Abstract

Introduction:
Ensuring equitable access to high-quality mental health services is fundamental to fostering healthy communities. In Israel, the 2015 mental health reform sought to integrate mental health services within general healthcare by shifting service provision from the Ministry of Health-to-Health Maintenance Organizations (HMOs). This structural change aimed to enhance accessibility, reduce stigma, and promote community-based care, particularly for underserved populations. This study evaluates the reform’s impact on mental health service utilization, medication use, and hospitalization trends over an eight-year period (2012–2019), providing insights into its role in promoting equity and integration within the healthcare system.

Methods:
A retrospective, descriptive analysis was conducted using data from Israeli HMOs and the Ministry of Health. The study population included HMO members accessing mental health services from 2012 to 2019. Service utilization was assessed through psychiatric diagnoses (ICD-9/ICD-10 codes), psychotropic medication prescriptions, and patterns of outpatient, emergency, and inpatient care. Demographic factors such as gender, age, ethnicity, and socioeconomic status, as well as comorbid physical conditions, were analysed to examine disparities in access and treatment.

Results:
The reform significantly expanded access to community-based mental health services. Between 2012 and 2019, the number of visits to community mental health professionals increased substantially, with psychologist visits rising by 1.6 times. Overall service utilization grew from 21.1% of the population in 2012 to 30% in 2019. Women were 1.4 times more likely to use services than men, with the most significant increase observed among the Arab population, where service utilization rose 7.07 times. Outpatient clinic visits grew 3.3-fold, and the number of patients receiving care doubled.
During the early years of the reform, a sharp increase was observed in HMO clinic visits (16%, P<.0001), external provider agreements (81%, P<.0001), and outpatient hospital clinic visits (61%, P<.0001).
Psychotropic medication prescriptions increased significantly, with the number of patients receiving psychiatric prescriptions growing by 57%. Antidepressant prescriptions rose by 62%, while stimulant prescriptions for ADHD increased by 88%. Hospitalization rates remained stable at approximately 23,000 annually, but the proportion of hospitalizations among mental health service users declined from 0.65% in 2012 to 0.45% in 2019, indicating a shift toward outpatient care. Notably, emergency department visits without hospitalization increased, particularly among children and adolescents (ages 0–17), rising from 15.15% to 24.9%.

Conclusion:
The 2015 mental health reform in Israel contributed to a more equitable and integrated mental healthcare system by increasing access to community-based services and reducing dependence on hospitalizations. The expansion of services benefited women, ethnic minorities, and younger populations, demonstrating progress toward inclusive, patient-centered care. However, disparities persist among underserved groups, requiring continued efforts to promote equitable access.
Future research should examine the long-term implications of the reform, particularly in the wake of the COVID-19 pandemic and security-related crises, which have intensified demand for mental health services. A data-driven approach to mental health policy—grounded in service utilization trends, pharmacological treatment patterns, and emergency care dynamics—is essential for ensuring sustained progress. Strengthening community-based interventions, enhancing integrated treatment approaches, and addressing barriers to care will be key to building a resilient, equitable mental healthcare system that supports the well-being of all populations.