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[Mental health reform in Israel: how to increase the opportunities and reduce the threats].

Since the publication in 1990 of the Netanyahu Commission Report on Health Reform in Israel the issue of Mental Health Reform (MHR) has been discussed extensively. As steps toward the implementation of the MHR progressed, concerns were increasingly voiced that it would adversely affect the accessibility, availability and quality of mental health services. The main source of threat is attributed to the mechanisms of Managed Behavioral Health Care (MBHC) expected to be applied by the Health Funds. The authors review recent evaluation studies of MBHC in the US with a special reference to issues pertaining to ambulatory treatment of those suffering from mental illness and to outpatient psychotherapy. The findings reviewed suggest that the key to the success of MBHC systems is a strategy endeavoring to bring together the professional and the economic management mechanisms of the service system in a mutually supporting effort to bring about a paradigmatic change in the organization, payment methods and evaluation of the services. The authors also refer to recent studies of outpatient psychotherapy that provide information about trends and utilization patterns and provide support for its overall effectiveness. The authors discuss the implications of the findings reviewed to the implementation of the MHR in Israel.