Mental health begins at home

There’s something wrong with a system that sends emotionally disturbed children to psychiatric hospitals. Philip Veerman is coordinator of the Israel Section of Defense for Children International. Yair Ronnen is an attorney representing children in the juvenile courts for Defense for Children International – Israel Section.
AN Israeli juvenile court judge was recently requested to place an adolescent girl with anorexia nervosa in a psychiatric hospital. The judge believed that she had no discretion to do so. Others disagreed.
Are there no better alternatives for such a girl than the possibility of death or the stigma of psychiatric hospitalization?

The UN Convention on the Rights of the Child, ratified by Israel and 125 other countries, obliges those countries to provide children with “the highest attainable standard of health.”
Cases like the girl with anorexia nervosa have led to a debate on the desirability of psychiatric hospitalization. It is being carried on in the media, in legal and mental health professional circles and in a Knesset subcommittee.
It is widely agreed that even in cases where hospitalization is initially justified, it often continues needlessly, owing to a lack of adequate alternative facilities. Not only do minors often pay for our inability to solve their problems; we pay a heavy price too.

Hospital beds cost a lot more than community mental health care, and when minors reach the hospitals, their situation has usually deteriorated so much as to make lengthy, expensive treatment necessary. Family therapists stress that early family intervention can be effective in treating syndromes like anorexia nervosa.

To date, the debate has focused on the desirability of psychiatric hospitalization and the procedures involved. But it misses the most important point. While, fortunately, there seems to be no lack of psychiatric beds for children, there is a severe lack of treatment facilities outside hospital for emotionally disturbed children. Placement facilities are not well developed, and there is little implementation of the principle that prevention should be the cornerstone of child mental health policy.

This country has an estimated 7,000 children up to 14 years of age in residential care, and about 12,000 to 15,000 teenagers in residential care in the Youth Aliya network. But there is a severe lack of treatment facilities for children who are emotionally disturbed.

We are in urgent need of an overall supervisory body embracing the ministries of Labor and Social Affairs, Health and Education, where local welfare authorities can get information about facilities for children with emotional problems.
THE UN Convention on the Rights of the Child tells us that the signatory state “shall respect the rights of the child who is separated from one or both parents to maintain personal relations and direct contact with both parents.”
Currently, children from Ashkelon are placed in Karmiel, and there is no consistent policy to keep children in the vicinity of their families and communities or to maintain all the necessary facilities in those communities.
The UN Convention recognizes the child’s right to be placed in care, protection or a treatment facility, and to have the placement periodically reviewed.

The way things are now, children often stay in a residential facility for many years without regular review; no ministry inspectors require that children’s homes and psychiatric hospitals implement this article of the convention.
The convention also recognizes that children “should grow up in a family environment.” And yet organizations like Orr Shalom, which are treatment homes based on the family model, do not get enough government support.
The “highest attainable standard of health” presumes a right to preventive services. Israel has no lack of models for such services, but there is no policy to give them a push.

In Haifa, the Yehidat Shlom Hayeled project tries to rehabilitate families who have abused children. The Orion project tries to improve positive interaction in families. The Yahdav project supports young mothers with serious problems, who have small children. The Shiluv organization in Jerusalem provides family therapy and also reaches disadvantaged families.

Since those in this last category cannot afford treatment and the national and local government do not offer enough financial support, Shiluv is struggling to survive.
Organizations like these, given the financial means, could prevent the escalation of emotional harm to children, which will likely result in more expensive psychiatric hospitalization.

What we need, therefore, is not only a change in the legal criteria of psychiatric hospitalization, but vision, reorganization and coordination so that emotionally disturbed children can obtain adequate services while remaining within their families and communities.

Jerusalem Post – Jerusalem
Date: Jun 9, 1993

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