ISRAEL AT WAR - DAY 193

Prof. Yair Bar-Haim, head of the National Center for Traumatic Stress and Resilience at Tel Aviv University, January 2024 (Courtesy of TAU)
Prof. Yair Bar-Haim, head of the National Center for Traumatic Stress and Resilience at Tel Aviv University, January 2024 (Courtesy of TAU)
Interview'PTSD lags behind treatment for other psychological disorders'

October 7 and war trauma will lead to at least 30,000 new cases of PTSD, expert says

Prof. Yair Bar-Haim, head of the National Center for Traumatic Stress and Resilience, warns mental health system unprepared to handle patient deluge, challenges will last decades

Renee Ghert-Zand is the health reporter and a feature writer for The Times of Israel.

Prof. Yair Bar-Haim, head of the National Center for Traumatic Stress and Resilience at Tel Aviv University, January 2024 (Courtesy of TAU)

Psychology experts predict that there will be 30,000 new cases of post-traumatic stress disorder (PTSD) among Israelis as a result of the current war with Hamas in Gaza.

“Thirty thousand is a conservative estimate. It all depends on how things unfold and whether [full-scale] war will also break out in the north,” said Prof. Yair Bar-Haim, head of the new National Center for Traumatic Stress and Resilience at Tel Aviv University.

The center is expected to house one of the largest PTSD clinics in the country.

PTSD is a difficult-to-treat mental health condition that is triggered by either experiencing or witnessing a terrifying event, such as the Hamas atrocities of October 7 or battles in Gaza. Symptoms of the disorder may include flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about what happened.

While only about 10 percent of those who experience acute trauma go on to develop PTSD, the huge number of new cases in addition to the 60,000 existing ones will put a massive strain on Israel’s mental healthcare system.

“The system was already clogged before October 7. People had to wait nine months for an appointment with a psychologist in their health maintenance organization. The situation wasn’t much better if a person opted to go the private route, which has waiting lists and is expensive,” Bar-Haim said.

In mid-January, the Health Ministry and Finance Ministry came to terms on an injection of NIS 1.4 billion ($386 million) for each of the coming two years to boost mental healthcare. It’s a start, but private funding will also have to be an important part of the equation, as it is in the creation of the new TAU center.

Illustrative: A man struggling with post-traumatic stress disorder (LightField Studios/Shutterstock.com)

Bar-Haim, a TAU professor of psychology and neuroscience, said plans had been underway for eight years to establish the TAU National Center for Traumatic Stress and Resilience. A building for the center is under construction and slated to open its doors in early 2026.

“We’d been planning the center with the view that Israel would at one point have war, and that the PTSD issue is undertreated and there’s a lot to do about it. We secured several donations for the building,” Bar-Haim said.

“Then the war came. I realized that we should open [our] clinic early and gear it mostly towards treating the people who come back from the war, and civilians who were affected. There’s a huge need for this treatment.  The university provided us with alternative temporary space and strong financial backing so we were able to open on January 1,” he said.

In a recent conversation with The Times of Israel, Bar-Haim spoke about what differentiates the TAU center from other PTSD treatment facilities, the challenges in treating the disorder, and why people need to be careful about whom they seek help from.

Architect’s rendering of the Miriam and Moshe Shuster Building for the Center for Traumatic Stress and Resilience at Tel Aviv University expected to open in 2026. (Courtesy of Erez Shani Architecture)

The Times of Israel: Your center is not just a clinic. There is much more to it. Tell me about that.

Prof. Yair Bar-Haim: The center is built on four pillars. The first is clinical research on traumatic stress, resilience, and trauma-related psychopathology. This will include molecular-level research, neuroimaging, behavioral treatment development, and randomized controlled trials. The second pillar is a large clinic that serves the public and conducts research in conjunction with the research center. The third pillar is training for experienced professionals — psychologists, clinical social workers, and psychiatrists — who want to learn how to diagnose and treat PTSD. The fourth pillar is aiding policy and decision-makers so they have the information they need.

Who has been staffing the clinic since it opened on January 1?

Dr. Ofir Levi, who served in the IDF for 25 years, including almost a decade as commander of the PTSD unit, is the director of the clinic. We have the best clinicians in the country, and Ofir is an example. Those we hired have between 15 and 42 years of experience treating PTSD. We have clinical psychologists, clinical social workers, and one psychiatrist. There are also 10 clinical professors at TAU with relevant experience who are volunteering with us. We also have three clinical psychology interns in the advanced stages of their internship helping us with patient intake. We have 33 people in total on our team right now.

Dr. Ofir Levi, director of the National PTSD Clinic at the National Center for Traumatic Stress and Resilience at Tel Aviv University in an undated photo. (Courtesy of Tel Aviv University)

How many people have you been able to treat so far?

Don’t forget we have been open for only about a month. We have had 400 calls and have started treating more than 50 patients. Recently we started accepting referrals from the Defense Ministry. They have a huge waitlist and they’re going to direct it towards us.

So far 50% of the referrals and calls are from IDF reservists. The rest are civilian cases; some people from the Gaza envelope area who are living in Tel Aviv now and some who were at the Supernova music festival. We also have patients who have no direct connection to Gaza or October 7, such as victims of rape or car accidents.

We plan to tackle 10% of the national load, which means treating 3,000 PTSD patients over the next two years.

How will people pay for treatment?

For IDF veterans it will be paid for by the Defense Ministry. Others may be covered by National Insurance. We are also fundraising so that treatment payments can be subsidized for those who are not entitled to or do not apply for those benefits.

A former IDF soldier and post-traumatic stress disorder sufferer expresses his anger and frustration about the lack of sufficient appropriate mental health services at an emergency meeting at the Knesset, Jerusalem, August 8, 2023. (Oren Ben Hakoon/Flash90)

From a medical and clinical perspective, why does attention need to be directed to improving PTSD treatment?

Generally, the treatment of PTSD lags behind treatment for other psychological disorders, for example, anxiety disorders or depression. For those, a combination of psychological treatments and medication can help about 70% of the patients. With PTSD, medications are currently not effective, and psychological treatments are useful for patients only 40% of the time — and that’s on a good day.

There is a clear gap and our center aims to close it within 10 years by harnessing all the intellectual academic talent not only at TAU but also from all around the country.

So what are the best practices and treatment protocols available to clinicians at this point?

We are guided by what has been shown scientifically to be effective. The first-line treatment is trauma-focused cognitive behavior therapy. If someone doesn’t improve enough and we think that we could move them to an additional type of treatment, we will move them to group therapy, or even psychodynamic therapy. But it’s not our goal to keep patients for the long term. All our treatments are time-limited. We’re not offering an open-ended kind of treatment that lasts for five years. It may take a year and a half to go through all the protocols, but our goal is to try to be effective with our first-line treatment.

Prof. Yair Bar-Haim, head of the National Center for Traumatic Stress and Resilience at Tel Aviv University, with a patient in the center’s National PTSD Clinic, January 2024. (Courtesy of TAU)

Since October 7, many mental health initiatives have sprung up, including some for PTSD treatment. Do you have any concerns about this?

Our clinic is just part of the vision to address the huge need. No one place is going to satisfy the demand. I am happy to hear about any serious initiative, but there are many that seem [dubious] to me. So many of the initiatives are not truly going to provide serious treatment for PTSD. You have to have a lot of experience in treating it. Intervention or places where you do yoga or the like is all fine and good, but this is not treatment.

How long can we expect PTSD resulting from this war to last?

I think the problem we’re facing is going to last for decades ahead, at least 30 years. Some of those affected will be dealing with it for decades, and there will also be the late-onset people who are okay for a couple of years and then their PTSD comes out. We’re going to have to treat all of them. This is a serious problem and it’s not going to be solved immediately. We need to prepare for a marathon.

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