“Resilience” has long been the goal of Israeli mental health practitioners, an emotional ruggedness allowing Israeli society to bounce back quickly after tragedy. 

This has been particularly the case since the Oct. 7 terror attacks and the resulting wars that continue to claim the lives of soldiers and civilians, including the recent 12-day conflict with Iran, which killed 28 Israeli civilians and displaced thousands. The night after a ceasefire was declared, Israelis were seen back at the beach, and the following morning, schools reopened. 

However, mental health professionals warn that beneath this celebrated toughness lie deeper, troubling emotions — fear, guilt, shame, vulnerability, anger and anxiety — affecting all layers of society. 

Mental health hotlines and clinics run by three of Israel’s top providers — ERAN, NATAL and ELEM, the latter of which supports at-risk youth — have reported sharp increases in demand since Oct. 7, 2023. Calls to ELEM’s digital programs have tripled; NATAL now treats over 3,000 people weekly, up from 350 before the war; and ERAN volunteers have handled over 500,000 calls since the outbreak of the war, averaging 1,200 to 1,500 a day.

This surge reflects the complex emotional and psychological issues people are facing now, Bar-Ilan University professor Rivka Tuval-Mashiach, steering committee chair of NATAL, told eJewishPhilanthropy, with call volumes related to anxiety issues significantly increasing to both of NATAL’s two dedicated hotlines — one for the general public and one for soldiers and veterans.

One recent study in the Israel Journal of Health Policy Research warned of the need for a “comprehensive system-wide transformation” of the mental health system before Israel is hit by an “oncoming tsunami of war-related psychiatric illness.” The Jerusalem-based Taub Center social policy think tank similarly warned last year of an impending mental health crisis and an urgent need to strengthen the country’s psycho-social infrastructure, which it said has been significantly neglected in recent years.

And these dire studies came even after the Israeli government allocated an additional $416 million over two years to improve mental health services in Israel, aiming to address shortages of professionals, improve psychiatric hospitals and enhance community care programs.

Dr. Eyal Fruchter, a leading figure in the Israeli psychotrauma field, told eJP that while resilience is valuable, it has not necessarily fostered a more compassionate society capable of supporting those grappling with emotional trauma.

After the Oct. 7 attacks, Fruchter left his role as CEO of the Maale HaCarmel Mental Health Hospital in northern Israel to rejoin the Israel Defense Forces as head of its mental health department. He completed a 2 1/2-month stint of reserve duty with a deep sense of concern for the mental health of both soldiers and the nation, he told eJP.

“I understood that it [would be] such a vast trauma that we would suffer, that we needed to make sure that they’re getting the right things, and it’s not just treatment,” said Fruchter, who last year co-founded Israel’s Collective Action for Resilience (ICAR) with Gila Tolub, Lisa Silverman and Roy Peled with the aim of creating greater societal awareness and community support for understanding trauma and its effects.

After five difficult years in Israel, starting with the COVID-19 pandemic, Fruchter believes ICAR’s community-driven model is key to addressing both individual and collective trauma.

ICAR brings together experts in medicine, psychology, public health, philanthropy and investment to promote a holistic, collaborative approach to trauma healing — mapping the mental health landscape, building partnerships, gathering knowledge and directing strategic investments.

ICAR will soon launch a public campaign to raise awareness about the psychological impact of conflict and encourage communal support for those affected, he said. The initiative is being led in collaboration with government ministries and key partners, including Hebrew University, Columbia University, Enosh, Jewish Federations of North America, Jewish United Fund of Chicago and the Jewish Federation of Greater Philadelphia.

“Everybody is working with us and everybody is joining in, and we’ll go with a very big, broad campaign hopefully to change the concept and understanding that we need to do more work on the healthy side [of trauma] and less on the illness side,” said Fruchter. Labeling someone as “ill” with trauma is a straight route to medication, he said, and ICAR proposes community-action options first, such as neighborhood events and in-person visits to foster a sense of togetherness.

He also noted a growing awareness of “moral injury,” a concept similar to but distinct from post-traumatic stress disorder, where individuals, for instance, feel betrayed by their leaders or the state. This is particularly relevant in military or other high-stress contexts. This sense of betrayal can trigger profound anger and shame, further complicating the psychological landscape, he said.

“You can see that deep break has changed a lot of the ways that we conceive things and how we trust things. But we need to live with that. It is less about [being a] resilient society, which is strong and rigid, but [rather] understanding that the resilience does not come from rigidness and [strength]. It comes from calmness and from patience and from smiling sometimes and from good words,” said Fruchter. “It’s a different aspect of resilience. Whenever I talk about trauma, I say that trauma is a balancing scale between the resiliency factors and the needs of the trauma.”

Despite widespread resilience, rising anxiety — especially among the elderly and children — is a growing concern, according to Tuval-Mashiach from NATAL. In response, her organization has expanded in-person and online support, offers webinars for families and increased its therapist network from 100 to over 400, with ongoing trauma training.

NATAL is prepared to serve millions if needed, she said, but prolonged war leaves lasting scars, with ongoing conflict causing intergenerational trauma and a societal “short fuse,” seen in rising public violence and declining tolerance for differing views.

Previous studies have predicted that between 10-18% of the Israeli population will exhibit signs of PTSD, she noted.

“If we have 15% of people who are going to be coping with PTSD, that’s a huge price. It’s a huge price financially, it’s a huge price socially, it’s a huge price in whatever way you want to think about it. But that’s NATAL’s mission, and that’s what we do,” she said.

Nevertheless, she said, on an individual level, while Israelis may be facing more mental health issues, studies have also shown that Israeli society as a whole will continue to cope well, she said.

“There’s a lot of research that shows that Israelis are resilient, we cope quite well… but there’s also burnout. The majority of Israelis are tired,” she said. “So we are more violent on the streets. We are less tolerant of different political views. I think it affects the way that we can tolerate differences. But this is more of a sociological, cultural thing than of a medical, psychological diagnosis.”

Children and youth in distress also present their own special needs, said Eran Zimrin, president of ELI, the Israel Association for Child Protection. The increased stress in society and within families also puts children more at risk of being neglected and abused, and over the last year ELI has been training therapists who do not usually work with trauma but are now having to deal with those issues. “A child’s life is determined in childhood…The things they are going through now are going to influence them for their whole life,” he said.

Lenore Rubin, president of the American Friends of ELEM, said that according to Israeli government statistics, even before the war, nearly one-third of all Israeli youth from kindergarten to senior in high school were considered to be on the at-risk spectrum. The numbers have only increased with the war, she said.

“Now with the war, we have to build up even more than what is considered to be our baseline, because right now every youth is traumatized, it doesn’t matter where they are from, every youth is traumatized,” Ruben said. “It’s a real crisis, and it’s a real crisis for our staff as well.”

With rising demand for services, mental health groups stress the need to support their staff and volunteers as well. ERAN is responding by establishing an Emergency Response Center in Netanya, which will allow them to add 20 more hotline volunteers and increase training capacity; they’ve secured $200,000 of the $500,000 needed, said CEO David Koren.

“There is a kind of cloud of despair sitting on top of most people. They are not seeing a clear future.  The sense of hope may be lacking, in a way, sometimes because of our leadership. The mental distress and the issues that we’re now dealing with will be with us at least another 10 years. There’s no way it’s going to fade out within a couple of months or a year,” said Koren. “And this is something that we have to be very much prepared for.”

Ed. note: An earlier version of this report incorrectly identified ICAR’s partners for its public awareness campaign.