Resilience coaches: First year outcomes of a large-scale, low-intensity stratified intervention program in the public mental health system in Israel

Background: Israel's public mental health system faces a persistent shortage of personnel alongside increasing demand for services, challenges that were further intensified by the events of October 7. To address this gap, 79 resilience coaches, each holding a BA in psychology or social work, were trained and deployed within Clalit Health Services (CHS) to provide brief, targeted primary mental health interventions. This stratified approach (initial allocation by symptom severity rather than sequential escalation) has not previously been implemented in Israel's public system. Objectives: To evaluate the Resilience Coaches Program among large, non-diagnosed populations in terms of: (a) feasibility, acceptability, and symptom trajectories of anxiety and depression, as well as perceived self-management of symptoms; (b) its impact on reducing referrals to the public mental health system; and (c) its safety, as indicated by the occurrence of serious adverse events. Method: A retrospective analysis was conducted using CHS electronic medical records. Clinical outcomes included anxiety and depression scores (Generalized Anxiety Disorder-7 [GAD-7] and Patient Health Questionnaire-9 [PHQ-9]), perceived self-management ability, and referral rates to further mental health care were measured. Results: Between February 2024 and January 2025, 7516 trainees participated in 29,754 sessions. Significant post-intervention reductions were observed in mean PHQ-9 scores (12.2 to 10.6, SD = 6.46–6.88) and GAD-7 scores (11.2 to 9.8, SD = 5.59–6.01), both p < 0.0001. There were no differences in improvement in GAD-7 and PHQ-9 between males and females. The mean improvement in both PHQ-9 and GAD-7 scores was significantly higher in the general and Jewish-Orthodox groups, compared to the Arab group. Improved perceived self-management was reported by 53.7 % of participants, and 90 % did not require further mental health referrals within three months. No serious adverse events occurred. Conclusions: The program demonstrated feasibility and safety. It was associated with modest symptom improvements and low referral rates, suggesting potential scalability.