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In Israel, as in other parts of the world (1), not every person in need of mental health care receives it (2). Although not all individuals with a diagnosable disorder require care (3), many do and yet remain untreated. The obstacles to care reside in a triad of factors: attitudes of the potential user, family and community; availability, accessibility and cultural adequacy of the services; and openness to psychiatry and belief system of the enveloping culture (1, 3). Recognition of this treatment gap by all stakeholders is an essential first step to diminish the burden of disease of the mental disorders (4).
How large is the treatment gap in Israel? The Israel National Health Survey (INHS) showed a considerable treatment gap in the care of common psychiatric disorders among adults (2). Among the findings: there was a 9.7% one-year prevalence rate of combined anxiety and mood disorders among Israeli residents aged 21 and over, of whom 64% were untreated. Projected, this would result in approximately 281,000 individuals untreated nationwide.
The treatment gap is even wider in selected population groups, such as residents of what is commonly referred to as the "periphery" (northern and southern Israel, in contrast to the cities of the central region) where mental health services are less available. Levinson reported that while 6.0% and 6.6% of the population in Jerusalem and Tel Aviv, respectively, consulted services for a mental health problem during a 12-month period, the corresponding figures in the northern and southern districts were 3.9% and 4.1%, respectively (5). With regard to the young, "39.1% of mothers whose child had any mental disorder consulted a professional source in the preceding year concerning the emotional or behavioral problems of their child, while only one-third of their children who had any mental disorder consulted someone in school in the past year" (6). In the ArabIsraeli minority, the treatment gap with regard to anxiety and depressive disorders is twice as high as in the Jewish-Israeli population (7). This may result from a combination of the three sets of potential obstacles to care referred to earlier. Members of other minority groups (i.e., ultra-Orthodox Jews) may be under-users of services even when available, perhaps because of the limited fit between the respective "assumptive worlds" (8)...