Approximately three million Israelis may suffer from PTSD symptoms, depression, or anxiety in the wake of October 7, State Comptroller Matanyahu Englman said in a report released Tuesday.

“They are not getting the mental healthcare that they need so much. It cannot be that you must wait half a year in line to get treatment from a psychiatrist through the health funds,” he added.

The report is the first in a series of reports by the comptroller on topics relating to October 7 and the Israel-Hamas War and focuses on mental health. These reports will focus on civilian issues because of resistance from the security establishment to a comptroller review, Englman highlighted.
Some 38% of those polled reported at least one symptom of post-traumatic stress disorder, according to the report. Of the 38%, 16% said they have a severe level of this symptom. The poll also showed that 32% of respondents reported signs of depression, and 21% reported anxiety.
Mental health [illustrative] (credit: PIXABAY)
Mental health [illustrative] (credit: PIXABAY)

The mental health crisis in Israel

Some 900,000 Israelis with symptoms of PTSD, anxiety, depression, or some combination of the three will seek mental health treatment in the future, the comptroller estimated, based on the April 2024 poll.

Additionally, the Health Ministry estimated that 340,000 people will require treatment to prevent PTSD with significant impacts on their functioning, the comptroller noted, saying that both of these estimates show that the number of those requiring mental health services could skyrocket.

The vast majority of respondents (90%) reported they have not yet received mental healthcare. Even among those who survived the Hamas attack on southern Israel, the large majority (77%) did not seek help, and among those who were present at the site of rocket impacts, 90% did not seek treatment.
The primary reason for this, according to 38% of respondents, was long wait times. The wait time for treatment from health funds was six and a half months as of April and May 2024, the comptroller noted. This wait time has not shortened in spite of repeated warnings that it is too long and that there is a shortage of manpower providing mental health treatment in Israel, according to the report.
“Delayed treatment in cases that require treatment could lead to mental health symptoms becoming permanent; continued distress; and ongoing, significant harm to social functioning, family relationships, and employment,” the report said. The next most common reason people didn’t seek treatment was that they didn’t know it was available, with 23% naming this reason.
Another reason a significant number of people did not seek treatment was a lack of trust in health fund providers or systems, with some 19% saying they did not trust health fund treatment providers and 17% saying they were worried about information security.
The report also reviewed mental health services for evacuees, highlighting that in spite of emergency plans indicating that an evacuation of civilians might be a security necessity, the Health Ministry did not prepare for this possibility.
In spite of a National Emergency Management Authority assessment that said 300,000 people could be evacuated or leave their homes in case of emergency, “the system was not prepared to provide the necessary mental health treatments following the events of October 7, nor to ensure the continuity of mental health care,” the report highlighted.
“All of these were lacking on the eve of October 7 and, as noted in the report, led to delays in providing treatments and disrupted their management.” The ministry’s plan for emergency scenarios was published in 2001 and was not updated in the 23 years since, the comptroller highlighted.
Just 11% of evacuees from the North and South had received mental health care from health funds and resilience centers in the six months following October 7, the report noted. The report also focused on ZAKA first responders, highlighting that just 13% of ZAKA volunteers got mental health treatment from health maintenance organizations or national resilience centers.
The report stressed that Zaka volunteers are regularly exposed to scenes that could significantly impact their mental health. “The events of October 7 are an extreme and severe example of this,” it noted, saying this puts them at an increased risk of PTSD.
The Health Ministry did not formalize treatment for Zaka volunteers, the report said, but added that it did allocate a series of treatments for Zaka Tel Aviv volunteers and that the National Insurance Institute allocated NIS 1.7 million for their treatment.
“The mental healthcare system, which struggled to function before October 7, collapsed in the first few days of the war,” said Englman. “I alerted the prime minister about failures in mental healthcare treatment in a letter around a month after the outbreak of the war,” he added, saying that all of the flaws have yet to be fully fixed.
“The State of Israel has a moral obligation to treat those whose mental health was injured,” he went on, adding that this is especially true of those harmed in hostilities. “The government and its leader must form a comprehensive, long-term plan for those harmed on October 7 and in the Israel-Hamas War and ensure the necessary budgets for it.”

“The State of Israel has a moral obligation to treat those whose mental health was injured,” he went on, adding that this is especially true of those harmed in hostilities. “The government and its leader must form a comprehensive, long-term plan for those harmed on October 7 and in the Israel-Hamas War and ensure the necessary budgets for it.”

In response to the report, the Health Ministry said, “The position of professional authorities, as presented to the state comptroller, is that the report is not professionally accurate and misinterprets the psychological impacts of the event, leading to incorrect conclusions about the ministry’s actions in this area.”

“Moreover, the report’s conclusions regarding the scope of the population in need of mental health treatment may create a sense of chronic helplessness and harm the resilience of Israeli citizens, making it not only incorrect but also detrimental to the public.”

“The mental health system was already in crisis before the war, and the responses provided since then remain insufficient to meet public needs. However, mental health is a top priority for the Health Ministry and the entire system.”

“We acknowledge that the system is not perfect and that many steps still need to be taken, some within the Ministry’s control and others dependent on other government entities. However, we believe that the approach we are implementing through the National Plan is the right direction, and it is essential to avoid policy determinations that are unfounded and not endorsed by the country’s leading professionals.

“These create a misleading public perception regarding the scope of necessary mental health services, based on a one-time opinion survey at a specific point in time, which is neither a valid nor relevant tool for shaping long-term policy.”

Dr. Itay Gal/Maariv contributed to this report.