Work practices and the provision of mental-health care on the verge of reform: a national survey of Israeli psychiatrists and psychologists

BACKGROUND The State of Israel is preparing to transfer legal responsibility for mental- health care from the government to the country's four competing, nonprofit health-plans. A prominent feature of this reform is the introduction of managed care into the mental-health system. This change will likely affect the service delivery patterns and care practices of professional caregivers in mental-health services. The study examines psychiatrists' and psychologists' patterns of service delivery and practice, and their attitudes toward the reform's expected effects, focusing on the following questions: To what extent do today's patterns of service delivery suit a managed-care environment? To what extent do professionals expect the reform to change their work? And do psychiatrists and psychologists differ on these questions? METHODS A survey of 1,030 psychiatrists and psychologists using a closed mail questionnaire for self-completion was conducted from December 2011 to May 2012. RESULTS Substantial differences were found between psychiatrists' and psychologists' personal and professional characteristics, work patterns, and treatment-provision characteristics. In addition, the study identified gaps between the treatment-provision characteristics of some of the professionals, mostly psychologists, and the demands of a managed-care environment. Moreover, a high percentage of the mental-health professionals (mostly psychologists) do not expect improvement in the quality of care or its accessibility and availability following the reform. However, those reporting practices associated with managed care (e.g. short-term treatment, compliance with monitoring procedures, and emphasis on evidence-based treatment) are less likely to expect negative changes in the provision and quality of care after the reform. CONCLUSIONS Steps need to be taken to reduce the gaps between the treatment-provision characteristics of the professionals and the demands of a managed-care environment, and there are several possible ways to do so. In order to recruit experienced, skilled professionals, the health plans should consider enabling various work models and offering training focused on the demands of working in a managed-care environment. It is advisable to implement this kind of training also during the training and specialization process by including these topics in the professional curricula.