Hemla - a National Mental-Health Plan

D. Strengthening employment as a central part of life rehabilitation: expanding the continuum between vocational training, rehabilitative employment, supported employment and transition to the open labor market, alongside support for employers and examining mechanisms that will prevent a sharp harm to the economic safety net as a result of going out to work.

Implementation of the axis will rely, among other things, on strengthening coordination roles in local authorities, including making the pilot of mental-health coordinators in the authorities a permanent program; expanding existing health-promotion infrastructures, such as "Efsharibari" (אפשריבריא); parent guidance and resilience programs in schools; and training "resilience agents" in the community - people who provide a service, including education, health and community-leadership workers, who will be trained to identify distress, listen and connect to sources of help, without replacing professional treatment.

In the fields of early childhood, children and adolescents, diagnosis, the child-development institutes and the educational-psychology service will be expanded, alongside dedicated responses for adolescents.

The aim of the plan is to create real change: to move the mental-health system from one that responds late to extreme situations to a proactive, compassionate, continuous and coordinating system. A system that places the person, their family and their community at the center. A plan that promotes resilience and growth and ensures treatment, rehabilitation, integration into community life, and a good, meaningful life.

Compassion in mental health means a moral, professional and state commitment to reducing mental suffering, preventing deterioration, preserving human dignity and creating conditions that allow recovery, participation, belonging and growth. Compassion is not limited to an emotional response to distress; it requires action. Therefore a compassionate system is also judged by how it is planned: by its accessibility, the continuity it ensures, the coordination between bodies, the reduction of bureaucracy and its ability to allow the person a meaningful life.

• •A compassionate system does not ask only what the diagnosis is, but also what the person has been through, what they need now, who supports them, what strengthens them and what makes things hard for them, what their family and community need in order to support them, and what will allow them to live from within connection, functioning, belonging and hope.

The national plan will ensure an accessible and coordinated continuum of services: promoting resilience and prevention, early detection, diagnosis, community treatment, response in crisis situations, hospitalization alternatives, hospitalization, medical rehabilitation and rehabilitation of life in the community. National policy will set public responsibility for results: availability, accessibility, quality, continuity, the ability to move between frameworks and coordination, and not a single clinical model for choosing the type of treatment or its degree of intensity. Decisions on the type of intervention, the identity of the suitable professional, the duration of treatment and its intensity are professional decisions. They will be made according to the person's needs, level of risk and the complexity of their situation, taking their preferences into account and, of course, according to current scientific and professional knowledge and the training, expertise and authority of the professionals.

• •Expanding low-intensity responses, community services, peer support, digital services or new service-delivery models will not serve as an automatic substitute for professional diagnosis or treatment when these are required. A shortage of manpower, waiting times or budgetary considerations do not justify a blanket replacement of one professional service with a service that is not professionally equivalent to it.

The plan will be implemented on the principle of non-reduction of the person's rights and of the level of professional service they are entitled to receive. A structural, budgetary or organizational change, an expansion of the range of responses, the integration of additional service providers or a change in where responsibility lies between systems will not reduce an existing entitlement to a service included in the health services basket or granted by law. The system will ensure that a person receives the professional service suited to their needs and not only the most available service. Where psychological diagnosis, psychodiagnostic assessment or psychological treatment is required under the law, the professional standards or the person's needs, access will be ensured to a psychological service provided by a psychologist with the required training and expertise.

• •This principle does not detract from the importance of multi-professional work or from the need to regulate all the psychotherapy professions. Its purpose is to ensure that each profession operates according to its training, authorities and professional advantage, and that the variety of responses in the system will broaden treatment options and not come at the expense of a professional service the person needs.

Goal: To build a national infrastructure of resilience and growth across the lifespan, strengthening individuals, families and communities and linking health promotion with early identification and referral to help.

• •Resilience is not only the ability to prevent illness or limit deterioration; it is also the ability to dream, to choose, to belong, to create meaning and to realize personal and community goals, and of course also the ability to overcome crises and grow from within them. Therefore the plan will develop the factors of resilience, namely emotional language, relationships, regulation skills, a sense of capability, participation, local leadership and support infrastructures.
• •Main policy moves: developing a continuous infrastructure of resilience across the lifespan; linking health promotion, early identification and referral to help; strengthening individuals, families and communities; and clarifying that resilience and prevention are not a substitute for professional treatment when it is required.
• •Implementation of the axis will rely, among other things, on strengthening coordination roles in local authorities, including making the pilot of mental-health coordinators in the authorities a permanent program; expanding existing health-promotion infrastructures, such as "Efsharibari" (אפשריבריא); parent guidance and resilience programs in schools; and training "resilience agents" in the community - people who provide a service, including education, health and community-leadership workers, who will be trained to identify distress, listen and connect to sources of help, without replacing professional treatment.

Goal: To expand the ability of the health funds and the public service to give an early, professional and accessible response, and to require a clear continuum from the first contact to the suitable response.

• •Main policy moves: expanding the professional mix in the community; access to psychological diagnosis, assessment and treatment; setting standards for availability, continuity and closing the referral loop; strengthening the interface with family medicine, education and welfare; and developing responses adapted to early childhood, children, adolescents, people with dual conditions (mental and addiction) and populations with unique needs.
• •Professional principle: The plan will ensure availability and continuity but will not set a uniform clinical model. The type of treatment, the provider and the degree of intensity will be set according to need and professional judgment.
• •Implementation of the axis will include, among other things, expanding health-fund clinics and public psychological treatment, opening hospitalization and day-treatment frameworks outside hospitals, family and group therapy and dedicated responses in the periphery. In the fields of early childhood, children and adolescents, diagnosis, the child-development institutes and the educational-psychology service will be expanded, alongside dedicated responses for adolescents.

Goal: To create a national, available continuum of crisis and emergency responses, so that a person receives the response suited to their situation, in the community, in an intermediate framework or in hospitalization, while preserving safety, rights and continuity.

• •Main policy moves: expanding crisis teams and urgent responses in the community; developing day treatment, balancing homes and stabilization frameworks; gradual opening of the hospitalization areas and offering a choice; building informed competition among the frameworks; ensuring safe and dignified hospitalization and a structured plan for discharge and return to the community.
• •Implementation of the axis will include crisis teams and an urgent mental response in the community, including making the "Mental MDA" (Magen David Adom) pilot a permanent program and rolling it out across the country, day treatment, balancing homes and stabilization frameworks, alongside proactive follow-up after a crisis or hospitalization.

Goal: To create a national rehabilitation continuum that clearly distinguishes between medical-functional-mental rehabilitation, as part of the health system, and rehabilitation of life in the community, as part of welfare and disability policy; to ensure a continuous transition between the tracks; and to preserve in full the rights, entitlements and professional expertise.

• •A. Developing medical-functional-mental rehabilitation in the health system: creating a distinct and accessible service track under the responsibility of the Ministry of Health and the health funds, based on clinical and functional need and not on prior recognition of disability, which will include, among other things, cognitive and functional rehabilitation and prevention of re-hospitalization. The service may be given in a variety of frameworks: ambulatory, day treatment, rehabilitation at home, intensive frameworks and, where needed, also frameworks that include overnight stay and supervision.

Goal: To establish a coordinating national mental-health headquarters, with a clear cross-ministry mandate, that will hold the systemic picture and ensure planning, coordination, follow-up and accountability.

• •A. Drawing up a national multi-year work plan and coordination between the ministries, health funds, hospitals, local authorities and other bodies.
• •B. Mapping budgets, manpower, capacity, waiting times and gaps, and setting national priorities.
• •C. Regulating responsibility interfaces and navigation and coordination mechanisms, especially in cases that pass between several systems.
• •D. Publishing metrics and an annual report on the implementation of the plan, the budget and the results.
• •The accountability principle: the headquarters will coordinate, measure and warn, but will not replace the powers of the executing and statutory bodies.

Goal: To ensure a professional and available workforce, in the scope and mix suited to the population's needs.

• •A. Multi-year planning of supply and demand by profession, expertise, region and framework.
• •B. Expanding training, internship and supervision according to areas of shortage, including scholarships for training and internship.
• •C. Incentives for work in the periphery and in fields where there is a shortage.
• •D. Retaining the workforce through working conditions, supervision, professional development and burnout prevention.

Goal: To create a clear framework of quality, safety and professional responsibility, while preserving multi-professional work and the fields of practice already set by law.

• •A. Drawing up a multi-professional framework for regulating mental treatment and psychotherapy, including requirements for training, experience and supervision.
• •B. A clear distinction between professional mental treatment and support, accompaniment, guidance and peer support.
• •C. Setting binding standards for ethics, informed consent, documentation, privacy, risk assessment and complaint mechanisms.
• •D. Ensuring transparency to the public about training, licensing, expertise and the nature of the service.

Goal: To create a shared national infrastructure for information, navigation, measurement, research and evaluation, that will support the continuity of services and continuous improvement of the system.

• •A. Establishing a national data system that will include waiting times, service volumes, manpower, outcomes, dropout and gaps between populations, while protecting privacy.
• •B. Regulating information sharing and closing the referral loop, and in complex cases creating a single coordinating address for coordination between systems.
• •C. Setting a national system of metrics for quality, outcomes, rights, equality and compassion, and publishing periodic reports to the public and the Knesset.
• •D. Creating a permanent infrastructure for research, service evaluation and forming professional consensus, based on evidence, real data and the lived experience of service recipients.

The guiding principle will be to see the family as a partner in the process, in accordance with the person's wishes, age, the law and the circumstances of the case, while preserving their privacy, autonomy and safety. In situations where there is concern about harm, violence, exploitation, neglect or harmful dynamics, the degree of involvement will be examined professionally and case by case. For children and adolescents, special weight will be given to the role of parents and primary caregivers, according to the best interests of the child or adolescent, their age, development and the law.

• •Following the principles set in section 2.6, the family is a cross-cutting issue in all four service axes and in the systemic infrastructures. It is a significant partner in treatment, rehabilitation and recovery, and at the same time a population with needs of its own. Involvement will be in accordance with the person's wishes, age, the law and the circumstances, alongside preserving their privacy, autonomy and safety.
• •In resilience and prevention: among other things, parent guidance, tools for coping with situations of stress and change, and support in periods of transition and crisis will be provided, in order to strengthen the family's ability to support without making it a substitute for the system.
• •In community treatment: the needs of family members will also be examined, and family therapy, guidance, counseling and general information on coping methods, rights and routes of application will be offered. For children and adolescents the family will be given involvement according to the best interests, age and development of the child.
• •In crisis, hospitalization and discharge: the family will receive information, guidance and support. Discharge planning will explicitly address its ability and resources, and will not assume that its mere existence makes it possible to forgo a required professional framework or service.
• •In measurement: the quality and compassion metrics will include family members' experience, their access to information and support and the burden placed on them, and will examine whether policy changes in practice transfer unreasonable responsibility from the system to the family.

Populations requiring dedicated attention include:

• •Direct victims, survivors of the massacre, bereaved families, returned hostages and the family members of hostages and returnees.
• •Soldiers, reservists, members of the security, rescue and medical forces and their family members.
• •Victims of hostile acts who receive a response through the National Insurance Institute, and wounded IDF soldiers who receive a response through the Rehabilitation Department of the Ministry of Defense.
• •Children and adolescents; young adults and students; pregnant and postpartum women; parents of young children and primary caregivers in the family.
• •People coping with existing mental conditions or with mental disability, who may experience deterioration, disconnection from the continuum of care, loneliness and harm to the rehabilitation process.
• •Senior citizens, people with additional disabilities, Arab society, Haredi society, immigrants and communities in the geographic and social periphery.
• •Professionals in the fields of health, welfare and education and in civil society organizations, who care for others while themselves living in a reality of threat and burnout.
• •The dedicated tracks for war victims will be integrated into all six axes of the plan. In this way the response to the unique needs of direct victims will be preserved, while preventing competition over resources between trauma victims and veteran mental-health patients or people coping with other mental conditions.

Equality and accessibility will be examined at every stage of the continuum: availability of services between regions and population groups; cultural and linguistic adaptation; accessibility for people with additional disabilities and fairness in outcomes. Service and outcome data will be presented, as far as possible, broken down by age, region, language, socioeconomic status and type of service, to prevent a situation in which an average improvement hides a deepening of gaps.

The national headquarters will set a binding coordination mechanism between the Ministry of Health, the Ministry of Defense, the National Insurance Institute, the health funds and the Ministry of Welfare and Social Security. The aim is not to transfer full responsibility to the Ministry of Health, but to set a shared standard: early assessment of needs; separation between determining disability percentages and eligibility for an allowance and drawing up a treatment and rehabilitation plan; support for the family; continuity between systems; and proactive follow-up over time.

• •Prioritization will be done according to need, risk and urgency, and not according to public visibility or belonging to a particular eligibility track. This principle is essential so that the expansion of responses for war victims does not come at the expense of people with existing mental conditions.

Legislation is an implementation mechanism of the plan and not a substitute for policy. A focused package of amendments is proposed that will anchor public responsibility, preserve rights and enable the structural change without creating a broad and burdensome framework law.

Law for the Treatment of Mental Patients

• •Amending the name and content of the law toward a "Mental Health Treatment and Rights Law"; adding principles of compassion, continuity, choice of hospitalization place, a discharge plan, coordination and preservation of rights.
• •To anchor dignified treatment, rights and a continuum of care alongside the hospitalization and coercion arrangements.

State Health Insurance Law

• •Anchoring measurable standards for community mental-health services, including waiting times by service type and professional need; choice of hospitalization place; access to psychological diagnosis, assessment and treatment when they are required; psychiatric and family treatment and multi-professional services; continuity after hospitalization; remote treatment; measurement and reporting.
• •To ensure that the right to mental treatment is a right to the professional service suited to the person's needs, and not only to receiving some response, and to prevent reduction of existing rights because of organizational changes or new service-delivery models.

Medical-functional rehabilitation in mental health - State Health Insurance Law

• •Anchoring the right to medical-functional-mental rehabilitation as part of the health services basket, for a person who has undergone an acute mental crisis, hospitalization, deterioration or significant functional decline and needs a rehabilitation process to restore function, prevent re-hospitalization and gradually return to community life. Eligibility will be determined on the basis of clinical and functional need and will not be conditioned on prior recognition of disability or eligibility for a community rehabilitation basket.
• •Criteria for referral, continuity with hospitalization and the community, a professional mix and outcome metrics will be set.
• •To close the gap between acute treatment and rehabilitation of life in the community, and to anchor medical rehabilitation in mental health as a health service in its own right, on the basis of clinical and functional need.

Regulation of the mental-emotional treatment professions, including psychotherapy, quality and supervision

• •Establishing a multidisciplinary professional team that will submit within a year a framework for regulating psychotherapy and mental treatment, while preserving the existing fields of practice and authorities of regulated professions. Legislative amendments will be advanced after the alternatives and their implications are examined.
• •To protect the public through a clear definition of competence, training, ethics, responsibility and transparency, without harming professional authorities already set by law

Information sharing and measurement

• •Regulating the transfer of information with consent, reporting of aggregate data and reporting of outcomes, while protecting privacy.
• •To enable continuity, planning and measurement without harming privacy and trust.

For negotiation purposes, a cumulative target framework of up to about NIS 8.75 billion for five years is proposed, beyond the base budgets and additions already approved. This is not a final actuarial estimate. Within 120 days of the formation of the government, an inter-ministerial budget mapping will be completed that will identify existing budgets, commitments, possible duplication, capacity gaps and implementation costs; on its basis the final five-year framework and its annual division will be approved. Insofar as the mapping identifies existing resources that can be diverted or pooled without harming existing rights and services, they will be taken into account before increasing the budget.

Year 1

• •NIS 1.00 billion
• •Establishing the national headquarters and the measurement system; expanding the health funds' services; pilots in local authorities; opening the hospitalization areas, starting the regulation of psychotherapy and mental treatment in the public system and outside it; and operating the first emergency responses

Year 2

• •NIS 1.50 billion
• •Expanding community treatment, balancing homes and suicide-prevention responses; medical rehabilitation; resilience programs in the authorities; and strengthening the workforce

Year 3

• •NIS 1.90 billion
• •Additional manpower, expanding rehabilitation of life in the community, responses for children and adolescents and expanding the navigation and coordination mechanisms

Year 4

• •NIS 2.10 billion
• •National expansion, integration of information systems, incentives for the periphery and dedicated tracks for war victims and for people with dual conditions

Year 5

• •NIS 2.25 billion
• •Anchoring the addition in the budget base, full measurement, expanding the housing and employment responses and retaining the workforce

Total over five years

• •NIS 8.75 billion
• •A multi-year target framework for negotiation, to be updated after a full budget mapping.

Axis 1 - resilience and prevention

• •12%
• •NIS 1.05 billion
• •Making the pilot of mental-health coordinators in the authorities a permanent program, expanding "Efsharibari" (אפשריבריא), resilience agents, parent guidance and school programs

Axis 2 - detection, diagnosis and treatment in the community

• •38%
• •NIS 3.325 billion
• •Health-fund clinics, public psychological treatment, family and group therapy and responses in the periphery; of which about NIS 875 million for early childhood, children and adolescents: diagnosis, child-development institutes, the educational-psychology service and responses for adolescents

Axis 3 - crisis and hospitalization

• •15%
• •about NIS 1.31 billion
• •Crisis teams, suicide prevention, balancing homes, day treatment, stabilization frameworks, opening of hospitalization areas and follow-up after a crisis

Axis 4 - rehabilitation and integration

• •20%
• •NIS 1.75 billion
• •Medical-functional-mental rehabilitation (about NIS 875 million): tracks after a crisis, hospitalization, deterioration or functional decline, cognitive and functional rehabilitation and prevention of re-hospitalization; rehabilitation of life in the community (about NIS 875 million): housing, employment, supportive community and training of the disability systems and local authorities

Infrastructure - governance and coordination

• •3%
• •NIS 262.5 million
• •The national headquarters, positions, inter-ministerial coordination mechanisms and reports to the public and the Knesset

Infrastructure - workforce

• •8%
• •NIS 700 million
• •Scholarships, incentives for the periphery and for fields of shortage, supervision, burnout prevention and training of teams

Infrastructure - regulation and quality

• •1.5%
• •about NIS 131 million
• •Regulation of psychotherapy and mental treatment, quality and safety standards, supervision and transparency to the public

Infrastructure - information, research, measurement and navigation

• •2.5%
• •about NIS 219 million
• •A national data system, a navigation system, outcome metrics and compassion metrics, aggregate data, research and service evaluation

The proposed division above is a working scenario for budget negotiation and not a final allocation. Before its approval, a full mapping of all public expenditure in the field will be carried out, including the budgets of the Ministry of Health, the health funds, the Ministry of Welfare and Social Security, the Ministry of Defense, the National Insurance Institute, local authorities and support for nonprofits. Every transfer of responsibility will require a "transfer envelope" that includes the base budget, activity budget, positions, training, information systems and a mechanism protecting against harm to rights.

• •The first budget report will distinguish between an addition to the base, one-time expenditure and investment in infrastructure, to allow tracking the continuing cost of the plan. The dedicated responses for war victims are not a separate budget cluster: in accordance with section 5.2 they are budgeted within each of the service axes, and will be marked in the budget reporting to allow tracking their scope.

Implementation will be based on four principles: (1) expanding services in parallel with building infrastructure (2) pilot and evaluation before national expansion (3) preserving rights as a condition for any structural change (4) tying every move to a budget, workforce, metric and timeline.

The first 120 days

• •Establishing an inter-ministerial team and a steering committee; budget, service and workforce mapping; setting the structure of the national headquarters and a responsibility map; formulating baseline metrics.
• •Mapping waiting times and capacity; choosing authorities for the pilot; mapping gaps in crisis responses; defining the target populations for medical-functional-mental rehabilitation.
• •Publishing a work plan, responsibility map, initial budget and baseline metrics.

Up to 180 days

• •Approving a government decision and establishing the national headquarters; approving a multi-year workforce plan; publishing service targets; formulating principles for information sharing; establishing the legislation and regulation teams.
• •Operating a pilot for navigation and coordination in the authorities; expanding emergency and suicide-prevention responses; approving a national model for medical-functional-mental rehabilitation in a variety of frameworks (ambulatory, day, home, intensive and, where needed, also frameworks that include overnight stay and supervision).
• •A first progress report; an approved service model for medical-functional-mental rehabilitation; public service and workforce targets.

The first year

• •Approving the first year's budget; completing the legislative outline; drawing up an inter-ministerial transition plan for rehabilitation of life in the community and examining the threshold conditions for transfer of responsibility.
• •Expanding community treatment; opening crisis and intermediate frameworks; operating the first medical-functional-mental rehabilitation tracks; expanding responses for children and adolescents and resilience programs in the authorities.
• •Evaluation of the pilots; recommendations for regulating the treatment professions; a decision on whether the threshold conditions for continued structural change in rehabilitation are met.

Years 2-3

• •Advancing the required legislation; expanding the workforce; adjusting the five-year framework on the basis of real data; strengthening information and measurement systems.
• •Gradual expansion of community treatment, crisis responses and medical-functional-mental rehabilitation; strengthening rehabilitative and supported employment; expanding models that have proven beneficial.
• •Annual reports to the Knesset and the public; expansion only of models that meet quality, outcome and equality metrics.

Years 4-5

• •Embedding ongoing budgets in the base; completing national rollout and information infrastructures; updating regulation and legislation according to implementation findings.
• •National rollout of the continuum of services; full implementation of the changes in rehabilitation only after the threshold conditions are met and rights are preserved.
• •Evaluation of the five-year plan, publishing results and formulating a follow-on plan for the next five years.

Every move in the annual work plan will be defined through a responsible body, partners, budget source, milestones and outcome metrics. A move whose performance cannot be measured or for which no responsible party has been defined will not be considered part of the implementation plan.

The plan's measurement system is intended to examine whether the person and their family receive a professional, accessible, continuous and compassionate service, and not only whether the system produces more actions or services. Accordingly, a limited number of national super-metrics will be set, and each metric will be interpreted alongside a balancing metric, in order to prevent incentives to turn away applicants, to reduce treatment for non-professional reasons, to transfer applicants between services or to choose simpler cases.

• •The metrics will be calculated at the level of the service, the district and the national system, and will not be used alone to reward or punish an individual professional. As far as possible, data will be presented broken down by age, region, language, socioeconomic status and type of service, with adjustment for the complexity and risk level of the population.

1. Time to receiving the suitable professional response

• •Median and 90th percentile of the number of days from the first contact to a professional assessment, and from the assessment to the start of the response determined as suitable. Measurement will be by service type and required profession.
• •All applicants will be included in the denominator, including those not accepted for service. In parallel, the rate of referrals that were rejected, closed or transferred to another service will be published, so that it will not be possible to "shorten waiting time" by screening applicants.

2. Matching the response to the professional need ◆

• •The rate of applicants who received the type of service determined for them after the professional assessment, and within the time frame set as a target.
• •The rate of cases in which an alternative response was given because of shortage or availability will be measured separately, to prevent replacing a required treatment with a cheaper or shorter response.

3. Continuity of care ◆

• •The rate of cases in which, after hospitalization, crisis or transition between frameworks, documented contact with the next service took place within the time frame set; and the rate of referrals for which confirmation was received that the person actually arrived at the next service.
• •The metric is not satisfied with a referral being made. "Closing the loop" will be counted only when real contact with the next service took place or an agreed alternative solution was found.

4. Treatment outcomes and functioning

• •Change in symptom, functioning and quality-of-life measures chosen in advance according to service type, using valid assessment tools and, as far as possible, the person's own report.
• •A uniform "improvement" target should not be set for all populations. Measurement should be adapted to the severity of the condition and the goals of treatment, and services treating different populations should not be compared without adjustment for complexity.

5. End of treatment and continued need

• •The rate of treatments that ended in a joint professional decision; the rate of treatment stoppages initiated by the service; and the rate of applicants who returned to the framework or turned to the emergency room within a defined period because of deterioration or a need that did not receive a response.
• •A service should not be rewarded for a high number of "treatment completers". The metric is examined together with return to treatment, deterioration, emergency applications and continued need, to prevent artificial shortening of treatment.

6. Rights and service experience ◆

• •A uniform, short survey of service recipients, which will include, at the least: dignity, partnership in decisions, clarity of information, a sense of choice, cultural and linguistic adaptation, and whether the person received the service they were told they needed.
• •The results will be presented alongside the rate of complaints, incidents of harm to rights and cases of replacing a required professional service with a service that is not equivalent to it.

7. Family as anchor and partner ◆

• •Among services where the family is relevant: the rate of families who were proactively offered information, guidance or support; the rate of families who received an independent response when they asked for it; and the rate of those reporting that they understand how to help, whom to turn to in a deterioration and what the limits of their responsibility are.
• •Family involvement should not be measured by the amount of care the family provides. In parallel, it will be measured whether family members experience an unreasonable transfer of burden, are forced to serve as case managers, or give up work, studies or functioning to compensate for gaps in the system.

8. Resilience and early detection

• •The rate of local authorities in which a permanent resilience and coordination program operates; the number of "resilience agents" who were trained and are active; the rate of those who turn to help at an early stage, before turning to the emergency room or hospitalization; and a periodic survey of mental well-being and sense of resilience in the population.
• •Success should not be measured only by the number of activities or participants. An increase in requests for help as a result of early detection will be considered a desirable outcome, and will be examined alongside the availability of the responses to which applicants are referred.

9. Integration into community life

• •The rates of independent or supported housing, employment (rehabilitative, supported and in the open labor market), studies and social participation among recipients of rehabilitation services; and the time from eligibility to actually receiving the service.
• •Moving to the open labor market or leaving a framework should not be rewarded in themselves. Employment stability, preservation of the economic safety net and the person's satisfaction will be measured in parallel, to prevent premature pushing out of support frameworks.

10. Response to war victims

• •The rate of victims who underwent an early needs assessment; time to start of treatment; continuity between the Ministry of Health, the Ministry of Defense, the National Insurance Institute and the health funds; and the rate of those who were cut off from the continuum of care.
• •The metric will be presented alongside the availability metrics for people with existing mental conditions, to ensure that the expansion of responses for war victims does not come at their expense (section 5.4).

11. Equality in access and in outcomes

• •For each of the ten metrics above, gaps between regions, age groups, languages and main populations will be presented.
• •The metric is not only a "national average". Success will not be considered full if the general improvement is accompanied by an increase in gaps between population groups.

◆ Compassion metrics: The metrics marked in the table examine the experience of the person and their family, the preservation of their dignity, the continuity of treatment and its suitability to their needs, in accordance with the definition of compassion in section 2.3. Together they make up the plan's "compassion metrics".

No single target will be set without a balancing metric. For example, shortening waiting time will always be examined together with the rate of referrals rejected and transferred to other frameworks.

• •All applicants are included in the denominator. A referral that was rejected, transferred or closed does not disappear from the measurement.
• •Reducing treatment should not be rewarded in itself. Treatment duration, number of sessions or hospitalization rate are not independent success metrics; they will be examined only in relation to professional need, outcomes and continuity.
• •The metrics will be adapted to the complexity of the population. A service treating people in complex situations or at high risk will not be harmed in comparison with a service treating a lighter population.
• •Measurement will be done at the system and service level and not at the level of the individual therapist, except where a professional quality metric has been explicitly set for it.
• •The national headquarters will examine once a year the effect of the metrics themselves. If a metric is found to create undesirable behavior - turning away applicants, shortening treatment, shifting burden to the family, avoiding complex cases or harming rights - the metric will be amended or replaced.

B. Transferring rehabilitation of life in the community to the responsibility of the Ministry of Welfare and Social Security: a gradual transfer of the areas of housing, employment, education, social life, leisure and long-term accompaniment, including a supportive community, to the Disabilities Administration, while preserving the unique expertise in mental health and close contact with the treatment system.

• •The rates of independent or supported housing, employment (rehabilitative, supported and in the open labor market), studies and social participation among recipients of rehabilitation services; and the time from eligibility to actually receiving the service.

B. Transferring rehabilitation of life in the community to the responsibility of the Ministry of Welfare and Social Security: a gradual transfer of the areas of housing, employment, education, social life, leisure and long-term accompaniment, including a supportive community, to the Disabilities Administration, while preserving the unique expertise in mental health and close contact with the treatment system.

• •Transferring responsibility to the Ministry of Welfare and Social Security matches the social model of disability and the Convention on the Rights of Persons with Disabilities, which Israel ratified and which anchors the right to independent living and integration in the community. It will make it possible to rely on the existing infrastructures of the Disabilities Administration and of the local authorities in the areas of housing, employment and accompaniment, will reduce duplication between systems and will allow the Ministry of Health to focus on its core responsibility: medical-functional-mental treatment and rehabilitation. The transfer does not express a reduction of the health system's commitment. It is conditional on preserving the unique expertise in mental health, on continuous contact with the treatment providers and on meeting the threshold conditions that will be set in the implementation plan (section 6.3).
• •C. Ensuring continuity and preserving rights: the transition between the two rehabilitation tracks will be planned and coordinated, without a need to restart assessment and eligibility processes. Any structural change will be conditioned on preserving the full rights, on the transfer of the budget, positions and infrastructures, and on a gradual and measured transition period.
• •Any transfer of responsibility will be done gradually and will be conditioned on four conditions: (1) preserving the full rights and entitlements; (2) full transfer of budget, positions and infrastructures; (3) retaining professional knowledge and expertise; (4) a gradual transition period accompanied by measurement and by the involvement of people with lived experience and their family members.

One of the conceptual changes required in the mental-health system is a move from seeing the family mainly as an accompanying factor, but in most cases as a problem to be managed, to seeing it as a central resource and an anchor of the person throughout life. A family is usually the most stable factor in a person's life, certainly at the time of their illness, and so it should have been in mental health too. They are the first to identify the change in the person's condition, are meant to accompany them at the time of crisis, during hospitalization and on return to the community, help them realize their rights, support functioning and remain at their side even after frameworks and professionals change.

• •Alongside its critical role as a source of support, the family itself is affected by the distress or illness. The condition of one family member may affect relationships, the division of roles, functioning, employment and the economic situation of the family unit. Therefore a compassionate policy cannot be satisfied with relying on the family; it must also see its needs and ensure that family members are not left alone with the difficulty.
• •Recognizing the family as an asset does not mean transferring the treatment, rehabilitation or economic responsibility from the state to the family. Family members are not supposed to become case managers, caregivers, supervisors or funders of services that the public system is committed to providing.
• •In rehabilitation: family members will be given information, guidance, counseling and support in coping with changes of roles, burden, burnout and realizing rights. Responsibility for the responses for the family will be explicitly defined, including in transitions between systems.

Law for the Rehabilitation of Persons with Mental Illness in the Community

• •A transition arrangement that will ensure preservation of existing rights, adaptation of the committees and the services basket, gradual transfer of rehabilitation of life in the community to the Ministry of Welfare and Social Security, and budgetary protection.
• •To prevent loss of rights during the structural change and ensure a continuous transition.

Welfare Services for People with Disabilities Law

• •Adding a dedicated chapter on mental disability in the areas where professional adaptation is required; including housing, employment, education, social life, leisure and long-term accompaniment.
• •To integrate people with mental disability into general disability policy, with professional adaptations.

Realizing rights and bureaucratic simplicity

• •Anchoring the Ask-Once principle for transferring information and linkage between the National Insurance Institute, health and welfare with the patient's consent, and holding eligibility committees on the basis of documents only
• •Reducing the bureaucratic burden on the person coping and their family and preventing re-harm at the gateway to services.