Background
The mental health (MH) insurance reform in 2015 shifted the responsibility for the provision of MH services from the Ministry of Health to the health plans. Shortly thereafter, in 2016, the Myers-JDC-Brookdale Institute conducted a comprehensive baseline study that examined the utilization of MH services by people with severe mental illness (PSMI) from their point of view. The current report presents a follow up study conducted in 2020, that is, five years after the enactment of the reform.
Objectives
To examine changes in PSMI’s utilization of MH services, including community-based MH care, psychiatric rehabilitation (‘rehabilitation basket’ services) and psychiatric hospitalization, as well as of general healthcare services, five years after the reform went into effect. The study also examined the aspects in which the reform achieved its goals and the aspects in which the concerns that were raised regarding its implementation materialized, as perceived by PSMI.
Methodology
A telephone consumer survey that was conducted among 678 PSMI in 2020. The 2020 data were compared to the 2016 data for all PSMI. In addition, at each point of measurement, data of PSMI with only a MH disability were compared to data of PSMI with multiple disabilities.
Main Findings
Relative to the baseline study, the current study found an increase in psychiatric hospitalizations during the five years prior to the survey (from 30% in 2016 to 36% in 2020) as well as a decrease in the utilization of community-based MH care during the year prior to the survey (from 89% in 2016 to 83% in 2020). In addition, 48% of PSMI who received their routine outpatient MH care in the public sector utilized it from the health plans, as was the case right after the reform implementation. In was also found that the utilization rate of psychiatric rehabilitation services in 2020 was apparently a little higher than in 2016 (36% vs. 32%, respectively), however, the difference was not statistically significant. Finally, PSMI with multiple disabilities used each kind of the MH services (i.e., community-based MH care, psychiatric rehabilitation and psychiatric hospitalization) to a lesser extent than PSMI with only a MH disability.
Conclusions and Recommendations
Five years after the launching of the reform and despite the COVID-19 pandemic, the MH system managed to maintain the provision of psychiatric rehabilitation services, which are essential to the participation of PSMI in the community. At the same time, the reform aimed at expanding the scope of PSMI utilizing their MH care from the health plans, which serve as their primary healthcare service coordinators. However, the rate of PSMI treated in the health plans remained unchanged. Considering this finding as well as the increase in inpatient hospitalizations, it is recommended that efforts be invested in strengthening the health plans’ capacity to meet the needs of PSMI and to improve continuity of care among the various MH services and between them and general healthcare services.
Citing suggestion: Haran, D., & Bachar, Y. (2022). Utilization of Mental Health Services by Persons with Severe Mental Illness Five Years After the Mental Health Reform: A Consumer Survey. RR-919-22. Myers-JDC-Brookdale Institute. (Hebrew)