Singer and creator Avi Toledano bravely shared about a week ago in Haaretz that his eldest son suffers from schizophrenia and drew quite a few reactions and shares from other parents that revealed their complex dealings with children and relatives who are experiencing mental difficulties. The wide echo that arose, peeled off another important layer from the shroud of shame that still exists around the issue of mental health in general and the coping of relatives and friends around in particular.
Upon taking office, Health Minister Nitzan Horowitz announced a comprehensive reform he intends to implement in the field of mental health, which will end the long.standing neglect. The budget for next year was recently approved, and as part of it, a rehabilitation program for the mental health system was agreed upon, with an emphasis on alternatives to hospitalization and professional guidance in the home environment. Among other things, as part of Phase A of the program, 400 chronic inpatients will be transferred from mental health hospitals to community settings. In addition, new projects will be launched to establish “balancing homes” and the HMOs will operate crisis teams that will reach the patient’s home.
From the conversations we also had with Avi Toledano and other people who experience for themselves or who accompany those who face difficulties from the entire mental spectrum, the need for a process of changing perceptions in the day.to.day relationship of all of us to the mental difficulties many around us sharpens, along with institutional and budgetary recognition. That involve family and friends in the complex process.
“I received quite a few responses from both private individuals and from an organization that works for the mentally handicapped who wanted me to help them with some issues.” Avi Toledano tells. “There is also a Knesset member who regretted the issue on her banner and she asked to harness me in an effort to put the issue on the agenda.”
What do you think should be the next step?
“It’s important for me to say that I’m not just talking about schizophrenia but about all the mentally handicapped of all kinds as well as battle victims. In general I would not say that this issue is neglected but it is quite marginal. On the one hand people are not so happy to share their feelings and the fact With this challenge in their lives and on the other hand the authorities do not always know how to deal with it.
If you see a straight open wound go to the emergency room, put on a bandage and know how to deal, but with a wound in the mind we are far from knowing how and what. I think the time has come, especially today when people are much more open to sharing, to put the issue at the center in front of the Ministry of Health. ”
Where are the difficulties reflected in your life?
“My son, Eran, has been defined as a schizophrenic since the age of 17, today he is 48. This means that for many years we have been dealing with hospitalizations and transitions between hostels. Our son is an intelligent, sensitive person who plays the guitar. He has a great sense of humor and is balanced. People fall in love with it in a second, but there are quite a few falls, and in such cases do not know how to deal with it.
We need to go to the Ministry of Health committee next week to determine the continuation of Eran’s path. His hostel in Ramat Gan is no longer interested in him, because when he is unbalanced, he is not well and he challenges his environment. It is important for me to say that he has never been violent either to himself or to his environment, but there is a principal there who does not like him so much, and she sent him to a closed ward in Geha. Even there we are told that they cannot hold it too much and are called to take it.
I have 3 more children, ages 12, 18 and 21. How can I deal with all this while? ”
Where is the most important thing to make the change?
“I would like them to really be more tolerant, to understand that these people are in dire straits every day for an hour and need to find resources and frameworks to deal with it in the best way possible. We are in the 21st century. A person cannot be neglected just because he is mentally injured. These are people in part who have given and sacrificed their lives to fight and protect us, and today they need us much more than they receive.
There are quite a few mentally ill who simply to survive, had to adapt to all sorts of tricks to get on with their lives. Such as suicide threats, which are usually a false alarm and an expression of a cry of deep pain. But hostel caregivers do not always know what and how to deal with such extreme situations. ”
As stated, as part of the new budget of the Ministry of Health, a rehabilitation plan for the mental health system was agreed upon, including the transfer of budgets to alternative inpatient settings, which do not require hospitalization in a closed ward. “It should be a top priority for decision makers.” Toledano emphasizes. “Unfortunately there are so many illnesses and difficult struggles, but to live with it within family and friends, to see a young person whose whole life goes parsh only because he does not get the right treatment for him it just hurts and to continue to ignore it is inhuman.”
Behind every label there is a soul
In recent years, one can see various projects that reveal another tap on the inner world of mental contenders. In their mind, a fascinating network series of ‘here’ that came out last year, brought to the screen 6 short episodes of 6 men and women, who are diagnosed with various disorders, including schizophrenia and depression. Placing them at the center is another important expression of the “normativeness” of those who are usually on the margins.
Here you can go crazy
Itai Ziv, 39, came out of the mental closet, after dealing with a psychotic attack in mid.life or as he calls it a “spiritual emergency” (Spiritual Emergence). His awakening that began at age 32 led to forced hospitalization and a painful encounter with traumas he repressed from his days of military service as a combat officer. About a year ago he published a book called ‘Writing Myself to Know’ in which he describes the difficult process he went through, which included a lengthy two.year rehabilitation process, during which he began to study and deal with the whole issue of community hospitalization alternatives.
After the rehabilitation period he began to accompany others in various settings for the mentally handicapped and there the understanding permeated the concealment that is common to all. “At this point I started messing with the whole issue of coming out of the mental closet.” Tell me. “I started a Facebook group called ‘You Can Go Crazy’ where people told and shared their personal exit stories. Later I also published my book, since I get a lot of stories from others and that’s how the idea of another book started to roll out.”
The new project led by Ziv, is a collection of crisis and coping stories of 12 people who chose to come out of the mental closet and share their coping. Funding for the book was raised in the Dastart campaign, which was supported by 500 people, and will be published in about two months. From these stories, a picture emerges of a lack of knowledge and tools to deal with mental crises. This lack of knowledge stems, among other things, from the same sense of shame that accompanies the delicate mental states, which leaves the knowledge on the subject in the hands of professional therapists only. Professional care is not accessible to the majority of the population because it is not adequately subsidized by the HMOs and the state. The possibility of reaching preventive psychiatric treatment is the domain of those with only financial means, thus creating a situation where a person’s first encounter with the mental health system is only when the situation is already very acute and requires aggressive intervention, which can often produce more trauma, as in involuntary hospitalization.
One of the stories in Ziv’s new book is by Lila Hefer, who today is a social worker who promotes the open dialogue approach in Israel. This approach has developed in Finland and its main focus is on the patient’s home care, even in the most acute situations, while involving the family and community in care. According to her, there is considerable evidence that this approach yields results that are much better than the results of the regular system, but in order to promote it, more budgets and a broader change of perception are needed.
As someone who has been exposed to so many personal stories, what do you think should be focused on to produce change?
“There is the crisis itself and above all the difficulty there is another layer of shame that produces a crisis in itself. To produce change requires a profound change of perception, if everyone talks to his immediate circle he will find that he is not the only one. The wound.If we were proud of it we could get support from family and friends and avoid unnecessary hospitalization which could be a trauma in itself.
In addition there is also the economic aspect, a day hospitalization is an expensive thing and if there was preventative medicine that includes subsidy for people experiencing crisis before they come to hospital we would also save it. There are few subsidized mental health treatments, and most people cannot afford long.term psychological treatment. ”
“The family is also thirsty for information and guidance”
According to Enosh, the Israeli Association for Mental Health, 1 in 4 people in Israel experience a mental crisis. “Mental health is the story of us all,” says Dr. Hela Hadas, the association’s executive director. “In Israel live 250,000 soul contestants, with hundreds of thousands of family members, from the first circle who need help – almost a million people surround the soul contestants, and live with the guilt, shame and prejudice that surrounds the families, along with the mental burden involved in caring for soul contestants. “And only a few dare to break through the walls of shame and discover that the path to recovery begins with the recognition and participation of the immediate community. Therefore, Avi Toledano’s choice to share is a brave and important step, and the more people break through the walls of shame, the less social exclusion can be reduced.”
Dealing with a mental crisis in the family is a shaky experience, involving pain, confusion and helplessness not only of the mental contenders but of the whole family. “It is no secret that people with mental disabilities suffer from severe social exclusion and often prefer to give up treatment than identify and admit that they belong to this group. No less difficult is the feeling and recognition among family members. “Adult children of struggling parents are forced to see their loved one in mental distress and sometimes, in their sense, have no savior. They too are thirsty for information, need help, professional tools, guidance and especially a covered ear, for someone to listen to them and their distress, near warm, soothing and caressing.”
Mental support for families as well
“We are surprised to discover how little the family members know about the rights they and their loved ones deserve, and make efforts to help them deal with the crisis, deal with state institutions, support groups and individual counseling.” “Dr. Hadas says that on October 20.21, we will hold the association’s annual family conference in order to allow family members a respite and acquaintance with family members who are dealing with similar situations.”
Enosh currently operates more than 70 service centers for contestants and counseling and assistance centers for family members throughout the country. In order to support the families of the contestants, Enosh established the Milam – Counseling Center for Contestant Families, supervised and funded by the Ministry of Health, which operates in 12 centers and branches throughout the country, and provides emotional support and assistance in exercising rights for the contestants’ families. And without the need for the candidate’s recognition of Social Security or a rehabilitation basket.