The recent State Comptroller’s report highlights critical gaps in Israel’s mental health response after October 7. Some findings are valid, particularly regarding long-term public health risks and the need for better data integration. But other conclusions are flawed, based on unrealistic benchmarks that risk spreading fear rather than driving real solutions. Instead of fixating on incomplete statistics, we need to focus on practical reforms that will make a real difference.
High Therapy Dropout Rates: A Misleading Narrative
The report cites high dropout rates in PTSD treatment—23% in National Resilience Centers and 47% in health funds—comparing them to a global average of 18%-19%. But this ignores a fundamental difference: international studies are based on stable environments where trauma has ended. Israel’s reality is entirely different. Therapy is happening while people remain under attack, displaced, and in survival mode. Stability is often necessary for trauma therapy—something many Israelis simply don’t have right now.
Similarly, the claim that “98% did not complete the full 36 therapy sessions” is misleading. The number 36 is not a clinical gold standard; it’s a funding guideline. Some people improve in fewer sessions, while others require different forms of support. Recovery isn’t a box-checking exercise. Instead of fixating on numbers, we should focus on whether people are getting the right care at the right time.
The report also treats all reported symptoms as signs of a long-term crisis. But many people experience distress that resolves naturally. Treating every stress reaction as chronic PTSD risks overwhelming the system and diverting resources away from those who need them most. We must differentiate between temporary distress and long-term conditions.
Delays in Access: Unrealistic Expectations
The report is right to highlight long wait times—up to 6.5 months in early 2024. But it fails to acknowledge that no system could have been fully prepared for the scale of October 7.
Israel suddenly faced mass casualties, 124,000 evacuees, and a country in crisis. The surge in mental health needs exceeded capacity—not due to negligence, but sheer logistical reality.
The report also criticizes reliance on volunteers. But many of these volunteers were trained trauma professionals who stepped in when the government response was slow. The real issue is not their involvement, but the lack of immediate government funding, which left mental health services dependent on philanthropy for months.
Going forward, Israel must improve preparedness: implementing a step-care model, training non-specialists, and establishing a rapid-response mental health reserve.
Data Fragmentation: A Major Weakness
Here, I fully agree with the report. The lack of integration between hospitals, health funds, and mental health centers is a serious issue. Israel is a leader in digital health, yet mental health data remains fragmented. Hospitals treating trauma patients don’t have access to their mental health history, and there is no centralized tracking system for PTSD patients. As a result, people fall through the cracks.
To fix this, Israel must standardize data protocols, strengthen privacy safeguards, upgrade IT infrastructure, and create a national trauma registry. Without these changes, the system will remain reactive rather than proactive.
The Real Crisis: Trauma’s Long-Term Impact
Where the report falls short is in fully addressing trauma’s long-term effects. Untreated trauma isn’t just about PTSD—it increases risks for cardiovascular disease, immune disorders, and even type 2 diabetes. Children exposed to trauma are twice as likely to develop chronic health issues and struggle in school. Adults face higher risks of unemployment, workplace accidents, and domestic violence.
And let’s talk about security. Trauma affects serotonin levels, impacting attention, impulsivity, and aggression—leading to more car accidents, addiction, and violence. If PTSD isn’t properly addressed, we risk long-term societal instability and soldiers unfit for service. This isn’t just a public health issue; it’s a national security issue.
The Report’s Recommendations: Good Intentions, Limited Vision
The recommendations focus heavily on individual therapy and traditional methods. While important, trauma healing must be scalable. Digital solutions, group interventions, and AI-powered screening tools must be part of the strategy.
Israel needs to move beyond outdated models and embrace task-sharing, technology, community-based care, and better coordination between institutions. The real challenge isn’t just the scale of PTSD—it’s the missed opportunity to rethink how care is delivered.
Building a Stronger System—Together
The State Comptroller’s report raises important concerns but also makes misleading comparisons and overlooks critical realities. Israel isn’t failing its trauma survivors—it is struggling under unprecedented conditions. Instead of measuring against peacetime standards, we need trauma care strategies that reflect the realities of war.
That means adapting therapy models, integrating mental health data, expanding community-based care, and leveraging technology to scale solutions.
The question isn’t whether Israel’s response has been perfect—it hasn’t. The real question is whether we will use this moment to build a stronger, more resilient mental health system for the future.
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