Stigma, Discrimination, and Mental Health in Israel: Stigma against People with Psychiatric Illnesses and against Mental Health Care

The stigma associated with psychiatric illness and mental health care may inhibit people from seeking treatment, which may prevent an improvement in their condition and even lead to a deterioration. Stigma has a destructive effect on the lives of people with psychiatric illnesses and on their rehabilitation and integration into society.

This is one in a series of studies conducted jointly with the Mental Health Services at the Ministry of Health to suggest directions for interventions to reduce stigma with regard to objectives, intervention methods, and target sub-populations. The study described in this report, examines the cognitive, emotional, and behavioral facets of stigma against “mental illness,” people with psychiatric problems, and mental health care. The study is based on a sample representative of Israel’s entire adult population (N=1,583) and special samples of the ultra-Orthodox Jewish sector and Arab localities (2,100 interviews in all). Concurrently, a study on people attending public mental health clinics and a preliminary study of parents of people with psychiatric illnesses were also conducted. Selected findings of the current study:

  • The public is open, in principle, to seeking psychiatric treatment, but half of the respondents believe the negative attitude of people around them to be justification for not doing so. About a third do not know whether there is a mental health clinic in their area.
  • If psychiatric hospitalization is required, people would prefer to be admitted to a psychiatric ward in a general hospital rather than a psychiatric hospital. In contrast, when it comes to ambulatory treatment, there is a slight preference for clinics dedicated solely to mental health care.
  • The public perceives the “mentally ill” to be characterized by abnormal or unexpected behavior and violence. The perception of violence is reflected in fear of the “mentally ill” and of people with schizophrenia.  In contrast, people with depression are perceived more as “guilty” of their condition and more anger was expressed against them.
  • An examination of the public’s willingness to have contact with people with psychiatric illnesses revealed that 52% of the respondents would not hire a person with a psychiatric illness, 35% were not willing to work with one, and 31% were not prepared to have one as a neighbor. These findings are probably an underestimate of the barriers facing persons trying to rehabilitate themselves and integrate into society.

The report discusses objectives and possible methods of intervention: reduce the stigma associated with psychiatric hospitalization; decrease the perception that people with psychiatric illnesses are violent and reduce the fear of them; reduce the blame for their condition and the anger directed at them; inform the public about the existence of medications for schizophrenia and about the chemical basis of depression and the treatments available. The report discusses differential interventions for different target populations, including the ultra-Orthodox and Arabs. It also discusses the importance of presenting a multi-dimensional picture stressing that people with psychiatric illnesses have normative aspects, without ignoring the “ill” aspects; the positive and negative implications of providing information about the illness and the etiology; and issues relating to increasing exposure to, and contact with, people with psychiatric illnesses. With regard to seeking mental health treatment, the study discusses informing the public about mental health clinics and their location, reducing the stigma of seeking treatment, and interventions with family doctors.

The findings of the study have been submitted to the heads of the Mental Health Services at the Ministry of Health and to the National Council for the Rehabilitation of the Mentally Disabled in the Community and presented before the Council plenum. The study was funded with the help of by the National Institute for Health Services and Health Policy Research.

Citations in the professional and academic literature

Soffer, M., Rimmerman, A., Blanck, P., & Hill, E. (2010). Media and the Israeli disability rights legislation: progress or mixed and contradictory images?. Disability & Society25(6), 687-699.

Struch, N., Levav, I., Shereshevsky, Y., Baidani-Auerbach, A., Lachman, M., Daniel, N., & Zehavi, T. (2008). Stigma experienced by persons under psychiatric care. Israel Journal of Psychiatry and Related Sciences45(3), 210.

Nakash, O., Nagar, M., Danilovich, E., Bentov-Gofrit, D., Lurie, I., Steiner, E., … & Levav, I. (2014). Ethnic disparities in mental health treatment gap in a community-based survey and in access to care in psychiatric clinics. International Journal of Social Psychiatry60(6), 575-583.

Nakash, Ora, Maayan Nagar, and Itzhak Levav. “Predictors of mental health care stigma and its association with the therapeutic alliance during the initial intake session.” Psychotherapy Research 25, no. 2 (2015): 214-221.

Tal, A., Roe, D., & Corrigan, P. W. (2007). Mental illness stigma in the Israeli context: Deliberations and suggestions. International Journal of Social Psychiatry53(6), 547-563.

Neikrug, S., Roth, D., & Judes, J. (2011). Lives of quality in the face of challenge in Israel. Journal of Intellectual Disability Research55(12), 1176-1184.

Rosen, B., Nirel, N., Gross, R., Bramali, S., & Ecker, N. (2008). The Israeli mental health insurance reform. Journal of Mental Health Policy and Economics11(4), 201.

Itzhaki, M., Meridan, O., Sagiv-Schifter, T., & Barnoy, S. (2017). Nursing students’ attitudes and intention to work with mentally ill patients before and after a planned intervention. Academic Psychiatry41(3), 337-344.

Neikrug, S., Roth, D., Judes, J., & Zmiro, N. (2014). Challenged with disability: Quality of life of Arab families in Israel. סחי” ש: סוגיות בחינוך מיוחד ובשילוב, 98-115.‎

Novis‐Deutsch, N. (2015). Identity Conflicts and Value Pluralism—What Can We Learn from Religious Psychoanalytic Therapists?. Journal for the Theory of Social Behaviour45(4), 484-505.

Abramowitz, M. Z., Bentov-Gofrit, D., Khawaled, R., Bauer, A., & Cohen, T. (2011). Attitudes among medical and law students toward decision-making in regard to involuntary psychiatric hospitalization. International journal of law and psychiatry34(5), 368-373.

Roth, D., & Brown, I. (2017). Social and Cultural Considerations in Family Quality of Life: Jewish and Arab Israeli Families’ Child‐Raising Experiences. Journal of Policy and Practice in Intellectual Disabilities14(1), 68-77.

Sykes, I., Menashe, E., Lazerwitz, E., Vlodavsky, A., & Zaga-Shabbat, L. (2007). Reflections on an effort to develop a cross-disability consciousness inclusive of people with psychiatric disabilities. Disability Studies Quarterly27(4).

Lavie-Ajayi, M., Moran, G. S., Levav, I., Porat, R., Reches, T., Goldfracht, M., & Gal, G. (2018). Using the capabilities approach to understand inequality in primary health-care services for people with severe mental illness. Israel journal of health policy research7(1), 49.

Saymah, D. E. (2015). A proposed approach for management of community mental health projects in areas of political conflict (Doctoral dissertation, University of Birmingham).

Nagar, M., Levav, I., Danilovich, E., Abu-Tair, M., & Grigory Podolsky PhD, M. D. (2016). Psychological Factors Associated with Emotional Distress among Palestinian Arabs from East Jerusalem Accessing Psychiatric Care in Israel. The Israel journal of psychiatry and related sciences53(3), 33.

ROZPRAWY, A. I. (2017). Rodziny wychowujące dziecko z niepełnosprawnością–czynniki społeczne, kulturowe oraz polityczne: rodziny żydowskie i arabskie mieszkające w Izraelu. CZŁOWIEK–NIEPEŁNOSPRAWNOŚĆ–SPOŁECZEŃSTWO, 5.