Mental health service utilisation following reform among Arab, Ultra-Orthodox Jewish and general populations in Israel
Rachel Shvartsur, Orly Weinstein, Avital Esther Alfandari Cohen, Arad Kodesh, Gilad Bodenheimer, Jordan Lewinski, Tali Shmueli, Marnina Swartz Vanetik, Arnona Ziv, Racheli MagneziBackground
Israel’s 2015 mental health reform transferred responsibility for mental health services from the government to community health maintenance organisations (HMOs), aiming to improve accessibility and equity and reduce stigma. However, its implications for different populations remain significantly underresearched.
Aims
To examine trends in mental health service utilisation and psychiatric medication issue rates among Arab and Ultra-Orthodox Jewish populations before and after the 2015 mental health reform.
Method
A retrospective cohort study using data from Israel’s four HMOs (2012–2019), including all individuals with mental/behavioural disorder diagnosis, psychiatric medication or a community-based mental health service encounter ( N = 2 847 184). Participants were classified as either general (non-Ultra-Orthodox Jewish), Ultra-Orthodox Jewish or Arab. The study analysed annual community visits to mental health professionals and dispensed psychiatric prescriptions.
Results
Between 2012 and 2019 the number of mental health service users increased across all populations, most prominently among Ultra-Orthodox Jewish and Arab populations (1.94- and 1.91-fold, respectively), compared with 1.55-fold in the general population. Annual community visits increased 2.4-fold in the general population, 2.2-fold in the Ultra-Orthodox Jewish population and 3.7-fold among Arabs, who had the lowest baseline utilisation. Psychiatric medication issue rates increased most in the Ultra-Orthodox Jewish population (2.5-fold), compared with 1.7-fold in the Arab and 1.5-fold in the general population. Women consistently used more services than men, with the greatest relative increase among Arab women.
Conclusions
The findings suggest improved access to mental health services over the study period spanning the 2015 mental health reform, particularly in previously underserved populations. Continued progress requires culturally sensitive, community-tailored interventions for Arab and Ultra-Orthodox Jewish populations.