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Our newest position paper examines the widening gap between growing mental health needs and the limited capacity of Israel’s public healthcare system to respond. Despite a national crisis and efforts to expand services through a national mental health plan, current responses remain insufficient. The paper explores how new patterns of care have emerged to address these gaps, yet fail to provide comprehensive, high-quality treatment. It also proposes measures to prevent these inadequate responses from becoming the default standard of care.
Data from Israel’s Health Maintenance Organizations reveal significant systemic failures. At Clalit Health Services, for example, 95% of patients who received medication for depression or anxiety in a primary care setting did not subsequently receive publicly funded mental health services. This suggests that medication is often being used as a substitute for unavailable mental healthcare within the public system.
Family medicine specialists play a critical role in identifying, monitoring, and initiating treatment for mental health conditions, and their accessibility and familiarity with patients can provide important support. However, when meaningful alternatives are unavailable, medication frequently becomes the only option — an inadequate substitute for specialized mental healthcare and appropriate treatment frameworks. This concern is particularly serious given that the necessary training and resources are not consistently available: only half of primary care providers are trained family medicine specialists, and in peripheral areas, the rates are even lower, with some localities having no trained family medicine specialists at all.
Testimonies from primary care physicians included in the paper reinforce these findings. Ideally, pharmacological treatment should form one component of a broader care framework that also includes psychological support. In practice, however, high patient loads and limited access to psychotherapy often mean that medication is provided on its own — a “stopgap” response, as one physician described it, “that patches over major gaps in care.”
Even pharmacological treatment delivered through primary care settings is not always provided under optimal conditions. When administered under time constraints, without sufficient training, and in the absence of psychotherapy or specialist support, medication may be ineffective or even harmful. As one physician noted: “I’ve met patients who take six or seven Oxazepam pills a day,” referring to a potent anti-anxiety medication that carries a risk of physical dependence.
This harm does not affect all segments of Israeli society equally. For populations facing exclusion and marginalization, particularly Palestinian citizens of Israel, for whom poverty and violence are well-documented drivers of poor health outcomes, the absence of adequate mental healthcare responses is felt even more acutely. Moreover, the limited services that do exist are often neither culturally nor linguistically accessible.
We call on Israel’s Ministry of Health to work toward closing these gaps, ensuring high-quality care, and systematically monitoring treatment patterns and their impacts. This is essential to prevent temporary solutions born of shortages from becoming standard practice, and to advance more effective and equitable care.
