How is Psychiatric Hospitalization Performed in Israel, When is it Required, and What are the Patient’s Rights?

What is Psychiatric Hospitalization and Why is it Sometimes a Necessary Step?

Psychiatric hospitalization is an intensive treatment framework that provides a protected environment and continuous professional support for people dealing with mental conditions that require in-depth and close treatment. Its main purpose is to stabilize acute states of mental distress, enable accurate and in-depth diagnosis of the disorder, and initiate or adjust concentrated drug and psychological treatment. Hospitalization is often required when outpatient (ambulatory) treatment is insufficient, in psychiatric emergencies, or when there is an immediate danger to the patient or their environment. It is important to understand that psychiatric hospitalization is not a punishment, but a necessary treatment stage for many on their way to recovery and improved quality of life. Knowing the process and your rights as patients is essential for successful coping with hospitalization.

In What Situations and Under What Conditions is Psychiatric Hospitalization Required in Israel?

The need for psychiatric hospitalization arises from mental states in which there is an immediate danger to the patient or their environment, or when their condition does not allow them to take care of their basic needs independently, and treatment in an ambulatory setting is insufficient. This usually involves acute crisis situations that require close supervision and intensive treatment in a protected environment.

One of the common situations requiring hospitalization is when there is a real concern of suicidal danger. If a person expresses suicidal intentions, plans them, or tries to carry them out, hospitalization may be required for protection and stabilization of their mental state. Similarly, if a person poses a real danger to others due to their mental state, for example in a state of uncontrolled violence or aggression, hospitalization may be necessary.

Acute psychotic states, characterized by loss of contact with reality, delusions (false beliefs) or hallucinations, often require hospitalization for rapid diagnosis and treatment. In these situations, reality judgment is impaired, and the person may behave in a way that is dangerous to themselves or others.

Even when a severe mental illness causes a significant inability to take care of basic needs such as eating, drinking, personal hygiene, or taking medications, hospitalization may be necessary to ensure the patient’s physical and mental well-being.

In cases where prolonged outpatient treatment, including meetings with a psychiatrist, psychologist, or social worker, has failed to stabilize the mental state, hospitalization may offer a more intensive treatment framework with a multidisciplinary team available around the clock.

Sometimes, hospitalization is required for complex diagnosis of an unclear mental state, or for careful and controlled adjustment of drug treatment under close medical supervision, especially when dealing with new drugs or complex situations.

It is important to distinguish between voluntary and involuntary hospitalization. Voluntary hospitalization is carried out with the full consent of the patient. Involuntary hospitalization, on the other hand, is carried out without the patient’s consent, in accordance with defined criteria in the Mental Health Treatment Law, and by order of a district psychiatrist or court order, in cases where the patient is dangerous to themselves or others due to mental illness, or is unable to make informed decisions regarding treatment due to their illness. The criteria for involuntary hospitalization are strict and aim to protect human rights while ensuring the necessary treatment.

How Does the Admission Process to Psychiatric Hospitalization Actually Work?

Understanding the [admission process to psychiatric hospitalization] can ease coping with the situation. This process usually begins in one of several ways: an initiative of you or a family member to a psychiatric hospital or a psychiatric ward in a general hospital, a referral from a treating physician (family doctor, treating psychiatrist), or arrival through emergency services such as MADA or the Israel Police in acute crisis situations.

Upon arrival at the hospital, you will undergo an initial assessment by a medical team, usually in a psychiatric emergency room or a dedicated patient reception office. This assessment includes a conversation with a psychiatrist or on-call psychiatric doctor, the purpose of which is to understand your current mental state, your medical and mental background, and the reasons that led to the referral. During the assessment, the team will ask questions about the symptoms you are experiencing, history of previous treatments, medication use, as well as your functional and social status.

After the initial assessment, a decision will be made whether there is a need for hospitalization. This decision is based on your clinical condition and the criteria established by law. If hospitalization is decided upon, it can be of different types: voluntary hospitalization, which is carried out with your full consent, or involuntary hospitalization, which is carried out without your consent in exceptional cases defined by law, such as in a state of danger to yourself or others due to mental illness, or when you are unable to make an informed decision regarding treatment. Involuntary hospitalization requires an order from a district psychiatrist or a court order.

Upon admission to the ward, you will undergo initial procedures including arranging administrative matters, handing over personal items (there are items that are prohibited in the ward for safety reasons), and an initial acquaintance with the ward environment and the treatment team. The team will explain to you the ward routine, the rules in place, and the treatment team that will accompany you during the hospitalization.

Subsequently, the treatment team will formulate a personal treatment plan tailored to your specific needs. This plan usually includes a combination of drug treatment, individual talks with a psychiatrist, psychologist or social worker, participation in group treatments, occupational therapy, and sometimes additional treatments depending on your condition. The purpose of the plan is to help you cope with the difficulties, stabilize your mental state and acquire tools for future coping.

What are the Rights of a Person Hospitalized in a Psychiatric Ward in Israel?

When you are hospitalized in a psychiatric ward in Israel, it is important that you know your rights enshrined in law and hospital procedures. Knowing these rights allows you to be more active partners in the treatment process and ensure that you receive the best treatment while maintaining your dignity.

First, you have the right to receive full and clear information about your medical and mental condition. The treatment team is required to explain to you the diagnosis, the proposed treatment plan, including the types of drug and psychological treatment, as well as present you with possible treatment alternatives, detailing the advantages and disadvantages of each option, the risks and chances involved.

You have a basic right to knowingly consent to the proposed treatment or refuse it. However, it is important to know that in cases of involuntary hospitalization, the law allows treatment to be given even without your consent, if it is considered necessary to preserve your life or prevent significant danger to you or others. Even in these cases, you have the right to appeal the decision.

Your rights also include the right to appropriate hospitalization conditions and preservation of human dignity. The hospital is required to provide you with a safe, clean and respectful environment. Your privacy and medical confidentiality are required to be carefully maintained.

You have the right to maintain contact with the outside world. You are entitled to receive visitors in accordance with the ward’s procedures, use the telephone and receive and send mail. There may be certain restrictions on this contact, but they must be justified for therapeutic or safety reasons.

In the case of involuntary hospitalization, you have the right to appeal the decision to a district psychiatric committee. This committee examines the necessity of hospitalization and protects your rights. You are also entitled to legal representation, whether on behalf of the legal aid or privately, to protect your rights in these proceedings.

In addition to mental treatment, you have the right to receive appropriate medical treatment for any physical problem that may arise during hospitalization. The hospital staff is required to take care of your general health. Knowing these rights and standing up for them will help you get through the hospitalization experience better.

What Important Steps Should Be Taken After Discharge from Psychiatric Hospitalization and What to Expect in the Recovery Process?

Discharge from psychiatric hospitalization is not the end of the road, but often a significant stage in a long and ongoing recovery process. To ensure a smooth and successful transition back to routine life, it is essential to adhere to a personalized discharge plan, which was formulated together with you and the treatment team during hospitalization. This plan usually includes continued follow-up and treatment in the community, whether in mental health clinics, with private psychiatrists or psychologists.

It is important to understand that the recovery process is gradual and may include ups and downs. You may face various difficulties, including coping with social stigma or challenges in returning to full functioning. Rehabilitation frameworks in the community, such as those included in the rehabilitation basket, can offer important support in this process, and help you gradually return to social and occupational functioning. It is important to set realistic goals, be patient with yourself, and develop effective coping strategies to prevent recurrence of symptoms. Family and social support is of critical importance at this stage.