Psychiatric Services in Israel: An Overview
Psychiatric services in Israel are provided in both public and private settings. The following is a brief explanation of outpatient services provided through the public system, as well as a brief outline of some differences between the public and private settings.
According to the National Health Insurance Law of 1994, every Israeli resident is entitled to health care services through one of the four Health Care Providers (HCP), which are, in order of size, Clalit, Maccabi, Meuchedet and Leumit. In the past, mental health care services fell under the responsibility of the Government rather than the HCPs.
In June 2015 Israel underwent a Mental Health Care (MHC) reform, which transferred the responsibility for providing mental health care services from the Government to the Health Care Providers.
Click here for a brief explanation of the Health Care Reform on the Israeli Ministry of Health website.
To learn more about the rehabilitation basket (sal shikum) for the mentally ill, click here.
Psychiatric Services provided by the Health Care Providers
Since 2015, with the implementation of the MHC Reform, psychiatric services are included in the medical services that are provided by the Health Care Providers.
There are 4 settings in which ambulatory (non admission) mental health care is provided in the public sector, all of them are through the Kupot Holim:
1) Mental Health Care Clinics:
These are multidisciplinary clinics that provide psychiatric, psychological and rehabilitation services. Clinic staff members include psychiatrists, psychologists, social workers, and may also include occupational therapists, art therapists and dietitians. Within the clinics there is potential for consultation between the different caregivers. Centers may offer a wider range of services, including group therapy sessions. There is no fee for services in these centers, beyond the fees due for HMO membership.
2) Independent Psychiatrists:
Independent psychiatrists are affiliated with the HCPs and are located either within the Kupat Holim, or in their own private clinics. Some clients find it more discrete to meet a psychiatrist at a private clinic rather than at a multidisciplinary MHC Clinic. There is generally no fee for psychiatric services in this setting, beyond the fee for consulting a specialist through your HCP.
(Similarly, most HCP employ Independent Psychologists who provide psychological services in private clinics. Consultation with Indepenent Psychologists often entails a subsidized fee.
3) Hospital (or other) Outpatient Clinics:
Most major hospitals in Israel and all of the mental health care hospitals provide psychiatric services through their outpatient clinics. Since the implementation of the MHC reform, in some cases it is possible to receive a referral as well as a financial commitment to subsidize treatment (‘Tofes 17”) from your HCP to receive service in an outpatient setting. The MHC provider may restrict the number of sessions that you receive in such a setting. Reasons for being referred to an outpatient clinic might include long waiting times for HCP services, or specialty services at the Outpatient Clinics are not available through the HCP.
4) Emergency Services:
Emergency psychiatric services are provided in every emergency room in Israel, including the ERs of psychiatric as well as general hospitals. It is important to remember that there is a psychiatrist on site or on call at all hospitals, 24 hours a day, 7 days a week, including weekends, holidays etc. Emergency services are free of charge in cases of suicidal ideation, drug poisoning/ intoxication, or psychosis. There may be a fee for services in other cases.
There are several advantages to public psychiatry. The following are points to consider:
Psychiatrists in the Kupat Holim have access to your medical records, including diagnoses, medications, and medical evaluations. This might be advantageous in cases in which there are additional medical conditions or an extensive or prolonged psychiatric history.
Your psychiatric record at Kupat Holim is confidential and can be seen only by other mental health care professionals within the Kupa; however, medications purchased using a Kupat Holim prescription can be seen by additional specialists in the Kupa. It is generally advantageous for the medical team to know what psychiatric medications you are taking in order to avoid drug interactions.
There are cases in which there is an advantage to being cared for by different therapists who work together and are able to communicate with each other, as available through the Kupa, particularly in the MHC Clinics.
Some specialty psychiatric services are provided only through Hospital Outpatient Clinics. This might be the case for the treatment of eating disorders and autistic spectrum disorders, for example. Your Kupat Holim psychiatrist has information regarding these services and can refer you to them.
Waiting times may vary between the different services. You may be referred to a Hospital Outpatient Clinic for therapy due to there being a long wait for psychotherapy, for example, within the Kupa.
Nefesh B’Nefesh also offers a comprehensive guide, which can be seen here.
Psychiatric Services Provided by Private Practices
Alongside the public service, psychiatric services are also provided by private psychiatrists. There is a fee for private psychiatric consultation.
Advantages of choosing care in the private sector might include:
Privacy: private clinics may be more discrete. Private psychiatrists do not have access to your Kupat Holim records and do not update these records with your medical information.
Availability of services: often there are long waiting lists for services in the public setting. Private psychiatrists may have greater availability.
Choice: in the private setting you can directly choose a therapist/psychiatrist. This might be especially significant when looking for English-speaking therapists, for example.
Convenience: there may be more flexibility of hours and scheduling with a private therapist.
Insurance: if you are visiting in Israel and are not covered by local heath insurance you may not have access to services through the HCPs.