Very quietly, behind closed doors, at meetings with confidential minutes, a few Health Ministry bureaucrats made a dramatic decision on the Israeli public’s behalf: the liquidation of clinical psychology as a profession licensed and supervised by the state. There’s still no official document that bears this headline, but there’s already a date for implementing the decision, and also a budget for it.
We aren’t talking about battles over professional prestige, disputes between partisans of different treatment methods or even another round of responses to criticism of the establishment or the system. When the new regulations take effect, Israel will become the only place in the Western world where psychology has an expiration date. The reason for this is twofold: the expulsion of psychologists from the public health system, and changes in the nature of their specialization.
In 2015, the “reform of mental health insurance” is supposed to take effect. As part of this reform, responsibility for the public’s mental health will be transferred from the state to the health maintenance organizations. At a recent conference, a Health Ministry representative revealed that the reform includes the following decisions: Psychologists won’t be included in the multidisciplinary teams responsible for mental health, and they will also be dropped from the list of professionals authorized to run mental health clinics. Effectively, the word “psychologist” doesn’t appear even once in the document describing how treatment teams will look, after the reform takes effect.
The immediate impact, of course, will be felt by people who make use of the public psychological services, most of whom belong to the weaker strata of society. In plain language, the high-quality psychological services available to the public hitherto will be completely eliminated, and will cease to be available via the HMOs.
This will have dramatic, long-term implications for every citizen of the state, from the poorest 10 percent to the wealthiest. Once the reform is implemented, there will no longer be any organization responsible for and committed to training clinical psychologists.
For decades, the process of training psychologists was based on the same process as that of training doctors: after obtaining a master’s degree and clinical training, psychologists do a residency in the public service for minuscule pay. In exchange, they gain the experience and knowledge needed to become qualified clinical psychologists. But once the reform takes effect, psychologists will no longer be employed by the public health system – and therefore, they won’t do residencies. Period.
In effect, the Health Ministry has decided that the public should no longer receive the services of expert psychologists in either the public or the private health systems, since would-be specialists will have no place to receive training. When you want to send your son or daughter to a psychologist in another few years, there simply won’t be anyone to send them to.
Another, no less dramatic, document was published recently, containing recommendations for changing the nature of specialization in clinical psychology. This document sparked vehement opposition from leading psychologists, the broader community of clinical psychologists in Israel and the organizations that represent them.
The prevailing professional approach to clinical psychology, both in Israel and worldwide, sees a person as a whole, and it holds that you can’t address just one portion of a person in isolation from this whole. The process of specialization is built in corresponding depth, and includes intensive experience in interpersonal interactions and self-awareness, which are the necessary basis for any treatment method.
The recommendations, which are supposed to become binding regulations as early as next year, reflect a reductionist, piecemeal approach to the human mind. Their implementation would turn future psychologists from specialists in human beings to specialists in techniques, tests and treatments of specific disorders. The name of the profession might remain the same, but a duck that doesn’t talk like a duck, walk like a duck or quack like a duck isn’t a duck, even if a Health Ministry bureaucrat insists on calling it one and even if it confirms this in a binding regulation.
Psychological treatment has its own characteristics and a unique approach that isn’t found in related professions. Studies show that psychological treatment produces great benefits and long-lasting effects. Patient satisfaction surveys have shown time after time that patients are pleased with the psychological treatment they received, and that they prefer psychotherapy to other treatment methods. Psychological treatment is meant for anyone who needs help in coping with difficulties, even those who aren’t dealing with psychiatric disorders.
A decision of such cardinal importance to society, the health system and academia must not be made by anonymous bureaucrats with no public discussion. The public has a right to know when someone is deciding on its behalf that there’s no longer any need for clinical psychologists. The health minister is the person who has the authority, and with authority comes responsibility.
When we wake up in another year or two to a world in which there are no psychologists in the mental health system – to a system in which psychologists are discriminated against, with no authority to manage clinics or make their professional voices heard, and which has no commitment to quality training for psychologists – when all this happens, the health minister won’t be able to hide behind the bureaucrats or claims that she didn’t know. Yael German, by virtue of her position, will be one who signs off on the order with her own hand – a death sentence for clinic psychology in Israel.
The author is a resident in clinical psychology and a doctoral student in Hebrew University’s psychology department.
