Israel’s mental health services can’t cope with the mass trauma of October 7. Volunteers are trying to plug the gaps

By Lianne Kolirin, CNN

(CNN) — When Marina Golan traveled to Ukraine earlier this year, it was an emotional experience. Now 42 and a mother of two, she had left the country as a teenager when her family emigrated to Israel.

Golan was part of a delegation of Israeli psychologists who had volunteered to support the war-torn country with their expertise in treating trauma.

While there, they delivered workshops to doctors and teachers on the psychological management of trauma.

“It was very emotional and I felt like we were doing stuff that was very important. Our colleagues in Ukraine didn’t have this kind of knowledge so were very grateful to us,” Golan told CNN in a telephone interview.

Just weeks later, the situation was reversed. “When the (Israel-Hamas) war started I got messages from my colleagues in Ukraine asking if I needed their help now,” said Golan.

Like other mental health professionals, Golan has been working around the clock to deal with the fallout since the surprise attack by Hamas on October 7. As well as having her own private clinic in central Israel, she supports children and their families at two schools.

Shockwaves across the country

“I’ve been involved from the first day,” she said. “We had the first Zoom meeting that Saturday with teachers, and later with parents, to understand what kind of impact it had.”

Together, the therapists and teachers created a map showing the “circles of impact, to understand what we’re dealing with.”

Even though the schools were not located in the south of Israel where the attacks were focused, the shockwaves were strong.

“I have a child in second grade visiting his family on one of the kibbutzim and he saw everything,” said Golan. “Some of the family was killed in front of his eyes.”

Many of the people she sees are struggling with deep questions, she said. “A lot of people are trying to find some logical explanation to understand what happened and connect the dots.”

People are having to get on with their lives to some degree despite the ongoing war with Hamas and uncertainty over the fate of remaining hostages, but it’s still too early to assess the mental health impact, she said.

“It’s still happening and people are only now beginning to ask for mental health support,” she said.

There is a further aspect compounding the anguish, providing a stark contrast with Ukraine, according to Golan.

“Everybody understands what’s happening in Ukraine and they’re taking their side,” she said. “In Israel, we have the feeling we need to convince everybody and make people understand that what’s happening is really happening. If someone doesn’t believe you, it’s like double trauma.”

Dr. Ofrit Shapira-Berman is a psychoanalyst and lecturer at the Hebrew University of Jerusalem’s School of Social Work and Social Welfare.

An expert in trauma therapy, she heads the mental health team of First Line Med, a volunteer organization providing services, equipment and counseling to Israelis affected by the events of October 7.

Up to 500 volunteer psychoanalysts support the families of those killed, injured and taken hostage, she told CNN in a telephone interview.

“The situation isn’t good,” she said. “The mental health situation of everyone is getting worse.

“On October 6, we (the psychoanalysts) all had no hours to give, but on October 8, we all found the hours we didn’t have.

“We treat the survivors of the massacre and bereaved families, and of course those who were kidnapped,” she said.

Shapira-Berman has been supporting some of the hostages released by Hamas during the recent temporary truce.

For ex-hostages, mourning has just begun

“We’re only now beginning to see the deeper effects of the trauma,” she said.

“Almost all of the people who were freed either have a father or a brother still in captivity. They get more and more depressed and afraid of what’s going to happen to their loved ones.

“Others, when they came back to Israel, found out that one of their parents was murdered.

“They’re only now beginning to mourn, so it’s very, very complicated,” she added.

Homelessness is also an issue. “Most of them, because they are kibbutz members, have no home to go to. Everything is ruined and they have to live with their relatives,” said Shapira-Berman, who added that she keeps seeing the same themes coming up.

“The most painful thing I hear from all of them is that they aren’t able to trust humanity anymore.”

Survivor’s guilt is also widespread, she said. “Anyone who hasn’t lost someone feels both blessed and guilty, and the people who survived the massacres feel guilty too.

“I’ve personally treated someone who lost her whole family. She said there are some families from her kibbutz who emerged with three generations and a dog, all alive.

“Her parents and three sisters were all murdered. It’s very difficult for the people who lost everyone. I’ve no idea how she’s going to go on with her whole life.”

In an already overstretched mental health system, help has largely stemmed from grassroots initiatives, according to Shapira-Berman.

“Mental health public agencies couldn’t cope with the amount of people who needed help on October 6,” she said, adding that the average waiting time for therapy before the attacks was 18 months.

Prof. Eva Gilboa-Schechtman is a professor of psychology and head of the Emotional Processing Laboratory at Bar-Ilan University’s Multidisciplinary Brain Research Center.

She told CNN that recent research shows the proportion of people struggling with mental health difficulties has almost doubled since the terror attacks.

“The events of October 7 came at a point that Israeli society was in turmoil, so things were already quite difficult in terms of social cohesion and general mood of the country,” she said in a telephone interview, referring to the months of anti-government demonstrations that preceded the attacks.

She said that as Israel is a small country and military conscription is compulsory, the impact has been far-reaching.

“I live in central Tel Aviv and although I was not personally involved in the events of October 7 I know two people who were kidnapped. Four people from my laboratory are serving in the reserves, as are so many friends of my children or the children of my friends.”

Gilboa-Schechtman believes the unfolding mental health crisis has “several epicenters.”

“There’s one epicenter surrounding the families of the kidnapped, another surrounding the people killed and injured,” she said.

Another focuses on professionals, such as the emergency workers who attended to victims, and cyber experts who have trawled through hours of horrific, Hamas–filmed footage.

“Another circle is families and spouses serving in the army, young mothers with two or three children,” she said. “Then there’s a whole sea of others in less direct contact, and some are responding very intensely to the situation.”

Everyone is impacted, she said, not least because the war is unfolding in our hands, thanks to smartphone technology and social media.

“We are constantly bombarded by information, wanted and unwanted. The levels of exposure are extremely high.

“We’re all watching it on TV, on social media, with our friends, our families, when we go out, when the sirens are going off.”

“It’s almost impossible to switch off, and people have conflicting emotions about switching off. They think ‘I should be watching that because it happened to my friends, colleagues and countrymen.’”

And while civil society has been highly effective in plugging the gaps in government support, “I presume there will be a burn out eventually,” Gilboa-Schechtman said. “It’s not a secret that the country has been overwhelmed by events.”

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