A comparison of the mental health systems of New York State and Israel.

The article compares characteristics of the residential and non-residential mental health services in Israel and in New York State and considers their influences on extent of service utilization. The data is based on special surveys covering all patients seen in public mental health services in New York State and in Israel during one week in 1986. The results indicate similar overall residential prevalence rates in both systems (1.9 per 1,000 population). Israeli males aged 45-64 show much higher residential prevalence rates than males of this group in NYS. The Israeli non-residential rates are much lower, 3.5 per 1,000 as compared to 5.5 in NYS. These differences are seen in both sexes and across all age groups. Overall diagnostic distributions show a greater percentage of patients with major affective disorder in NYS and a somewhat greater percentage of patients with the diagnosis of schizophrenia in Israel. Three Service Dependency Levels (SDL) are defined and their distribution by loci of care are presented. A greater proportion of patients belong to the highest SDL (1) in Israel as compared to NYS. Both in New York State and in Israel, the development of public mental health services is generally oriented to a preference for the non-residential, community treatment model over the residential, institutional model. However, Israel is less advanced than New York in developing its non-residential psychiatric services, as reflected by the relative low rate of psychiatric referrals to community facilities and clinics. Analysis and explanation of these survey differences are presented.