One psychologist per thousand students: The mental health crisis hitting schools

"Every day, educational psychologists have to make Solomon-like judgments: who to treat and who not to, what is urgent and what is not. There is essentially no possibility to provide responses to the needs," claims Yonat Bornstein, chair of the Israel Psychologists Association and representative of the Forum of Organizations for Public Psychology. "The shortage of psychological responses for kindergarten children and school students has existed for years, even before the pandemic, and it has worsened significantly following the years of war. The circles of vulnerability are very wide, the psychological needs have doubled and even more, and there are not enough psychologists to provide these responses."

Bornstein, who until recently was a director of a psychological-educational service, says that mental assistance is currently required much more by young people, families, educational staff, and in fact, the entire community. "The circles of vulnerability are very wide, and there is almost no child who does not express signs of distress as a result of the war," she says. "The gaps between the rising needs and the system's ability to provide an available professional response are widening. For every patient, child or adult, who waits for treatment for a long period, the situation will worsen due to the waiting, as all studies show. This is also the case for adults, but among children, developmental processes in all areas may also be harmed."

Many are left behind. Bornstein explains how we reached this severe situation: "The Ministry of Education set a standard for a psychologist's position over 30 years ago. According to this standard, there is one psychologist for every thousand students in regular schools. In special education, there is one psychologist for 500 children, and the same in kindergartens. This means that even in places where the standard is fully staffed, the distress is immense."

However, the problem is not only in the limited staffing, but also in covering the existing positions of educational psychologists. "Before the war, the coverage was only 70% on a national average," she describes. "This is not happening because there is a shortage of psychologists in the country, but because the earnings in the public system are so low that people leave the system to make a living. About a year ago, after years of struggle, a new salary agreement was signed with the psychologists that slightly improved the situation, but there is still not enough return of psychologists to the system. A psychologist who works all day with such severe distress has great burnout. Psychologists are available 24/7, and with the pressure, the load, the demands, the frustrations — it is very difficult. Educational psychologists also provide responses to educational staff and parents. A situation of insufficiency is created, and there are many casualties along the way."

What is the solution? "More positions, returning psychologists to the public service, and increasing positions. Educational psychologists are considered employees of local authorities. The Ministry of Education provides two-thirds of their salary, and the authority must fund one-third. In the new salary agreement we achieved, there is compensation for increasing positions and for returning to the system. There are local authorities that understand the need, and there are also authorities that do not want to add positions. The authority can say 'leave me alone, my priorities are different.' If the teams were increased, every child in the country could receive free, available, and immediate service. We have studies that show how treatment that is delayed will eventually cost the system much more money. Another matter, a very outdated director-general circular determines that the psychological service provides its services from compulsory kindergarten until the end of middle school. A situation is created where pre-compulsory kindergartens and high schools are not covered."

And what happens when a high school student needs a psychologist? "There are heads of authorities who decide to give the high school another half-position at the expense of the municipality. And if they don't give it, that teenager will wait in line at the health bureau, will be referred to the mental health station, where waiting lists are between half a year to a year. It's terrible. Whoever can afford it pays for a private psychologist, but there are also queues in private clinics."

"Already during the pandemic, we saw a worsening in the mental state of the students, and the role of the counselor became much larger and more challenging," says Dr. Ella Sarel-Mahalev, chair of the Association of Educational Counselors. "At that time, we identified that there is a problem in the ratio between the number of counselors and the number of students. The war we have gone through in recent years is more acute than the pandemic."

Sarel-Mahalev, a senior lecturer at the Faculty of Human and Social Sciences at the College of Management, describes the current situation in the education system: "There is one educational counselor for one hundred kindergartens. In elementary and middle school, there is no fixed standard for a counselor; it is determined by the director's discretion. Usually, directors put counselors in a full-time position in an elementary school — usually one counselor who can dedicate on average two weekly hours to a class of about 40 students. These hours also include all the responses for the student's envelope — the teachers, the parents, welfare, mental health. That is, the child actually sees her perhaps ten minutes a week. This is, of course, too little."

What is the situation in middle school? "There too, the standard is determined by the director's discretion. The average is 1.7 hours per class per week. In middle school, the situation is even more difficult than in elementary: the organizational structure changes, there is high turnover of teachers, the student's ability to receive support decreases. Also, adolescence is a problematic age. In middle school, there is a need for the most counselors."

In high school, Sarel-Mahalev notes, the average standard in practice is identical to that which exists in middle school. "This covers the minimum required, but does not provide an emotional response to the teenagers," she clarifies. "What can you give in this time to a class? For example, in 12th grade, towards the recruitment, and even in a time of war, students need more. In high schools, there are also graduates who were killed, their brothers and sisters study at the school, the teachers themselves deal with the situation, and the counselors need to provide responses. The counselors have the knowledge and tools, but they don't have the hours."

The counselors, she emphasizes, "are the natural response for children because they are part of the daily staff at the school. They have appropriate intervention tools and a flexible and comfortable space for action to provide a response to all students, even those who refuse to go to treatment, or who are on a waiting list for treatment, which lasts on average between half a year to a year."

How can this situation be improved? "We are asking for one full-time counselor for 50 kindergartens, not a hundred, as it is today. We also ask for a standard of three and a half hours per week per class in elementary and high school, and four hours in middle school. This is the minimum required, not the ideal situation. At the end of the month, towards the beginning of the school year, a discussion will be held in the Knesset Education Committee on the need to increase mental responses for students within schools. We hope, for the sake of Israel's children, that in light of the situation, there will be an understanding of the importance of the matter."

"All of Israel's students today need some kind of mental response from clinical and therapeutic professionals because of the emergency situation and because of the collective trauma we are in," rules Dr. Ilana Lach, chair of the Association for Arts Therapies in Israel.

Lach, a visual arts therapist and analyst, describes the current situation in her field: "Arts therapy is regulated by the special education law to meet the mental needs of the students. Children in special education are entitled to therapeutic hours. It is not enough, but it exists. Also in integrated classes in regular schools, there are arts therapists for special education children. We are talking about 5,000 professionals, clinical therapists, with a master's degree, who are employed by the Special Education Division of the Ministry of Education."

And what happens in regular education? "In regular education, there are no positions for these therapists. There is a demand for them, but the system does not introduce them in an organized manner, but through all sorts of external programs, such as 'Program 360', which is part of the psychological-educational service. Arts therapists can provide responses of various kinds — individual, group, and also community. We need to add positions and funding. After October 7, staff work began in the Ministry of Education in favor of the move, but it got stuck."

Lach claims that introducing arts therapists into regular schools in an organized manner can greatly help students: "There are projects that are currently working on the basis of donations, such as the open studio in the Upper Galilee Regional Council, and there are schools that have chosen this project because they have a budget. In today's situation, students need a response where they can connect to their strengths and express in a creative way what is happening inside them. Arts therapy provides an answer to traumas that are trapped in the body."