State Comptroller says 3 million Israelis suffering from trauma since October 7
Engelman faults Health Ministry for ‘collapsed’ health care system; Health Minister Uriel Buso set to double the scope of mental health services
Reporter at The Times of Israel
In a report on the mental health system, State Comptroller Matanyahu Engelman said that in the aftermath of the October 7 Hamas-led massacre and subsequent war, approximately 3 million people among the adult population had experienced anxiety, depression and symptoms of post-traumatic stress disorder.
“The mental health system, which had difficulty functioning even before October 7, collapsed in the first days of the war,” Engelman said.
The report, released on Tuesday, said that in the six months following the October 7 attack, only about 0.6 percent of the population received mental health treatment through health management organizations (HMOs) and resilience centers, even though 38% of the population reported moderate to severe symptoms.
“I warned about the failures in the field of mental health care in a letter to the prime minister about a month after the massacre,” Engelman wrote, “but all the deficiencies have yet to be fully corrected.”
According to the findings of the report, an estimated 580,000 Israelis suffer from at least one symptom of PTSD at a severe level as a direct consequence of the events of October 7 and their aftermath.
The survey was conducted by the State Comptroller in April 2024, six months after the war began on October 7, when thousands of Hamas-led terrorists invaded Israel, killing some 1,200 people and taking 251 hostages.
Engelman said that he presented his first findings to the prime minister on November 13, 2023, after visiting conflict zones in the south and north of the country immediately after the massacre and the start of the war.
He accused Health Minister Uriel Buso and ministry Director-General Moshe Bar Siman-Tov of not updating the mental health system’s preparation for war and other traumatic events, despite a National Emergency Management Authority assessment that was first published in 2001.
Once the war broke out and thousands of Israelis were evacuated, Engelman said that the mental health system failed in its treatment of evacuees.
The system operated “without a structured approach, alongside local volunteer initiatives, and without maintaining treatment continuity and documentation,” Engelman said.
Of the comptroller’s sample of 1,010 adults, one-third of the participants reported moderate or severe post-traumatic stress disorder or depression symptoms. About one-fifth reported anxiety symptoms.
The survey predicts that approximately 900,000 people will seek help for mental health issues in the future.
As of now, however, the report found that since the massacre, health funds and health centers have provided treatment to less than one percent of the population.
Why don’t Israelis seek professional help?
According to the survey, a significant portion of those affected by PTSD, anxiety and depression are hesitant to seek treatment. While 17% of respondents expressed concerns about confidentiality, another 5% said they couldn’t find a suitable therapist. Of the 16% who experienced moderate to severe symptoms, they reported that although they had not yet sought care, they intended to do so.
The most important reason, however, is that people said they don’t want to wait an average of six months for treatment.
“It is unthinkable that people would have to wait in line for about six months to receive treatment from a psychiatrist at a health insurance company,” Engelman said.
“The lack of treatment for such a large number of people reporting symptoms can lead to chronic illness, accompanied by a decline in functioning,” the report said.
Engelman said that because of a shortage of manpower, the treatment offered by the HMOs and resilience centers is not sufficient to meet demand.
For example, of the 10,500 children who were evacuated from Sderot, treatment was provided to only 440 (4%).
Of adults, only about 11% of all evacuees from southern and northern communities received mental health care from health funds and resilience centers by the end of March 24.
The audit also revealed that only one percent (1%) of the survivors of the massacre at the Nova festival received treatment from the resilience centers or HMOs, despite a survey showing that those who experienced these traumatic events, or had close family members involved, had almost double the reported mental health symptoms compared to those who were not involved.
Moreover, only 13% of volunteers at the ZAKA organization who worked during the events of October 7 and the following weeks clearing and identifying human remains, received treatment from the public health care system.
In response, Buso said that the October 7 events were unprecedented and that “tens of thousands of Israelis received immediate professional mental health treatment through various means available to the healthcare system, in an incident of mass casualties never before seen.”
Mental health “has been the central focus of the healthcare system’s agenda” since the first days of the war, the health minister said.
“A self-reporting survey is fundamentally flawed,” he added, “and cannot predict the extent of those seeking mental health treatment. It may also cause real harm and lead to a sense of psychological helplessness in the general public.”
Professor Jonathan Huppert, Head of the Center for Trauma Recovery in the Department of Psychology at The Hebrew University of Jerusalem, agreed.
“The report relied entirely on a self-administered survey conducted at the height of the war in April 2024 and then estimates the extent of the population in need of mental health services,” Huppert said.
Buso added that the ministry had set a goal to double the scope of mental health services available to the public to address the needs arising from the October 7 events and the war, also determined by the public resources allocated to the healthcare system.
Despite the widespread need for services following the events, there is broad agreement that not everyone who experienced emotional distress will require mental health treatment, Buso said.
“It’s likely that once there is closure, people are more likely to start the natural recovery process even without therapy,” Huppert said. “What percentage? That’s a good question.”
However, he said, “There’s no ability to move on because of the enormity of the event. We’re not at closure. We’re still managing the trauma… we’re still in trauma.”
