The writing on the wall: how the government will prevent the collapse of mental health

In February, "Israel Hayom" reporters called a psychologist working under an arrangement with Maccabi in Ashkelon and asked to schedule a treatment. There was no appointment available. In July, five months and countless sirens later, the answer was the same. Face-to-face treatment was not available at all, and telephone treatment was only possible for October.

This is not an anecdote. An investigation published in "Israel Hayom", based on a survey conducted by the Forum of Organizations for Public Psychology among 361 psychologists, found that about 68% of respondents estimate that waiting in the public service lasts half a year or more, and more than a fifth estimate that it lasts at least a year. 86% believe that the waiting itself has worsened the mental state of the patients.

All this is happening even though the government invested 1.4 billion shekels in the National Mental Health Program, and even though in March 2025 a wage agreement was signed that raised the salaries of public psychologists by 40%.

These steps were essential, but because the system reached the war already worn out, even these budgets were not enough to deal with the widespread damage to society as a whole: tens of thousands of reservist families, communities evacuated from their homes, and children growing up between sirens. The number of patients in the health fund clinics rose from about 335 thousand before the war to about 435 thousand in 2025, and the number of sessions jumped by about 40% and reached about 3.5 million per year.

The deeper failure is that a resident of Tel Aviv and a resident of Sderot, with the exact same distress, are not standing in the same line. In Tel Aviv and the center, half of the psychologists report a wait of up to a month in their private clinic, and only 1% estimate a wait of more than a year. In the Negev, in the south, and in the Gaza envelope, the areas that absorbed the war more closely than any other, 16% estimate that the wait is more than a year even in the private sector. The availability of mental health treatment in Israel today depends on the ability to pay and the place of residence.

The solution requires two moves in parallel: the first is the continued strengthening of the public system. The wage agreements were an important step, but there is still a lack of standards and staffing keys that would allow for the absorption of more psychologists and social workers, to incentivize professionals to integrate specifically in the periphery, and to require the Ministry of Health to publish waiting times in the field of mental health, which are not published at all today. A system that does not measure the gap cannot close it.

The second move is the construction of a response layer in the community — and this is the role of the local authorities. Government ministries are not present below the district level, and those who meet the residents on a daily basis are the authority employees. Authorities must be given powers and budgets so that each authority invests in its own local resilience program: training resilience agents — teachers, nurses, family doctors, and youth instructors, who will know how to identify distress and connect a person to the right response in time; strengthening education, sports, culture, and volunteering frameworks, which have been found to strengthen social cohesion; and coordination between welfare, education, and psychological service departments, so that residents in distress who reach out do not fall between the cracks.

This layer does not replace professional treatment, but complements it, and there is simple budgetary logic in this: training psychologists takes years, training resilience agents takes weeks. So that the infrastructure is not built again according to the luck of the address, resources must be allocated according to a key that weighs gaps, so that precisely the peripheral and weak authorities receive the strongest backing.

Mental distress does not start on the day of the application to the clinic — but months earlier, and those who meet it first are not the psychologists, but the teachers in the classrooms and the nurses in the Tipat Halav clinics. In view of the mental breakdown of us all, if this infrastructure is not built now — the social and economic price we will pay for years and generations to come will be very heavy. Investing now will prevent the suffering of many, and will allow for recovery and growth from the crisis for society as a whole.

Advocate Tali Nir is the chair and founder of the 121 Association, which leads the "Tikva LaNefesh" partnership.