Negative attitudes towards patients with borderline personality disorder (BPD) may affect their treatment. We aimed to identify attitudes toward patients with BPD. Clinicians in four psychiatric hospitals in Israel (n = 710; psychiatrists, psychologists, social workers and nurses) were approached and completed questionnaires on attitudes toward these patients. Nurses and psychiatrists reported encountering a higher number of patients with BPD during the last month, and exhibited more negative attitudes and less empathy toward these patients than the other two professions. The whole sample evaluated the decision to hospitalize such a patient as less justified than the decision to hospitalize a patient with Major Depressive Disorder. Negative attitudes were positively correlated with caring for greater numbers of patients with BPD in the past month and in the past 12 months. Nurses expressed the highest interest in studying short-term methods for treating patients with BPD and a lower percentage of psychiatrists expressed an interest in improving their professional skills in treating these patients. The findings show that nurses and psychiatrists differ from the other professions in their experience and attitudes toward patients with BPD. We conclude that nurses and psychiatrists may be the target of future studies on their attitudes toward provocative behavioral patterns (e.g., suicide attempts) characterizing these patients. We also recommend implementing workshops for improving staff attitudes toward patients with BPD.

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The attitudes of psychiatric hospital staff toward hospitalization and treatment of patients with borderline personality disorder.

Staff attitudes toward patients with borderline personality disorder

In Israel, approximately one-third of the country’s nurses work in community settings – primarily as salaried employees in Israel’s four non-profit health plans. Many health system leaders believe that the roles of health plan nurses have changed significantly in recent years due to a mix of universal developments (such as population aging and academization of the profession) and Israel-specific changes (such as the introduction of extensive quality monitoring in primary care). The main objectives of the study were to identify recent changes in the roles of health plan nurses and their current areas of activity. It also explored the experience of front-line nurses with regard to autonomy, work satisfaction, and barriers to further role development. The study integrated interviews and surveys of nurses and other professionals conducted across 4 years. Data generated from earlier study components were used to guide questions and focus for later components. In 2013, in-depth interviews were held with 55 senior nursing and medical professionals supplemented by interviews in mid-2017 with the head nurses in the four health plans. In addition, a national survey was conducted in 2014–5 among a representative sample of 1019 community nurses who work for the health plans and who are engaged in direct patient care. Six hundred ninety-two nurses responded to the survey, yielding a response rate of 69%. The survey sample consisted of an equal number of nurses from each health plan, and the observations were weighted accordingly. Senior professionals identified general themes associated with a shift in nursing roles, including a transition from reactive to initiated work, increased specialization, and a shifting of tasks from hospitals to community settings. They identified the current main areas of activity in the health plans as being: routine care, chronic care, health promotion, quality monitoring and improvement, specialized care (such as wound care), and home care. In the survey of front-line nurses, 38% of the nurses identified “caring for chronically ill patients” as their main area of activity aside from routine care; 30% did so regarding “health promotion”, and 26% did so regarding “a specific area of specialization” e.g., diabetes, wound care or women’s health). In response to a separate question, 77% reported “great” or “very great” involvement in quality measurement programs. Four out of five front-line nurses were satisfied with their work to a great or very great extent, and approximately three out of four of them (73%) felt that they had autonomy at work to a great or very great extent. About half of the nurses take into account, to a great or very great extent, the financial concerns of the health plans that employ them. A large majority of the nurses (85%) indicated that the nature of their work had changed substantially in recent years, with an increase in autonomy noted as one of the key changes. Perceived barriers to further role development include attitudes on the part of some physicians and nurses, an insufficient number of dedicated nursing positions, and insufficiently attractive wage levels. The findings, gathered over 4 years, indicate alignment between universal and Israel-specific trends in health care and the evolving roles of nurses in Israel’s health plans. The findings provide support for ongoing efforts in the health plans to give nurses more authority and responsibility in the management of chronically ill patients, a more central role in health promotion efforts, more advanced training - both inter-professional and nurse-specific, and more opportunity to focus on the roles and tasks that require nursing professionals.

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The changing roles of community nurses: the case of health plan nurses in Israel.

In Western societies abnormal behaviour is permitted and encouraged on specific occasions, such as Carnival and Halloween. However, in many parts in the world people are possessed by supernatural forces that speak through them, or have dreams and hallucinations that convey important messages to the community, including health perceptions and behaviours. What is an acceptable conduct for African immigrants in a Western community such as Israel and how is this interpreted?To illustrate the cultural component in mental health care and link this to mental health prevalence and patterns of mental disease, two patients who immigrated from Ethiopia are presented: (1) a young woman who tried to commit suicide, and who, on arrival at the hospital informed the physician that her situation was the result of possession by an evil spirit, the ‘Zar’; (2) a 19-year-old student, who was brought by his older brother to the primary physician due to ‘sensations in his head’.This article also presents unique causes a...

Transcultural mental health care issues of Ethiopian immigration to Israel

In Canada, there is an ongoing debate about whether to expand Medicare to include a national pharmaceutical benefit on a universal basis. The potential health benefits are understood to be significant, but there are ongoing concerns about affordability. In Israel, the National Health Insurance benefits package includes a comprehensive pharmaceutical benefit. Nonetheless, per capita pharmaceutical spending is well below that of Canada and the Organization for Economic Co-operation and Development average. This paper highlights seven strategies that Israel has employed to constrain pharmaceutical spending: (1) prioritizing new technologies, subject to a global budget constraint; (2) using regulations and market power to secure fair and reasonable prices; (3) establishing an efficient pharmaceutical distribution system; (4) promoting effective prescribing behavior; (5) avoiding artificial inflation of consumer demand; (6) striking an appropriate balance between respect for IP rights, access and cost containment; and (7) developing a shared societal understanding about the value and limits of pharmaceutical spending. Some of these strategies are already in place in some parts of Canada. Others could be introduced into Canada, and might contribute to the affordability of a national pharmaceutical benefit, but substantial adaptation would be needed. For example, in Israel the health maintenance organizations (HMOs) play a central role in promoting effective prescribing behavior, whereas in HMO-free Canada other mechanisms are needed to advance this important goal.

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Expanding Canadian Medicare to include a national pharmaceutical benefit while controlling expenditures: possible lessons from Israel.

Background At present, Israel's mental health system functions separately from its physical health system in terms of financing, planning, organization and practice setting. The government is responsible for the provision of mental health care, while the country's four, competing, non-profit health plans are responsible for physical health care. A reform effort is underway to transfer legal responsibility for the provision of mental health care from the government to the health plans. Aims The main objectives of this paper are to summarize the key components of the reform, its objectives, and the concerns that it has raised. The paper also seeks to foster interactions between experts from Israel and other countries about the Israeli reform. Methods The analysis is based on official government documents, the scholarly literature about the Israeli reform and the relevant international literature about mental health care in other countries, participation in key public meetings related to the reform, discussions with leaders of the reform effort, and discussions with leading mental health experts in other countries. Results Two elements of the reform--the application of managed care principles to mental health and the integration of mental and physical care--are shown to be central both to the reform's objectives and to the concerns that have been raised about the reform. Discussion These same two elements are relevant to many countries implementing or considering reforms in their mental health systems. Conclusions The architects of the Israeli reform could learn a great deal from the experience with mental health care and related reforms in other countries. At the same time, the Israeli reform could offer important insights and lessons for other countries. Implications for policy The Government of Israel should work with the international mental health care professional community to create frameworks that would facilitate cross-national learning. Implications for further research It will be important to monitor the implementation of the reform and evaluate its impact, in order to assess the extent to which the objectives are met and the extent to which the concerns materialize. Cross-national research collaborations could be very helpful.

The Israeli mental health insurance reform--perspectives.

Background: At present, Israel’s mental health system functions separately from its physical health system in terms of financing, planning, organization and practice setting. The government is responsible for the provision of mental health care, while the country’s four, competing, non-profit health plans are responsible for physical health care. A reform effort is underway to transfer legal responsibility for the provision of mental health care from the government to the health plans. Aims: The main objectives of this paper are to summarize the key components of the reform, its objectives, and the concerns that it has raised. The paper also seeks to foster interactions between experts from Israel and other countries about the Israeli reform. Methods: The analysis is based on official government documents, the scholarly literature about the Israeli reform and the relevant international literature about mental health care in other countries, participation in key public meetings related to the reform, discussions with leaders of the reform effort, and discussions with leading mental health experts in other countries. Results: Two elements of the reform - the application of managed care principles to mental health and the integration of mental and physical care – are shown to be central both to the reform’s objectives and to the concerns that have been raised about the reform. Discussion: These same two elements are relevant to many countries implementing or considering reforms in their mental health systems. Conclusions: The architects of the Israeli reform could learn a great deal from the experience with mental health care and related reforms in other countries. At the same time, the Israeli reform could offer important insights and lessons for other countries. Implications for Policy: The Government of Israel should work with the international mental health care professional community to create frameworks that would facilitate cross-national learning. Implications for Further Research: It will be important to monitor the implementation of the reform and evaluate its impact, in order to assess the extent to which the objectives are met and the extent to which the concerns materialize. Cross-national research collaborations could be very helpful.

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Shuli Bramali

Papers

The Israeli mental health insurance reform--perspectives.

PERSPECTIVES The Israeli Mental Health Insurance Reform