The Israeli law for the rehabilitation in the community of persons with psychiatric disabilities: Achievements and challenges.

OBJECTIVE: The Community Rehabilitation of Persons with Mental Health Disability Law (2000a) is one of Israel's most important pieces of social legislation. It grants persons with psychiatric disabilities the right to receive rehabilitation in the community. This article is a case study of the development and implementation of a policy that led to the Rehabilitation Reform and that has become an important component in Israel's comprehensive mental health reform. The purpose of the study was to review and analyze the law and its elements, examine its implementation during its first two decades of operation, and to identify the issues it faces entering its third decade of application. METHOD: The study examined the key components of the reform such as intended beneficiaries, financing, workforce, and services provided. It used Israel's official statistical data and drew upon a series of interviews with officials and experts on rehabilitation, mental health and social services. RESULTS: In 2020, 30,000 persons were receiving community psychiatric rehabilitation services, constituting about one fifth of the estimated eligible population. In addition to the reform's achievements, this article also identifies a number of issues. Toward the end of the second decade, problems between the psychiatric Rehabilitation Unit and the mental health services became apparent. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: As the Rehabilitation Law enters its third decade, it is recommended to establish an independent committee of experts to examine needed modifications in light of the conclusions drawn about the first two decades of its implementation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The rehabilitation of the mentally disabled in the community act in Israel: Entrepreneurship, leadership, and capitalizing on opportunities in policy making.

This paper examines the role of policy entrepreneurs in the formation of a rehabilitation program in the field of mental health in Israel, shedding light on their role in general and specifically in mental health policy formation. Our research is based on a historical case study. The legislation process was examined through interviews with key actors in the legislative process and archival materials. While in general our findings reinforced existing literature, our research also revealed new information on several topics: organizations as policy entrepreneurs; inter-sectorial coalitions of entrepreneurs; and possible problems arising from the concept of 'leadership by example'.

The Reform of Rehabilitation in the Community of Persons with Psychiatric Disabilities: Lessons from the Israeli Experience.

Purpose is to present the mental health rehabilitation reform enacted in Israel in 2000, and to analyze the challenges it faces in its second decade of implementation. Lessons are drawn with regard to other jurisdictions interested in reforming mental health services. Besides reviewing the reform's accomplishments and its contribution to the changes that have occurred in mental health services, the article also assesses the dangers it has to contend with. Analysis focuses on the system's clients, budget, personnel and services-and on its functional environment. During the past decade, the rehabilitation services have considerably expanded. However they cover only about one-fifth of the target population. Paper discusses the mutual dependency between the rehabilitation services and the recently implemented (mid-2015) mental health insurance reform, emphasizing the importance of the rehabilitation system's efficient and effective functioning to the success of that reform and improvement of the mental health services in general.

Mental health reforms in Europe: Israel's rehabilitation in the community of persons with mental disabilities law: challenges and opportunities.

This column describes an innovative, government-sponsored, countrywide mental health reform focusing on rehabilitation and community integration of persons with serious mental illness, which was enacted into law in Israel in 2000. The reform was part of the country's efforts to shift the locus of treatment and care from psychiatric institutions to the community. The authors review preliminary evidence of the impact of reform and offer cautionary notes regarding the future direction of its implementation. The decade after the law's enactment saw an impressive increase in rehabilitation services, a significant reduction in the number of psychiatric beds, and major changes in government budget allocations. The authors examine factors that may endanger the viability of reform and discuss lessons to be learned from the Israeli experience.

Promises and pitfalls on the road to a mental health reform in Israel.

This study assessed efforts to reform the mental health (MH) service system in Israel, moving the locus of treatment and care from a mental hospital system to the community. It focuses on changes which occurred in MH policy and services especially during the last decade, evaluating trends and issues regarding legislation, clients, budgets and personnel of the system. Findings indicate a drastic decline in the number of psychiatric beds, length of stays in inpatient services, a reduction in the number of MH personnel, and a dramatic increase in rehabilitation services in the community. However, no government hospital was closed and budgets for hospitals actually increased, while MH community clinics budget was reduced. The efforts to transfer responsibility for MH services to the health care provider organizations have not been successful yet and the reform has not been completed, endangering the progress achieved so far. Promises and perils on the road towards a successful reform are discussed. It seems that the stigma and the social exclusion of persons suffering from mental disorders, as well as the salience of the issue of MH in relation to other problems the Israeli society has to deal with, have contributed to the failure of efforts to reform the MH service system.

Risk avoidance and missed opportunities in mental health reform: the case of Israel.

Passage of the National Health Insurance Law (NHI) [National Health Insurance Law (NHI) (1994). Israel Law Code, 1469, 156 (Hebrew).] provided a window of opportunity for mental health reform in Israel. The reform called for transfer, within a period of 3 years, of responsibility for psychiatric services formerly provided mostly by the Ministry of Health, to Israel's four major healthcare providers. Planners of mental health reform in Israel saw in the NHI Law an opportunity to bring about far-reaching structural changes in mental health policy and service provision, shifting the locus of care from psychiatric hospitals to the community. This paper reports results of a case study assessing factors that hindered or promoted the planned reform. The theoretical and conceptual framework of the study was derived from public policy theories and in particular on those related to public agenda and agenda setting processes. The study was also informed by organizational and interorganizational theories and exchange theory. Data was gathered from documents and interviews of key informants. Sources of data included official reports, proceedings of Knesset's Labor and Social Affairs (LSA) Committee, Ministry of Health documents, healthcare providers' reports, budget documents, newspaper analysis, and about 60 interviews with persons who played important roles in the process of the negotiations regarding the reform efforts. Analysis identified the major stakeholders and their concerns, distinguishing between the key stakeholders involved directly in the negotiations and secondary or additional stakeholders outside the main circle, some of whom were very involved and influential in the process. The study identified the major issues and the problems that emerged during the process of negotiations. Analysis of the failure of the attempt to implement the reform reveals a combination of obstacles emanating from the process of negotiation, on the one hand, and from the larger political, economic and social context, on the other. Findings show that conflict of interests and risk avoidance of the major stakeholders were major obstacles to reaching agreement on a formula for implementation. The major risks were related to the inability to predict future demand for ambulatory services, uncertainty regarding future costs, and disagreements regarding the reliability and validity of data. Contextual factors that undermined the chances for successful implementation of the reform included lack of a strong political commitment and a coalition supporting the reform, a financial crisis in the health system resulting from early stages of implementation of the National Health Insurance Law, and social turmoil created by the Rabin government's attempts to implement the Oslo agreements. This turmoil ultimately culminated in the assassination of the Prime Minister Yitzchak Rabin, creating a climate far from conducive to generating public interest in mental health reform and facilitating the planned change. As a result the mental health system remained virtually unchanged.

Mental health system reform: a multi country comparison.

In recent years many countries have embarked on various types of health and mental health reform. These reforms have in large part been driven by governments' concerns for cost containment which has, in turn, been driven by an increasing process of global marketization and the need to control national deficits. A critical issue in these reforms is the increased emphasis on the use of "market mechanisms" in the delivery of health and mental health services. This paper uses a policy analysis framework to compare recent developments in the mental health sector in Canada, the United States, Britain and Australia. The common framework to be used for this will focus on: the defining characteristics of the society; legislative mandate; sectorial location (within or separate from health sector); funding streams; organising values of the system; locus of service delivery; service technologies; the role of social work; interprofessional dynamics; the role of consumers; and evaluation of outcomes at multiple levels. This analysis provides an opportunity to explore similarities and differences in mental system reform and in particular identify the challenges for social work in the field of mental health in the 21st century.

The changing role of the social worker in the mental health system.

The purpose of this paper is to discuss the role of the social work profession in the mental health service arena. It analyzes the changing mental health environment and the challenges facing social work. It stresses that the profession must adapt to the dramatic changes that have been taking place since the advent of deinstitutionalization and the need for community care for mentally ill persons. Historical analysis of the social work profession shows that its involvement in the mental health field has started during the early stages of the development of the profession. Psychiatric social work has been considered a prestigious area of practice within the profession. Historically, social workers in the mental health field rarely challenged the dominance of the psychiatric profession. This position seems to have restrained social work from providing its full potential contribution to this field of practice and to the population it served. Assessment of the continuing problems and current issues of the mental health system shows the potential central role of social work in this area. However, changes must take place in the practice of social workers in the mental health service system, as well as in the education and training of social workers. The paper discusses factors that facilitate or hinder the profession from appropriately adapting to the current service needs of the mentally ill persons, their families and communities, providing quality mental health and social services to this population and society as well.