On the way to psychiatric reform in Israel: Notes for an ideological and scientific debate

Israel has launched its program for Psychiatric Reform. However, the implementation of its three areas of action, as the Reform has been conceived thus far, is uneven. While the development of the rehabilitation component has progressed as planned, the one that refers to the insurance component remains stalled. The third one, dealing with dehospitalization and community care, has advanced only in part. Although many of the issues related to the three components of the Reform, of a curative and rehabilitative nature, have been adequately addressed, some crucial aspects are still awaiting a more extensive discussion by all mental health stakeholders. This paper reviews some value-laden and scientific issues as well as strategic measures that are suggested to be taken into account in a forward-looking and democratic Reform. Examples of these issues are: the quest for equity, at the time when the poor population is increasing in the country; scientific issues (e.g., the application of epidemiological data in planning for community needs, training for community-based personnel), that if left aside bear the risk of undermining the depth of the Reform; and strategic measures, purported to recruit the support of professionals and the general public that is essential in a movement that thrives on inclusion and promotes community-based care.