Researchers: Nihaya Daoud¹, Nabil Geraisy²

Background: The mental health reform (MHR) in Israel was enacted in 2015. It defined a basket of mental health services (MHS) and shifted responsibility for these from the Ministry of Health to the health funds. MHR seeks to establish a continuum of treatment; improve treatment quality; remove stigma; increase service availability and accessibility; and close service gaps for certain groups, including the Arab population. The latter community currently experiences multiple barriers to MHS use.

Objectives: 1. To examine in Arab society changes in MHS (availability, accessibility, and cultural adaptation) following the mental health reform.
2. To examine changes in attitudes towards MHS, utilization patterns, barriers and facilitators for use of MHS.
3. To examine among the Arab population the rate of mental distress, seeking treatment, barriers and facilitators for utilization of MHS.

Method: A mixed methods research (quantitative and qualitative) was conducted from January 2020 to March 2023. The quantitative study included a population-based telephone survey among a sample of 507 participants who were interviewed using a structured questionnaire in the Arabic. The qualitative study included in-depth interviews with 12 policy makers and senior officials from the Ministry of Health and health funds, 8 staff members, 40 patients in mental health clinics, and accompanying family members. We conducted a thematic analysis for the qualitative interviews and a statistical analysis for the quantitative data.

Findings: Quantitative findings: out of 507 participants in the telephone survey, 35.9% (182) reported mental distress, of which only 71 (39%) reported seeking some kind of assistance, and of them only 18 turned to MHS. Over half (54.9%) reported barriers to MHS utilization including: long waiting times for appointments, technical difficulties in making an appointment, logistic difficulty in getting to the clinic, cultural gaps, lack of tolerance and feeling racism in the healthcare services, and low literacy in the MHS.

Qualitative findings: the mental health reform led to greater development of MHS in the community, and brought these services closer to the population, reduced stigma, and increased utilization of MHS. However, this resulted in longer waiting times, although the continuity of care in the community improved. In the Arab society, the picture was more acute and difficult due to the lack of historical development of MHS. The application of the reform highlighted the gaps in the array of MHS. Increased waiting times for appointments led to decreased quality of care. Most of the Arab patients receive drug treatment and not supportive care, do not receive a rehabilitation basket, and do not know their health and social rights in the system. The reform created barriers and systemic bureaucratic difficulties on the part of the sick funds. These barriers make it difficult for patients and their family members and reduce the quality of care.

Conclusions: The reform improved the accessibility and availability of MHS services in Arab society, and this improved the attitudes and patterns of referral and utilization of these services.

Recommendations: Systemic political, economic, organizational and social barriers arose that are important to overcome in order to improve the array of MHS in the Arab society.

Research end date: 04/2023