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

HOLIT, ISRAEL - NOVEMBER 01: A teddy bear is seen left on the ground near the bomb shelter of a kibbutz home attacked by Hamas on Oct 7th, near the border with Gaza, on November 01, 2023 in Holit, Israel. According to an IDF officer, two grandparents who resided here held the bomb shelter door closed during the attack to protect their grandchildren. All were injured but survived. (Photo by Alexi J. Rosenfeld/Getty Images)

The mental health shockwaves of the events of October 7 are being felt across Israeli society, experts say.Alexi J. Rosenfeld/Getty ImagesCNN — 

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.”

BE'ERI, ISRAEL - NOVEMBER 23: Bullet holes are seen in the decorated window of a kindergarten and nursery school, destroyed during the attack by Hamas at Kibbutz Be'eri on November 23, 2023 in Be-eri, Israel.. On Tuesday night, Israel and Hamas agreed to a four-day pause in fighting that would entail the release of 50 hostages held in Gaza, as well as 150 Palestinian prisoners in Israel. On Thursday, Qatar, who helped broker the truce, announced that it would begin at 7:00 am on Friday the 24th, followed by the release of hostages in the afternoon. According to Israeli authorities, around 240 hostages are being held by Hamas in Gaza after being captured from communities in southern Israel on Oct. 7. (Photo by Christopher Furlong/Getty Images)

Bullet holes are seen in the decorated window of a kindergarten and nursery school destroyed during the attack by Hamas at Kibbutz Be’eri.Christopher Furlong/Getty Images

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.”

An Israeli army soldier stands with an assault rifle hanging across his chest at a position in the upper Galilee region of northern Israel near the border with Lebanon on October 28, 2023 amid increasing cross-border tensions between Hezbollah and Israel as fighting continues in the south with Hamas militants in the Gaza Strip. Since Palestinian militant group Hamas carried out an unprecedented attack on Israel from the Gaza Strip on October 7, Lebanon's southern border has seen tit-for-tat exchanges between Israel and the Iran-backed Hezbollah, a Hamas ally. (Photo by Jalaa MAREY / AFP) (Photo by JALAA MAREY/AFP via Getty Images)

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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.

PETAH TIKVA, ISRAEL - NOVEMBER 24: A man wearing an Israeli flag looks toward ambulances outside the Schneider medical centre, where it is believed some of the released hostages may be brought, on November 24, 2023 in Petah Tikva, Israel. A four-day ceasefire began between Israel and Hamas began this morning, although Israeli forces remain in Gaza. A total of 50 hostages currently held by Hamas are to be released during a four-day truce with Israel, the first such pause in fighting since Oct. 7, when Hamas launched its surprise attack and Israeli responded with a vast military offensive to destroy the militant group that governs Gaza. Under the deal, 150 Palestinian prisoners are also to be released from Israel, and more humanitarian aid will be admitted at the Gaza-Egypt border crossing. (Photo by Erik Marmor/Getty Images)

The release of some of the hostages was closely followed across Israel.Erik Marmor/Getty Images

“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.

NIR OZ, ISRAEL - OCTOBER 19: Israeli soldiers patrol near the Gaza border as the clash between Israeli army and Palestinian factions continues in Nir Oz, Israel on October 19, 2023. (Photo by Mostafa Alkharouf/Anadolu via Getty Images)

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“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, Hamasfilmed 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.”

RAMOT NAFTALI, ISRAEL - OCTOBER 15:  An Israeli soldier hugs a woman near the border with Lebanon on October 15, 2023 in Ramot Naftali, Israel. Israel has sealed off Gaza and launched sustained retaliatory air strikes, which have killed at least 1,400 people with more than 400,000 displaced, after  large-scale attack by Hamas. On October 7, the Palestinian militant group Hamas launched a surprise attack on Israel from Gaza by land, sea, and air, killing over 1,300 people and wounding around 2,800. Israeli soldiers and civilians have also been taken hostage by Hamas and moved into Gaza. The attack prompted a declaration of war by Israeli Prime Minister Benjamin Netanyahu and the announcement of an emergency wartime government.  (Photo by Amir Levy/Getty Images)

The families of those serving in the IDF are also struggling with the mental health impact of the war.Amir Levy/Getty Images

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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