The state of mental health is “extremely challenging,” Efrat Shaprut, the CEO of NATAL – Israel Trauma and Resiliency Center, told The Jerusalem Post.
“October 7 met the public system unprepared – there were not enough therapists, insufficient treatment protocols, and no preparedness for a crisis of this magnitude, especially one unfolding amid previous crises,” she said.
“Despite Israel’s experience with trauma from war and terror, we have never faced an event of this magnitude, both in terms of numbers and the complexity of the cases.”
The COVID-19 crisis and judicial reform contributed to the current situation in which there is now a huge disparity between the demand for services and their availability, Shaprut explained.
“The mental health system in Israel has long been the neglected ‘stepchild’ of the healthcare system, lacking sufficient financial and professional resources,” she said.
Shaprut highlighted the complexity of the situation, explaining that mental healthcare professionals in the country are “simultaneously dealing with soldiers who have been fighting for over a year, civilians who have experienced massacres, kidnappings, and the destruction of their communities, along with prolonged missile attacks on most of Israel, creating an overwhelming national trauma.
“The gap between the severity of cases, the numbers affected, and the limited mental health infrastructure has created immense pressure.”
Shaprut added that the number of cases and their intensity also make this an unprecedented event.
“We encounter families where multiple members have been murdered, kidnapped, or are serving in reserve duty. This rare combination has almost no precedent, and even globally, there are few treatment protocols for multiple overlapping layers of trauma, and [especially] of this intensity,” she explained.
Another source of complexity is that the mental health professionals have also been personally impacted by the tragedy and crisis of October 7, in what is called a “shared reality,” she shared.
“They, too, are living through these traumatic events, are under stress, and many have personal connections to victims – whether kidnapped individuals, survivors, those who were killed on October 7, or displaced families. Others have loved ones serving in combat,” she said.
“This makes it incredibly difficult for service providers to function effectively.”
State response
SHAPRUT EXPLAINED that the state’s response has not been sufficient.
“While there is an understanding of the problem, the Health Ministry acknowledges its complexity, and there are programs in place; in practice, it took many weeks for the mental health system to begin adjusting, and it is still lagging very much behind,” she explained.
Shaprut added that there are long wait lists for treatment, insufficient in-patient facilities, and insufficient responses to handle suicide, addiction, and domestic violence, which she said have all escalated since October 7.
“It is clear that much more funding needs to be allocated to mental health,” she said, “especially in planning the budgets to be allocated strategically, as we know this will be a marathon and not a sprint.”
Shaprut highlighted that funds must be allocated toward bringing professionals back to public service, explaining that many have left for the private sector.
“Without significant reforms in wage agreements, budget allocations for national programs, and long-term planning, it will be very difficult to provide the necessary interventions.
“There also needs to be a focus on trauma-related training, strengthening resilience centers, which were exposed as lacking at the outbreak of the war, and funding [NGOs] that currently rely mainly on philanthropy,” she added, explaining that NGOs have been providing the majority of community mental health services since October 7.
Shaprut touched on the services offered by NATAL, highlighting that many of those reaching out to the organization for help are survivors of the massacre at the Nova festival, evacuees, soldiers, and reservists.
“We’ve received countless inquiries and calls for support since October 7. Our helplines have been open since 6:30 a.m. on that morning. Since then, more than 70,000 calls have been received, and over 4,000 individuals have been treated in our Clinical Unit,” she said.
“We provided tens of thousands of hours of resilience support to first responders – paramedics, social workers, doctors, nurses, forensic pathologists, burial workers, and others, supporting them through this crisis.”
Shaprut highlighted that it is important to remember that reservists are “civilians uprooted from their lives and homes into prolonged warfare, leaving behind families, jobs, and communities. They have experienced immense grief, severe violence, and the loss of many friends.”
After their duty, they are faced with the difficult task of returning home, a transition Shaprut called “incredibly difficult on a familial, economic, and psychological level.”
NATAL offers a variety of services for reservists, including group therapy, resilience building, and personal support.
It also offers a variety of services for anyone in need, including helplines, a variety of types of therapy sessions for individuals, couples, and groups, and trauma-informed career development.
The organization also provides thousands of hours of workshops to strengthen mental health professionals and emergency responders.