There was nothing unusual about the chronic abuse of patients that went on at the Neve Yaakov psychiatric hospital. It’s time to shake up the system.
Mental health is the neglected backyard of the health and welfare ministries and the National Insurance Institute. But even within this backyard there are those who are especially overlooked: those who are mentally disabled, those who suffer from chronic mental illness, and all those who have not found a place for themselves in society for other reasons. I was saddened to read recently some of the reports about the Neve Yaakov psychiatric hospital – the Petah Tikva facility recently shut down in the wake of allegations of long-term abuse of patients by staff. My urge, upon hearing the reports, was to say: “Now you noticed? Where have you been all these years?”
In the late 1970s I held the position of senior psychiatrist in the clinic of Shalvata Psychiatric Hospital, an enlightened university hospital in Hod Hasharon. The hospital’s director, the late Prof. Shamai Davidson, studied in the Britain of the pre-Thatcher period and was a great believer in the role of the community in rehabilitation and mental health. I learned much from him. In discussions we held I raised the issue of chronically ill mental patients who were referred from our advanced clinic to private psychiatric hospitals in the area. I wondered why I had never received feedback from them concerning the patients we sent them. In fact from the moment a patient was referred to a private hospital, he disappeared forever. In the course of our discussions we realized that we should, as a public hospital, be aware of what was happening in the private facilities. We created a number of teams whose task it was to interview patients at the private hospitals and discuss the findings of the interviews.
The private psychiatric hospital I visited, in central Israel, was small and crowded. Patients wandered about in the inner courtyard, poorly dressed and, above all, exhibiting unhealthy movements – moving mechanically, their shoulders hunched, their facial expressions frozen. A psychiatrist needed no more than one look to understand they were receiving high dosages of anti-psychotic medications (of the old type ) which bring about a Parkinson-like physical appearance and overall depression of psychic energy – it “turned off” people who are not aggressive or talkative. The hospital was run on a daily basis by a head nurse and “supporting staff.” A psychiatrist would visit once every week or two, go over the list of medications and approve it with his signature.
Let me tell you the story of one of the patients I interviewed. Mr. B., who at the time was in his fifties, very thin, speaking garbled Hebrew, arrived in Israel as a lone immigrant in the 1950s, without one word of Hebrew. One day he stood for hours at a bus station and could not communicate with people in order to understand which bus he should take. Night came, and, bursting with fear and rage, B. began to yell and hit himself in the station. Policemen arrived and brought him to the emergency room in a general hospital, and since he continued yelling there as well, he was sent for a tranquilizer injection at the psychiatric hospital, where he had remained since the incident. Over the years he had managed to learn some Hebrew, and since it became clear that he was neither ill nor violent, he gradually began to fulfill errands for the hospital. Being alone and without means, he didn’t even try to escape. He grew accustomed to living in the hospital and carried on with his lonely, yet safe existence, with the Ministry of Health footing his hospitalization bills. “Do you want to leave this place?” I asked him. “I’m afraid of the world outside. I’ve been here for 25 years. I don’t know anybody. What will I do there?” “There” was the entire world outside the hospital. Except for this patient and one other one, the condition of all the others was so bad that they could not be interviewed.
I shall not speak here of the poor physical conditions, the quality of the food, the terribly high medication dosages. I would like to linger for a moment on the particularly brutal violence I encountered, especially in the youth wings. In one of my visits to these “hospitals,” where youths and young men were hospitalized, I saw the most appalling scene of all: a row of youths seated on an exposed concrete floor, bound to iron rings set in the wall, all day long. The patients, who were either severely retarded, slightly retarded, psychotic, or had severe behavioral disorders, were all thrown together, without any care except for high doses of anti-psychotic medication. So it went on, day after day. Some were tied to their beds at night as well. The stench was horrible due to bodily emissions, dirt, vomit, and inadequate bathing. They were beaten with a rubber hose that was also used to spray water on them – that was their only “bath.” All this was described in the reports we prepared at the time.
My experience has taught me how easily a psychiatrist can abuse the authority he is granted in private hospitals. The psychiatrist receives especially high monetary remuneration from the hospital’s management in order to approve again and again high dosages of psychiatric medication without examining the patients. The dosage assists the staff in running the facility’s daily routine, without disturbances on the part of the patients. Such psychiatrists, as far as I know, were not under any supervision or control on the part of the Health Ministry, the management of the health maintenance organization (HMO ), or the Israel Medical Association. It is, in fact, a kind of lucrative business for all those involved, at the cost of the patients’ lives and the Israeli taxpayer’s money. If B. had undergone a proper psychiatric examination in the course of his long years of hospitalization, it would have emerged that he may be eccentric and withdrawn but certainly not mentally ill, and that all he needed was a supportive framework that would allow him to learn the language and find employment suitable to his abilities.
My experience also taught me about the power of suppression. What happened to the survey we prepared then, in the 1970s? Nothing. The entire affair was silenced from above and the authors of the report were punished: their health deteriorated, or their career was halted. Neither the government, in charge of state psychiatric hospitals, nor the Clalit HMO, then the only HMO that offered mental health services, took any interest in those days in the thousands of chronically ill patients. They had no desire to contend with the pressure of interested parties.
Thirty five years have gone by. All those with even the slightest connection to mental health in Israel know how awful the situation is in private hospitals. How grave it is that the exposure of the appalling conditions at Neve Yaakov should be presented as an anomaly that requires particular attention, and that politicians attribute the horrors there to the contemporary results of privatization policies. This reality existed in Israel many years before the word “privatization” was invented.
As for the mental health reform – no, it does not address the hellhole for patients, mistakenly referred to as “psychiatric hospitals.”
So what should be done? I’ll begin with what shouldn’t be done: We should not begin by criticizing only what goes on in private facilities. These facilities should be closed down completely. The responsibility for the lives and health of the patients must be laid squarely on the shoulders of the state. A serious and professional survey should be budgeted and carried out to clarify the needs of the patients and meet those needs: psychiatric hospitalization, rehabilitation, hospitalization in nursing homes, supported community living, and so on. All this, following a gradual and controlled reduction in medication dosage which, for many patients, verges on poisoning.
We should not take the easy path of authorizing private facilities and endorsing them. It should be known that this evil has been plaguing the State of Israel since the 1950s. Now, we must and should make fundamental amends and lay the foundations for the proper and fair future care of society’s helpless members.
Dr. Ruchama Marton is a psychiatrist, founder and president of Physicians for Human Rights-Israel, a non-governmental organization
