One-in-five Israeli adults report severe impairment in daily functioning from psychological distress. A day prior to the three-year anniversary of the Oct. 7 attacks, one of Israel’s largest health care providers, Clalit Health Services, is sounding the alarm about it.
“The problem is that we’re stuck in this one-in-five reality and the numbers don’t go down,” Prof. Ran Balicer, Clalit’s chief innovation officer and deputy director general, said. “And still to this point, one-in-five adult Israelis has a significant struggle in their daily function and has not returned to normal life.” Among the other figures presented: 35% of women ages 18 to 35 reported severe functional impairment; PTSD diagnoses among children and adolescents rose almost 2.5-fold after Oct. 7; and residents of communities near Gaza had PTSD diagnosis rates about 10 times those of the rest of the population.
The findings were presented in a media briefing held with the Israeli Embassy in the United States. Clalit has more than five million patients in Israel, 14 hospitals and over 1,600 community clinics.
Balicer presented findings from a nationwide Clalit-Brookdale study of more than 2,500 respondents using standard measures of depression, anxiety, post-trauma symptoms and daily functioning. In the first round, 34% crossed the survey threshold for depression symptoms. The figure in a previous study was as high as 25%. Anxiety fell from 27% to about 20%, while post-trauma symptoms fell from 30% to about 20%.
“Now talking about symptoms is not enough,” Balicer said. “We should think about the impact on daily lives.”
Prof. Amir Krivoy, director of Clalit’s Geha Mental Health Center in Petah Tikva, said that the number of new PTSD diagnoses from October 2023 through December 2025 were over 30,000 among Clalit members, and could be more than 60,000 nationwide.
Krivoy researched Clalit medical record data to examine diagnosed PTSD. He found that acute stress reactions rose in October and November 2023, but then fell. The rate of new PTSD diagnoses stayed elevated through 2024, 2025 and 2026. Krivoy said that many people who meet the criteria for PTSD have not availed themselves of any mental health treatment. He spent more than a year seeing patients in a community near Gaza that came under attack on Oct. 7. Two years after the attack, he said almost every person he saw there had not received a PTSD diagnosis despite meeting the full criteria for the disorder.
“They were afraid to get out of home. They were avoiding the situation,” Krivoy said.
Clalit has begun contacting patients who may need mental health care but have not requested it. Balicer said the health system contacts about 8,000 patients per week through an electronic outreach program. More than 1,500 had crossed a clinical threshold and received follow-up from a health care provider.
“We said, as Oct. 7 happened, there are so many patients that are silent, but not because they’re not in need, but because they don’t have the strength to get themselves up and request care,” Balicer said. He said that Israel’s mental health system had problems before Oct. 7 and that mental health care did not come under HMO responsibility in Israel until a 2015 reform.
“We said, as October 7th happened, there are so many patients that are silent, but not because they’re not in need, but because they don’t have the strength to get themselves up and request care.” Prof. Ran Balicer, Clalit Health Services chief innovation officer and deputy director general.
“For the mental healthcare system in Israel, this was an acute injury on a chronic problem of lack of resources,” Balicer said. “The system was heavily underbudgeted, saturated, long waiting times, half integrated into the [General Practitioner] clinics and suddenly Oct. 7 hits.” Balicer’s presentation showed that 75% of people seeking private care secured an appointment within a month, compared with 57% seeking public care. Clalit created a round-the-clock call center, where one option was a series of three calls with a social worker. Clalit also retrained primary-care doctors, added digital mental health questionnaires and created a mental health coach role to reduce wait times.
Developmental psychologist Nufar Bar Lipshatz said clinicians have seen sleep problems, nightmares, toileting regression, aggression, separation problems, withdrawal and changes in play among children. “We see them play sirens, we see them play soldiers hiding, running to the shelter,” Bar Lipshatz said. “You can see a kid taking all the animals and running to the shelter as rescue games.” Bar Lipshatz said more children began coming to her unit with stuttering during the war. The unit created group treatment with a speech therapist because a child could wait half a year for one-on-one care.
“Children just can’t wait,” Bar Lipshatz said. “They don’t have the time.” During one group session for children ages 3 to 4 and their parents, Bar Lipshatz and a speech therapist received an early warning on their phones that a siren was expected. Bar Lipshatz said they told the children that a siren was coming and that they would go to the shelter together. “We were not following any treatment protocol,” Bar Lipshatz said. “In many ways we are creating it while living through the situations ourselves because there’s no protocol written about what happens if there’s going to be a missile attack in the middle of the treatment.”
During the siren, Bar Lipshatz said she did yoga and a movement course with the children while the speech therapist worked with the parents. “We said, ‘there’s a siren, there is something happening, but this is how we’re going to deal with it,’” Bar Lipshatz said.
Irit Ben-Aryeh, an administrative manager for Clalit in southern Israel, is the widow of Haim Ben-Aryeh, a school bus driver who transported survivors from the Be’eri area on Oct. 7 to hotels at the Dead Sea that day. Ben-Arye said Haim returned home around 5 a.m. crying and in shock.
“And he had one thing to tell me,” Ben-Aryeh said. “He said, ‘I could not help them.’”
Haim drove south again on Oct. 10. After that trip, Haim stayed home and began watching television and news for long periods, which Ben-Aryeh said was out of character. Haim died by suicide on Oct. 25.
During shiva, Ben-Arye gathered the couple’s eight children and made them promise to ask for help if they were in pain. “We have to tell our story,” Ben-Aryeh said. “We cannot have anybody die of shame. We have to make people understand they need to ask harsh questions sometimes. They need to look around to see if there’s somebody in pain.”
Balicer said Israel will need to keep building mental health care for years. “This is going nowhere in the sense that a very large proportion of the population needs care and needs relief,” Balicer said.
