The October war of 2023 led to a sharp increase in the need for mental health services on the part of the general population and especially for specific groups within it, among them persons injured by the Hammas attack or dislocated as a result of that attack and the subsequent war, families whose homes were damaged from rocket fire and soldiers suffering from post-trauma. The widespread distress occurred at a time when Israel’s public mental health services had been suffering for years from a chronic shortage of personnel, unfilled positions and, as a result, the general inaccessability of public mental health services.

Subsequent to the war, numerous surveys indicated increasing needs, on the one hand, and decreasing options for meeting those needs, whether the needs were of schoolchildren or adults, and whether the needs were for school councillors, social workers, psychologists or psychiatrists.

With regard to resilience centers, whose purpose is to provide emergency mental health care, their treatment schedules were curtailed, and the continuation of treatment at health funds for individuals in need was and still is limited by a shortage of personnel.

Everything boils down to money: Israel spends relatively little on public mental health care, evidenced by the percentage of the total budget for public health care budgeted and expended on mental health care. For example, during the years 2016-2021, the budget for public mental health services constituted no more than 4% of the expenditures on total  public health care , in 2022 it amounted to 5%, and during the years of the 2023 war, 6%, followed by 7% budgeted for 2025. However, that budget increase (following a war, it should be remembered), is not impressive when compared with the recommended 10% spending on mental health services in high-income OECD countries and with the actual percentage in western European countries, which is much higher — between 12% and 16%.

The present crisis in the treatment of individuals in need of mental health services is first and foremost a crisis of personnel, that is, the difficulty of attracting mental health specialists to the public services, and the shortage of positions in those services, as well as the need to define the number of patients to be treated by professionals in each specialty.

The main recruitment obstacle is the pay, which fails to reflect the investment required with regard to study and training, and is much lower than that in the private sector. It should be pointed out that the majority of public sector mental health workersare women; their inadequate pay contributes to the larger phenomenon of what we havereferred to in other studies as “the treatment deficit.” The shortage of personnel and of positions results in a huge workload, leading to further erosion and leakage of man and woman power from the public services.

The origin of this crisis is inadequate budgeting of the public services over the years, resulting in the inability to provide public mental health services in accordance with demand. Two serious crises that occurred in recent years – the corona epidemic and the October 7, 2023 war – resulted in a sharp increase in needs for such services on the part of the general population as well as of specific social groups – needs that the mental health and welfare services find it hard to meet. This situation is harmful especially to poverty-stricken families and individuals residing in the economic and geographical periphery of the country, where the services are even less accessible, but also to members of the middle class who may find private services beyond their means.

The Ministry of Health introduced a reform that included a budget increase, but its implemention remains partial, due mainly to an ongoing shortage of personnel. Following the 2023 war, mental health services were budgeted at 1.4 billion shekels for the years 2024-25, and in 2025 two labor agreements were signed that significantly increased the salaries of psychiatrists and psychologists employed in the public services. A similar amount was allocated to the Rehabilitation Department of the Defence Ministry, in charge of the treatment of soldiers. However, no solution was provided for the shortage of psychologists, psychiatrists, social workers, educational psychologists and educational counselors.

Raising the salaries of psychiatrists and psychologists is an important step that has the potential to attract personnel to the public services, but it was taken very late, and it will take years to harvest the fruits of that move. Moreover, no decision was taken regarding how many patients were to be treated by each mental health expert, thus failing to deal with the huge burden experienced by each — and the subsequent erosion.

Against the background of mental health problems that arose or worsened due to the 2023 war and the social groups that were highly affected, among them reserve soldiers and residents dislocated from their homes, and the inability of the social services to answer the many calls for help, it is entirely likely that the problems will increase in severity. The steps taken to provide real time care, like crash courses for psychology graduates prior to their specialization and their inclusion in the cadre of treatment personnel, the creation of positions like trainers and supporters of mental fortitude, and chat-bots set up by the health funds, are no substitute for genuine professional treatment.

Mental health services cannot be dependent upon ad hoc solutions or emergency services, which are but poor substitutes for professional help: they need to be part and parcel of ongoing, long-term government services that are properly budgeted; otherwise the burden will remain on individual families and thousands of persons in need will remain without.

Translator’s note: This report was written prior to the Iran war, which has no doubt increased the needs described herein.

The full research in Hebrew is available here.