Researchers: Tomer Ziv¹, Shlomit Tsafrir², Ehud Mekori³

Background: In 2015, Israel reformed mental health services, shifting responsibility to HMOs to improve access. However, concerns emerged about the system’s capacity to serve children and adolescents and the risk of hospitals’ clinics becoming Overburdened.

Objectives: To analyze the influence of the reform on patient demographics, diagnostic tendencies, treatment approaches, and the accessibility of services within a tertiary outpatient setting for children and adolescents’ clinic.

Method: A retrospective analysis of clinical records from 2011 to 2019 was conducted. The data encompassed demographic characteristics, psychiatric diagnoses, types of treatment received, the number of visits, and waiting times. Comparative analyses were performed between the pre-reform and post-reform periods.

Findings: A moderate and non-significant increase was observed in the measurement over time of the number of new monthly referrals after the reform. Patient demographics remained stable, but there was a notable increase in psychiatric diagnoses, especially neurodevelopmental disorders, anxiety, depression, adjustment disorders, and suicidality. No significant rise occurred in severe mental illness, personality disorders, or tic disorders. The average psychiatric visits per patient and the proportion receiving medication increased, with more prescriptions for ADHD and atypical antipsychotics. Visits to non-psychiatrists decreased, while psychotherapy wait times grew significantly.

Conclusions: The reform did not alleviate the burden on hospital-based clinics. Instead, it was correlated with an increase in diagnostic activities and a greater dependence on pharmacological treatments, alongside diminished access to psychotherapy. These findings suggest ongoing processes of medicalization and underscore the disparity between service demand and availability.

Recommendations: Attaining the objectives of the reform necessitates substantial investments in expanding the mental health workforce, decreasing waiting times for psychological treatment, and guaranteeing equitable access across different regions and populations. The establishment of national quality indicators and the monitoring of clinical outcomes are vital measures to enhance mental health services for children and adolescents.

Research end date: 12/2025