The building where the mental health clinic for children and youth was located in Tiberias (Photo: official website, Eli Ashkenazi)
The mental health clinic for children and youth that operated in Tiberias was closed a few weeks ago, and once again the weak are being harmed and the periphery is being pushed to the bottom of the list of priorities. Since the closure of the medical institution, the children and adolescents treated there have been required to travel as far as Safed or Katzrin, just to continue receiving the treatment they received in Tiberias. The closure of the clinic is a severe blow, especially in light of the difficulty in finding appropriate treatment in the periphery and in light of the fact that since the COVID-19 pandemic, there has been a sharp increase in requests by children and youth for mental health services.
The mother of a girl who was treated at a clinic in Tiberias said that treatment for her daughter would soon be stopped because she could no longer continue in light of the change. "Traveling to Safed is a constraint that is hard for me to meet. I have to stop a day of work in the middle, go to Safed, and at the same time I have another girl finishing her studies and there's no one to take care of her. I'm really worried about the consequences," she told Walla. According to her, there are children and teenagers whose treatment has already stopped.
The clinic in Tiberias was an extension of the Ziv Medical Center for Children and Youth Mental Health Center in Safed. The Ministry of Health explained that "the clinic was located on a property allocated by the municipality. Over the years, the property's maintenance condition deteriorated. Therefore, after no other suitable solution was found, the activity moved from Tiberias to Safed and Katzrin, so that the children treated in Tiberias can receive further treatment in these clinics, while maintaining continuity of care. If a suitable solution is found for a clinic building in Tiberias, it will be possible to reexamine the clinic's activity there."
The mental health clinic building in Tiberias (Photo: official website, Eli Ashkenazi)
The building where the youth and child mental health clinic was located in Tiberias May 29, 2023 (Photo: official website, Eli Ashkenazi)
The Tiberias Municipality said: "In all the municipal ordinances there is not a single clause that assumes the responsibility of the local authority to allocate buildings for the provision of health services. The health basket in the State of Israel is fed by the health tax paid by citizens in order to cover all the costs of health services, including mental health services. Beyond the law, and although it is not its obligation, the Tiberias Municipality previously provided a vacant building that it owned and the Mental Health Unit used it to provide services for years."
"Now the Health Ministry claims that the building is inappropriate and asks the municipality to rent another building for it. The municipality does not intend to rent buildings for the purpose of providing health services, which is the role and purpose of the Ministry of Health, by virtue of the health tax payments of the citizens of the State of Israel, and in this case of the residents of Tiberias," the municipality added. "It should be noted that now there are government public housing buildings that have been vacated and they can be used for a clinic that is an extension of Ziv Medical Center, which is a government hospital. The Ziv Medical Center management would do well to turn to government housing and rent a more suitable building where they can continue to provide services – this is the role and responsibility of Ziv Medical Center and not of the Municipality of Tiberias."
The building where the mental health clinic for children and youth was located in Tiberias (Photo: official website, Eli Ashkenazi)
According to the mental health reform in Israel, since 2015 responsibility for mental health has been transferred to the health funds, but the Ministry of Health admits that indeed "the service is provided by the health funds, but in the periphery, because of the difficulty of the health funds in providing the service, it is provided by the Ministry of Health and government hospitals." The closure of the clinic, therefore, places children and adolescents from Tiberias and its environs, who need treatment, facing a broken trough.
The same mother also said that her daughter is insured by a "national" health fund. "Waiting in line is a matter of months, and even when you get on the list, it's a lone caregiver in itself. There is no clinic envelope where joint work with a psychiatrist is done, regular staff meetings to select the appropriate treatment and follow-up. Not to mention the possibility of group and family therapy, which the contestants and families sometimes need very much. The HMO does not have comprehensive treatment as there was in the clinic that was closed, but separate treatment with the psychiatrist, if there is an available appointment at all in the coming months. If the child doesn't get along well with the therapist, or if the treatment is less successful, no one cares, they provided the answer and that's it."
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The building where the mental health clinic for children and youth was located in Tiberias (Photo: official website, Eli Ashkenazi)
Leumit Health Fund said: "We have an excellent child and adolescent psychiatrist in Tiberias. As of now, no complaints have been received at the branch." The Maccabi Health Fund said, "The challenge of availability of appointments in the health system in general and in the field of mental health in particular is a national challenge stemming from a severe shortage of therapeutic manpower alongside underfunding for community medicine – in parallel with a significant increase in requests for services. The state must promote a comprehensive national plan that will include future manpower planning and a significant budget increase for community care. Regarding the implications of the closure of the Ministry of Health's mental health clinic in Tiberias, Maccabi works on behalf of its members and offers the necessary services through an online clinic that provides these services digitally, as well as receiving the service through therapists who have an agreement with the health plan in Tiberias and its environs."
According to Clalit Health Services' response, its policyholders were not harmed by the closure of the clinic: "We have had a pediatric mental health clinic in Tiberias for several years and it treats many more children than were in Ziv's branch. No child has completed treatment without continuation. We transfer everyone as needed either to our clinic in Tiberias or to the clinic in Ziv in Safed according to the type of treatment needed."
Ziv Medical Center said: "The HMOs are committed to providing psychiatric services in the community. Unfortunately, in the northern region, the HMOs have not yet opened this service, despite their legal obligation. From a place of responsibility for the residents, we decided at Ziv to continue to make the service accessible to the residents, in cooperation with the local authority, which is committed to the place, the clinic and all the components required for this. In Tiberias, the service is provided in a building allocated by the municipality, which suffers from severe infrastructure problems, safety and pigeon damages, a large number of drug addicts at the entrance to the building, and more. Our request to the committee in Tiberias for an alternative location was not answered despite many meetings between the director of the hospital, Professor Zarka, and the head of the authority. In the problematic situation that has arisen, we have been unable to continue providing the service we provided, even though the health funds are committed to it. Now there is a severe hospitalization shortage in the north of the country, and regardless of the building problem in Tiberias, we are required to open a new pediatric and youth hospitalization department in Safed for the entire north, and this is what the staff needs for us. It seems to us that the time has come for the health funds to exhaust and act in accordance with their legal responsibilities that have been established for the past seven years."
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