Reform and Changes in Mental Health: Everything You Need to Know

Starting this week, a significant change is happening as responsibility for mental health care will shift from the Ministry of Health to the health funds.

- What does this mean for you?

The primary implication is that you, the health fund clients, will be able to receive mental health counseling and treatment services just like any other advisory medical service (such as orthopedics and ophthalmology).

The treatment will take place, among other places, in dozens of community mental health clinics across the country and in hospitals. The change is expected to significantly improve the quality, availability, and accessibility of the mental health services you will receive. As any major change raises many questions, we will try to answer the main ones here.

- Who is eligible for mental health treatment?

Any insured person with a diagnosis or suspicion of a diagnosis in the field of mental health.

- What mental health services are included in the health basket?

Ambulatory services basket: 1. Diagnostic, evaluation, counseling and psychotherapy services, crisis intervention, individual therapy, family therapy, group therapy, support and maintenance follow-up, and home visits. 2. Day care. 3. Providing a psychiatric opinion or medical certificate about an insured person after a clinic examination, according to the district psychiatrist's instruction or a court order in a criminal proceeding, in accordance with the Mental Patients Treatment Law. 4. Service for an insured person receiving outpatient services, for assistance in submitting applications to the regional rehabilitation committee according to the Mental Health Community Rehabilitation Law, including preparation of opinions for the committee.

Hospitalization services basket: 1. Emergency and screening services. 2. Psychiatric hospitalization, day hospitalization. 3. Consultation and treatment in hospitalization in general hospitals. 4. Hospitalization of an insured person for observation, according to district psychiatrist's instructions or a court order in a criminal proceeding, following the Mental Patients Treatment Law, and providing a psychiatric opinion or medical certificate, after screening room examination or hospitalization, for such a procedure. 5. Service for an insured person in hospitalization or day hospitalization to assist in submitting applications to the regional rehabilitation committee according to the Community Mental Health Rehabilitation Law, including preparation of opinions for the committee.

Note: The services will be provided based on clinical and professional considerations of the treating professionals, as in all medical professions.

- Do I need a referral to receive mental health treatment?

Yes. The field of mental health belongs to advisory medicine (similar to ophthalmology and orthopedics, among others). This means that to receive mental health care in the community, in any of the treatment routes, a referral form is needed, except for direct approach which is allowed only to a liaison doctor and an independent therapist. The referral can be provided by a family doctor, liaison doctor, or consultant doctor (for example, a gynecologist diagnosing postpartum depression symptoms in a patient).

- Is there a limit to the number of treatments I can receive?

Each person will receive mental health treatment according to their health status, needs, and condition, based on the treating professional's recommendation and approval by the relevant authorities, provided there is a diagnosis or suspicion of a diagnosis in the field of mental health.

- Where can I receive the treatment?

Community treatment routes: Mental health clinics (organic clinics) - these clinics are spread across the country and consist of a multidisciplinary team: psychiatrist, social worker, psychologist, and nurse.

Independent doctor - similar to other advisory medical fields, mental health services are provided by independent doctors, specialists in general psychiatry or child and adolescent psychiatry.

Independent therapist (psychotherapy) – Psychiatrists, psychologists, and social workers provide psychotherapy treatments not within mental health clinics but in private clinics. This route is provided at a cost with patient participation.

Private provider - the service is provided in private institutes that include a multidisciplinary team and subject to commitment forms.

Hospital treatment routes: Emergency room - psychiatric hospitals. Emergency room - general hospitals. Hospitalization/day hospitalization.

Ambulatory clinic in a hospital - parallel to mental health clinics in the community, there are mental health clinics in psychiatric hospitals and general hospitals. These clinics include: psychiatrist, psychologist, social worker, and nurse.

Day treatment unit - Day treatment is an alternative to hospitalization. This framework is suitable for patients coming from the community who do not need hospitalization and for whom there is an additional treatment framework available.

Family Doctor - The Linking Thread

- Why is it important for the family doctor to know about the mental health treatment I am receiving?

The concept underlying the reform is that mental and physical health go hand in hand. The family doctor is the connecting thread between all the specialists the patient interacts with to provide the most comprehensive care.

Since there is a connection between mental and physical phenomena (for example, diseases like diabetes and hypertension affected by mental stress), information about a person's mental difficulties will help the doctor for early detection and prevention of physical illness typical of certain populations.

Additionally, information about the medication a patient is receiving, including psychiatric medication, is crucial for the family doctor to prevent adverse drug interactions that could endanger the patient.

- If I am treated in a psychiatric hospital, can I continue treatment in the same place even after the reform starts, yesterday, July 1st?

Yes, for this, the patient needs a Form 17 for treatment in the hospital clinic.

- What about those treated in outpatient psychiatric clinics of a general hospital?

A patient in an outpatient clinic of a hospital will need a commitment form (Form 17) to continue treatment, as customary in other medical fields.

- I want to continue treatment with the same psychiatrist, is it possible?

A patient treated by a psychiatrist in the public system can continue to be treated by them if that psychiatrist is included in one of Clalit's treatment routes, subject to the required approvals in that route.

- I need immediate help, who can I contact?

As before the reform took effect, you can contact the emergency rooms of psychiatric hospitals. Every mental health hospital has a psychiatric emergency room that operates 24 hours a day, and you can access it without payment or a commitment form (Form 17).

You can contact the emergency rooms of general hospitals, where psychiatric consultants are present. Payment in these places is according to the accepted rules for emergency room visits in a general hospital. During working hours, you can seek help at mental health centers in the community.

- With whom can I receive psychological (psychotherapy) treatment as part of the reform?

Every mental health clinic will have a psychologist regularly. Additionally, psychotherapy treatments can be received in an independent treatment track by psychologists, psychiatrists, or social workers under agreement with the fund.

The first visit with an independent therapist is for assessment (intake visit) and does not require a referral form (direct approach). Follow-up meetings require approval from the regional psychologist.

- I don't feel comfortable going to a clinic for treatment, what do I do?

As mentioned, there is an option to receive treatment from an independent therapist in a private clinic rather than a clinic or an independent psychiatrist in a private clinic rather than a clinic. Note: Treatment with an independent therapist involves patient participation fees.

How Much Will It Cost Us?

- How much will I have to pay for treatments?

Treatment in a community mental health clinic or by an independent psychiatrist or in a psychiatric clinic in a mental health hospital for doctor examination - a quarterly fee (every three months) of 24 shekels (as of July 2015).

Treatment in an outpatient clinic in a general hospital - a quarterly fee (every three months) of 32 shekels (as of July 2015).

Treatment in the independent therapist route for psychotherapy - a co-payment of 55 shekels for the first visit and 132 shekels starting from the second visit (as of July 2015).

As in general medicine, insured persons with a medical disability of 40% or more as determined by the National Insurance Institute are exempt from these fees.

- What should be done when a psychiatric patient needs a home visit?

A patient in a mental health clinic framework, unable to reach the clinic, is entitled to a home visit by clinic staff therapists.

- Who can give me a prescription for tranquilizers if needed?

A psychiatrist or the family doctor.

- Can I change my therapist?

Yes, subject to doctor assignment rules. This means that in every treatment track, there is a minimum period the patient must stay with that therapist. For example, the assignment period to a psychiatrist in a mental health clinic is one month. This means if you want to change therapists, it is possible after a month from starting the treatment. The assignment may be canceled under certain conditions. If the therapist is not a doctor but a psychologist or social worker - the assignment rules do not apply to them.