Israel needs to build a better system to handle mental health crises

Originally published in The Jerusalem Post on June 19, 2025. In a time of war, coordination is a given. Everyone understands that disjointed efforts lead to casualties. The same logic applies to the mental health crisis we face today: Without unified action, the casualties are invisible—but just as real.

When a country is at war, urgency is expected. Budgets move fast, silos fall, and things that were impossible in peacetime become standard. The Health Ministry can build a new hospital wing in days. The army can open trauma clinics within 24 hours. Entire systems bend to meet the moment.

But in the realm of mental health, the response has felt eerily familiar—not fast, not flexible, and definitely not coordinated.

We are in a national trauma crisis, and yet no one seems to be sounding the alarm. There is no “burning platform.” No clear rallying cry. No sense that we are treating this with the same urgency as other war-related needs. What we do see is fragmentation: Ministries pointing to each other. Municipalities scrambling. Schools making impossible choices alone. And behind all that? Thousands of people who need help—not in theory, not someday, but now.

Trauma is not a niche issue

Trauma is not just a mental health issue, and it’s certainly not just the responsibility of the Health Ministry. This is a central public health challenge that touches education, welfare, employment, national security, and the economy—just as much as it touches health.

Addressing trauma is not only about emotional healing. It directly impacts physical health, social cohesion, economic productivity, and national resilience. A 2023 study in The Lancet Psychiatry found that individuals with PTSD face significantly higher risks of cardiovascular disease, diabetes, and premature death (Koenen et al., 2023).

More recently, a new report recommended that several conditions—including fibromyalgia, psoriasis, and diabetes—be automatically recognized by Israel’s Rehabilitation Department as trauma-related due to their strong links with PTSD.

Since October 7, the rise in trauma symptoms has been thoroughly documented—among children, displaced families, soldiers, and survivors. And this is not just about therapy sessions. Unaddressed trauma increases national healthcare costs, disrupts educational outcomes, drives substance use, and sends shockwaves through every layer of society.

Not designed for crisis

Today’s mental health system in Israel is fragmented by design. Kupot holim (HMOs) manage clinical care. The Education Ministry oversees resilience programs, but each school must choose and fund implementation on its own. The Welfare Ministry supports municipalities, but each mayor is expected to decide how—and whether—to prioritize trauma care.

In theory, this model allows for flexibility. In practice, during a crisis, it leads to chaos.

“During crisis, decentralization without coordination is not empowerment—it’s abandonment.”—Prof. Eyal Fruchter

Municipal leaders are already operating at the edge of their capacity. School principals are being asked to choose from long lists of trauma programs, without the tools or time to assess what’s appropriate. Many genuinely want to help but don’t know where to start. The result? A sense of urgency and pressure to “do something,” but also inconsistent implementation, wasted resources, and the most vulnerable populations left behind.

What centralized support looks like

Centralization doesn’t mean stripping autonomy—it means scaffolding it.

It means:

• Curating 3–5 evidence-based trauma programs for schools, tailored by age and setting.

• Providing co-funding and training so municipalities can implement without reinventing the wheel.

• Publishing a national trauma response framework so each sector knows its role.

• Coordinating real-time data collection across kupot, clinics, and civil society to track need and response.

“We knew we couldn’t rely on individual schools to figure it out themselves. We needed a national strategy with local execution.”—Prof. Frank Oberklaid, reflecting on the state of Victoria’s trauma and resilience programs in Australia

Australia’s model shows how national coordination combined with local delivery can work. It’s not about micromanaging—it’s about aligning the system to act quickly, consistently, and equitably in times of crisis.

A call for state action

I’ll admit, this reflection feels uncomfortable. I come from a background that values market forces, bottom-up solutions, and innovation over regulation. But I’ve come to realize that no amount of private initiative can solve a public crisis alone.

“Mental health care cannot rely on the private and social sector. The state must ensure there is a floor beneath which no one falls.”—Prof. Natti Laor

I still believe in decentralization where it serves. But in a mass trauma context, leaving every school, every kupah, and every mayor to decide on their own isn’t a sign of flexibility—it’s an abandonment of responsibility.

The dilemma: urgency without fear

Many say we need to raise the pressure—more headlines, more public outcry, more political cost for inaction. But do we really want to spread fear to force action?

We walk a tightrope: create urgency without causing panic. We want people to feel supported, not hopeless. We want them to believe healing is possible—not to be overwhelmed by reports of a crumbling system.

And yet, hope alone cannot sustain public trust. If people don’t see coordination from their government, if they feel the chaos firsthand, they lose confidence—not just in services, but in the idea that recovery is even possible.

That’s why the burning platform is needed—not just for officials, but for all of us. Not to frighten, but to focus.

We can still build it

Civil society has stepped up in extraordinary ways. Therapists, volunteers, and communities have built pop-up support systems overnight. But they

cannot—and should not—replace the role of government.

We need our ministries to work together. We need clear roadmaps, curated tools, and shared data. We need a national trauma strategy with teeth. We need to act as though trauma healing is as urgent as physical recovery—because it is.

The burning platform won’t emerge on its own.We must build it—together.And we must do so with courage, coordination, and care.