Academic journal article The Israel Journal of Psychiatry and Related Sciences

The Israeli Model of the "District Psychiatrist" A Fifty-Year Perspective/Commentary/Commentary: Good Is Good Only at Its Appropriate Time/Authors' Response

Academic journal article The Israel Journal of Psychiatry and Related Sciences

The Israeli Model of the "District Psychiatrist" A Fifty-Year Perspective/Commentary/Commentary: Good Is Good Only at Its Appropriate Time/Authors' Response

Article excerpt

Moshe Kalian, MD,1 and Eliezer Witztum, MD2

1 District Psychiatrist of Jerusalem and chairman of the Forum of District Psychiatrists, Jerusalem, Israel

2 Professor of Psychiatry, Faculty of Mental Health, Ben-Gurion University of the Negev, Beersheba, Israel

Abstract: This article is about the role of the Israeli District Psychiatrist (DP), and explains how the DP came into being. The content is based upon documentation and the personal experience of the first author (M.K.) and reflects the views of both authors. The establishment of the DP model is deeply rooted in the history of mental health services in Israel. The authors illuminate philosophies and actual events leading to legislation of mental health laws, upon which the authority of the DP is based. The current laws broaden the scope of the District Psychiatrist's authority. In spite of a clear conflict of interest, the additional function of the DP as a director of the local psychiatric hospital governed by the Ministry of Health continued for 40 years, until the end of the 20th century. The new situation, backed by additional modern legislation, enables the DP to play a major role in the reforms that have characterized the mental health field in Israel over the past five years. Legislative attempts to reduce the authority of the District Psychiatrists have failed. In the emerging era of privatization and free enterprise, the position of the DP as a protector of patient rights for adequate treatment has become more prominent as has the conflict between the DP and service providers.

Preface

The Israeli model of the District Psychiatrist (DP) was officially born 50 years ago with the legislation of the "Law for Treatment of the Mentally 111 1955." The role of the DP is deeply interwoven with the development of mental health services in the country. The approach which led to the establishment of the DPs authority was derived from principles of charitable philosophy (e.g., "Parens Patriae" and "The Duty to Protect"), the practical experience of other nations, and local issues of public concern. Continuation of public concern, shifting of social views, "landmark" court rulings and advancements in technologies of treatment yielded the legislation of the 1991 version ("the new law") which is still in effect. The current law broadened the scope and depth of the District Psychiatrist's authority. In spite of a clear situation of conflict of interests, the double role of the DP as a director of the local psychiatric hospital governed by the Ministry of Health continued for 40 years, until the end of the 20th century. On June 1,1995, this unfavorable situation was put to an end. The new situation, backed by additional modern legislation, has enabled the DP to play a major role in the huge reforms that have characterized the mental health field in Israel over the last five years. Attempts were initiated by several hospital managers to deny the District Psychiatrists their authority by trying to advance changes in legislation. So far, these attempts have been blocked by strong judicial and public opposition.

Historical Background

The foundations of the establishment of the DP role are deeply embedded in the history of mental health legislation in Israel. Processes of legislation in the country were conflictual and slow. The first judicial regulations of psychiatric treatment are referred to in the application of "The Ottoman law of asylums for the insane - 1892." The law reflects (with minor changes) the immense influence of the French law of 1838 (1) and was considered rather progressive at that time (2). The major Ottoman clauses included the obligation of government license for the operation of an asylum; inspection by the authorities; forbidding restrictive measures to be taken at home towards the mentally-ill, unless approved by two physicians (one of them a government employee) who personally checked the patient; guidelines for specific measures, aimed at protecting patients' rights and properties once involuntary hospitalization was indicated. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.