International Handbook on Mental Health Policy

By Donna R. Kemp | Go to book overview
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position of a mentally disturbed person. Their judgment remains almost unchallenged by other authorities. However, the medical approach is also advantageous from a public utility perspective. It enables the application of modern medical developments to mental illness. Israeli psychiatric patients enjoy the advantages of the latest developments in medical psychotherapy.

Trends in mental health policy are also equivocal. The deinstitutionalization of mental health services was proposed by the state's administration and endorsed by the psychiatrists, in line with developments in other countries. It was manifested mainly in the diminishing rates of hospitalization. However, the pace of expanding community care did not match the decrease in hospital beds. The psychiatric community welcomed the expansion of psychiatric wards in general hospitals. It did not pressure health authorities to compensate for the decrease in hospitalization by allocating more resources to the alternative--community health ambulatory clinics. The state's bureaucrats were also reluctant to adopt the community model, partly because of bureaucratic conservatism but mainly because of the financial costs entailed. The structure of policy making--a duo comprising civil servants and professionals--decreased the effectiveness of pressures from without.

The most acute problem of Israel's mental health policy has been consumers' rights. Confronted with immense problems of immigration absorption and defense, the state developed a paternalistic attitude regarding citizens' services. The Israeli government is, in fact, one of the strongest and most intrusive in the democratic world in terms of its economic and social powers. The size of the public budget, the economic powers of the state, and the legitimacy of its institutions have turned it into a very powerful organization. This fact is also reflected in mental health policy, which has been defined and controlled by public authorities. Mental health policy thus encapsulates many problems of the unfinished process of nation building in Israel. It reflects fears of ancient demons and desires to "normalize" the Jewish people gathered into Israel from the Diaspora. It also demonstrates the state's commitment to protect the public, often at the expense of individual rights.

The protective attitude has many advantages. Mentally ill persons do not roam the streets but are taken care of by health authorities. Involuntary hospitalization has never been used as a means to detain political opponents or to combat subversiveness. Yet the time seems ripe for a change, brought about by both the progress in medical treatment and mounting public pressures. The fact that mental health is perceived more as a health and less as a mental problem is also conducive to change. A policy shift is thus imminent. It remains to be seen whether this change will be followed by a normative transformation legitimizing mental illness and those who treat it.

In February 1990 private mental hospitals admitted only twenty patients, that is, 1.8 percent of all admissions. The proportion of private beds in the general pool is 39.1


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International Handbook on Mental Health Policy


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