information regarding access to services; difficulties utilizing one's rights and navigating through the fragmented service system; and inadequate continuity of care between service providers.
Addressing these barriers may significantly improve service accessibility and utilization.
The findings will serve as the basis for a follow-up study to examine the changes that will occur in the utilization of MH services by the PSMI after the introduction of the reform.
The study was funded with the assistance of the Israel National Institute for Health Policy Research, the Wohl Strategic Fund and the Laszlo N. Tauber Family Foundation. The study findings have been presented to the administration of the MH department of the Ministry of Health and in other forums.