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Promises and pitfalls on the road to a mental health reform in Israel.

This study assessed efforts to reform the mental health (MH) service system in Israel, moving the locus of treatment and care from a mental hospital system to the community. It focuses on changes which occurred in MH policy and services especially during the last decade, evaluating trends and issues regarding legislation, clients, budgets and personnel of the system. Findings indicate a drastic decline in the number of psychiatric beds, length of stays in inpatient services, a reduction in the number of MH personnel, and a dramatic increase in rehabilitation services in the community. However, no government hospital was closed and budgets for hospitals actually increased, while MH community clinics budget was reduced. The efforts to transfer responsibility for MH services to the health care provider organizations have not been successful yet and the reform has not been completed, endangering the progress achieved so far. Promises and perils on the road towards a successful reform are discussed. It seems that the stigma and the social exclusion of persons suffering from mental disorders, as well as the salience of the issue of MH in relation to other problems the Israeli society has to deal with, have contributed to the failure of efforts to reform the MH service system.