Background
The percentage of children and youth with mental health difficulties ranges from 10% to 20% across the world. Following the outbreak of the COVID-19 pandemic at the beginning of 2020 there has been a sharp increase in the percentage of children and youth who experience mental distress, such as depression, anxiety, eating disorders, dangerous behavior, and other mental health difficulties. Apart from the various forms of mental distress experienced during the COVID-19 pandemic, the pandemic is expected to have long-term implications for the mental health and mental and emotional well-being of children and youth. Even before the onset of the COVID-19 pandemic along with its implications for the mental health of children, youth, and young adults, researchers predicted that mental health would be one of the main challenges for health systems the world over in the following years. To meet this challenge, appropriate measures and actions should be taken, including the allocation of adequate resources and human capital.
A proper response to mental health difficulties provided as early as possible in life has an important role in the prevention of a chronic mental health condition. The importance of integrative services provided within the community – addressing the needs of children and youth while allowing them to stay in their familiar environment as far as possible – has also been increasingly recognized in Israel in the last two decades, as reflected in the ‘Toward the Community’ reform launched in 2004 by the then Ministry of Social Affairs and Social Services (currently, the Ministry of Welfare and Social Affairs) as well as in the mental health reform launched in 2015 (whereby the responsibility for the provision of mental health services under the National Health Insurance Law was transferred from the Ministry of Health to the health plans). Accordingly, the need has increased for accessible community-based services for children and youth, as distinguished from services provided in segregated settings (that is, separate settings providing services outside the community, for instance, closed psychiatric wards). However, under the law in Israel, the state is not obliged to provide community-based care, support, or rehabilitation services (in contrast to services outside the community, i.e., in segregated settings) for children and youth with mental health difficulties or psychiatric disability.
Children and youth in Israel experiencing emotional and mental health difficulties and their family members receive services from the health system, the welfare system, and the education system, both within the community and in out-of-home settings. Yet, the community-based mental health system in Israel has been neglected, underdeveloped, and underbudgeted for years, resulting in a shortage of services. The growing need for mental health services for children and youth due to the significant increase over the years, and, in particular, during the COVID-19 pandemic, in the percentage of children and youth experiencing mental distress coupled with the unmet need for early treatment and prevention have led to a crisis in the mental health system. Faced with a shortage of human capital and lack of services, the system fails to provide an adequate response to the needs of children and youth who experience a mental health crisis or emotional and mental health difficulties (or, for that matter, fails to provide services for adults in need of mental health care or support) – whether in the community, in closed psychiatric wards, or community rehabilitation services. Given the above, it has been decided at the Myers-JDC-Brookdale Institute to map the mental health services for children and youth who experience emotional and mental health difficulties, and the related policy concerns, with the aim of laying the groundwork for decision-making and informing policy and service planning.
Goals
- To map the continuum of mental health services for children and youth who experience emotional and mental health difficulties, including community-based services, services provided in closed psychiatric wards, and post-hospitalization services funded or supervised by the state
- To identify community-based mental health services that need to be developed or expanded
- To identify policy issues arising from the mapping of services
- To explore the impact of the COVID-19 pandemic on these services
Method
Data collection for the purpose of mapping was conducted by,
- Reviewing papers published in academic journals
- Locating gray literature in the official websites of government ministries, hospitals, the health plans, and private providers of services for children and youth with emotional and mental health difficulties
- Analyzing administrative data related to the mental health system drawn from the Statistical Abstract of Israel and similar publications as well as data received from government ministries and the health plans under the Freedom of Information Law
- Conducting 35 semi-structured in-depth interviews with health, education, and welfare professionals and representatives of civil sector organizations providing services for children and youth with emotional and mental health difficulties
Findings
The system of mental health services for children and youth in Israel had been in an ongoing crisis over long years, a crisis that deepened following the outbreak of the COVID-19 pandemic. According to some professionals, the mental health system is now on the brink of total collapse. The findings of the mapping of services presented in this report point to the shortage of essential mental health services for children and youth all along the care continuum – from community-based services, through services provided in closed psychiatric wards, to post-hospitalization services. The findings are relevant on a national level, but the shortage of services is all the more acute in the geographical and social periphery of Israel. Thus, for instance, the mental health services for children and youth in the local Arab population and Jewish Ultra-Orthodox population are inadequately staffed. Furthermore, dedicated services in response to unique needs such as eating disorders, sexual abuse, and various addictions are inadequate or unavailable. On top of this, following the COVID-19 pandemic, there has been a sharp increase in the prevalence of mental distress and emotional and mental health difficulties among children and youth in Israel (and across the world), the burden on the health, education, and welfare services for this population has also significantly increased, and the relevant ministries have been unable to provide adequate services along the entire care continuum. Professionals foresee enduring implications of the COVID-19 pandemic for the emotional and mental health status of children and youth in the years to come and an ever-growing shortage of mental health services, compounding the distress of prospective service consumers.
Summary and Recommendations
The crisis in the mental health system providing services for children and youth in Israel calls for a national program for addressing this issue in the short and immediate term as well as in the long term. Other countries, among them Canada, Ireland, and the UK, have already recognized this need and adopted such national program. The most appropriate way in Israel to similarly ensure the right of children and youth with emotional and mental health difficulties to mental health services is by passing a dedicated legislation. Therefore, Israel should pass the draft bill on the issue.
Unless adequate resources and budgets are allocated to the system according to a systematic and comprehensive program that takes into consideration the needs of diverse populations for a range of widespread services, the social implications are liable to be far-reaching. Such a national program should take account of the interface between the health, welfare, and education systems and focus on the provision of community-based services, in line with the national inter-ministerial program proposed by the Health, Welfare, and Education Ministries in 2022, which comprised services provided by each of the three ministries and included reference to identification and prevention, therapeutic interventions, and rehabilitation, whether within the community or in post-hospitalization residential facilities, with the focus on community-based services. As of the publication date of this report, the inter-ministerial program has not been approved.
Citing Suggestion: Rimon-Greenspan, H., & Barlev, L. (2023). Services for Children and Youth With Emotional and Mental Health Difficulties: Mapping of Services and Policy Issues. RR-942-23. Myers-JDC-Brookdale Institute. (Hebrew)