Following two and a half years of heavy conflict, including the deadly Hamas invasion of October 7, 2023, and two wars with Iran — the second still ongoing — Israel and its citizens have been forever changed, with so many circles of grief that nobody knows how many people need, and will need, trauma support.

“The mental health system, which had difficulty functioning even before October 7, collapsed in the first days of the war,” the state comptroller concluded in a February 2025 report.

Similar to other aspects of the post-October 7 period, many nonprofits stepped up to assist in the mental health sphere, among them veterans such as NATAL, ERAN, ENOSH, the Israel Trauma Coalition, and, one of the oldest, the Community Stress Prevention Center (known in Hebrew as Mashabim, or Resources) in the northern Lebanon border city of Kiryat Shmona.

But alongside them, a flurry of new organizations also sprang up, like mushrooms after the rain, offering everything from surfing, hiking, and therapeutic riding to yoga, meditation, and breathing. Some aimed at specific locations, age groups, or genders (for example, women in the security services). Others were created to memorialize a fallen relative or friend.

This reporter counted over 50 organizations in the Hebrew-language Guidestar database established after October 7, 2023, that offer some form of therapeutic support.

The system, however, is fragmented, and there is nobody in overall control.

The Health Ministry, which has opened 14 new trauma clinics next to mental hospitals since October 7,  says it is responsible only for public services — those provided by hospitals and clinics run by the health funds (kupot holim, in Hebrew).

Now, several initiatives are trying to make order of the chaos; to map what is available to identify gaps and duplication, coordinate between the many actors involved, provide coping tools to the general population, and formulate standards to ensure that provision meets needs in the field, in a properly funded and supervised manner.

Unknown depths of pain

Since October 7, Israelis have been impacted by a seemingly endless cycle of war. This includes the Hamas invasion of southern Israel, which saw some 1,200 people slaughtered and 251 kidnapped, all of whom have since returned, dead or alive; the Swords of Iron war against Hamas in Gaza; rocket fire from Hezbollah in Lebanon, which has now resumed after a November 2024 ceasefire; two rounds of war with Iran, the first in June last year, the second since February 28; an uptick in violence in the West Bank, and missiles from Houthi terrorists in Yemen.

More than 900 soldiers, officers, and reservists, including several dozen local security officers, have been killed, with some 22,000 wounded IDF soldiers having gone through treatment. Of the latter, 58 percent were suffering from post-traumatic stress disorder and other mental health conditions. The Defense Ministry’s Rehabilitation Department receives approximately 1,500 requests for recognition of mental health issues each month.

In addition to injuries, long reserve duty periods have imposed impossible pressures on marriages and destroyed jobs, businesses, and career plans.

Furthermore, between 200,000 and 250,000 Israelis were either officially evacuated from their homes on the southern (Gaza) and northern (Lebanon) borders or self-evacuated, according to the UN.

A study published in April on Israeli mental health in the aftermath of  October 7 found that the Israeli mental health system was “ill-equipped” to handle the surge in demand for psychological support. It warned, “Israel needs to dramatically retool to face the oncoming tsunami of war-related psychiatric illness.”

Estimates of the number of people who will need mental health treatment following October 7 vary hugely, from 300,000 by the Taub Center to three million estimated by the state comptroller in February. The Health Ministry’s estimate is 80,000 to 500,000.

A University of Haifa study found that around 60% of Israelis who were not directly affected by the war (i.e., not residents of border communities, injured, or with harmed family members) developed severe acute stress disorder, which is a risk factor for developing PTSD. One in four people used more drugs and medications after October 7, according to the Israel Center for Addiction.

In December, Maccabi Healthcare Services, one of Israel’s four health maintenance organizations, published an end-of-year survey, revealing that some 9,000 post-traumatic stress diagnoses were recorded among its members last year, up nearly 30% from 2023 and approximately 40% compared to 2022 levels.

And yet despite these upward trends, an analysis of the state’s 2025 budget for mental health (of which trauma treatment forms just a part) found that despite a 17% increase in funding, mental health still received only 4.5% of Israel’s national health budget – far below the OECD benchmark of eight to 10%. Less than half of the system’s needs were being funded, the ICAR (Israel’s Collective Action for Resilience) organization said in its report, with an estimated annual shortfall of NIS 3 to 4.5 billion ($940.6 to $1.4 billion). The study also discovered a “lack of coordination and governance.”

Who’s in charge of the nonprofits?

Gila Tolub, executive director of Israel’s Collective Action for Resilience, which was set up after October 7, explained that a gap in the state’s mental health provision opened between 1994, when the four national healthcare organizations were established, and 2015, when they became officially responsible for mental health through a government reform.

During those years, little was done to develop mental health services, and many organizations emerged to fill the gap, often becoming service providers to the government.

“Now,” said Tolub, “It’s become unmanageable.”

ICAR is attempting to create order. As its website says, “Israel’s trauma ecosystem is fragmented with hundreds of organizations working day and night on the ground, [but] there is no natural owner to track and analyze the macro needs.”

ICAR brings together leaders in medicine, psychology, public health, health tech, philanthropy, investment, and more.

In February, it published the report of its first summit. (The second summit took place last week.)

The report said, “We came together because we refuse to accept the status quo. Because we know that mental health is a national priority. Because we understand that if we don’t act now, we’ll be dealing with the consequences for generations.” It said the summit’s message was clear: “We need systematic change… Mental health must be fully integrated into policy, healthcare, technology, and community initiatives — not as an afterthought, but as a core part of how we strengthen our society.”

Healing from trauma was not only a mental health issue, the report went on, but also affected physical health, productivity, economy, and security. “The scale of trauma we face today is unprecedented, and the response must be just as bold,” the report said.

ICAR was co-established by Eyal Fruchter, a professor of Psychiatry, former IDF head of mental health, former head of psychiatry at Rambam Hospital in Haifa, and former CEO of the Maale HaCarmel Mental Health Hospital in northern Israel. Worried about the lack of organization and standards, he teamed up with Tolub, a former partner at McKinsey & Company, to launch ICAR.

Fruchter performed 10 weeks of IDF reserve duty in the early days of the war against Hamas, heading the mental health unit and providing treatment to the most severely impacted soldiers evacuated from the front.

“I came away feeling that the treatment scene was limited,” he said. “It was too focused on trauma as an illness to be treated primarily with medication, rather than on rehabilitation and reconnection with families and communities. I also felt that no one was stepping back to assess the needs of the country as a whole.”

“Is there any regulation [of mental health aid organizations]? No,” he said. “Are there standards according to which an nonprofit can define itself as a treatment organization? No.”

ICAR began by mapping the organizations involved in well-being and mental health to understand who provides which services, for whom, and where. The aim is to identify gaps, duplication, and opportunities for cooperation and coordination.

The group has uploaded information in English to its website on over 400 organizations registered with the Registrar of Associations. A scan by this reporter indicated that around 20 of the groups on the ICAR list started operating after October 7, 2023, and deal with anxiety, depression, and PTSD. (The difference between this number and the one for Guidestar could be explained by the fact that ICAR has not yet added groups that were recognized in 2024.)

Together with Startup Nation Central and a mental health platform called Bezyl, ICAR has also mapped the health tech sector.

One of the priorities that ICAR has identified is the need for quality control and a “seal of quality.”

Fruchter said that the Health Ministry, as the supervisor of mental health care, understood the need for clear criteria and had started a process to define them, but had “stopped in the middle,” citing personnel shortages.

Earlier this year, ICAR launched a national psychoeducation campaign with 30 partners. Running a minute before the main TV news broadcasts, it explained why people were experiencing feelings such as hypervigilance or were crying more than usual. The aim, said Tolub, was to reassure people that these reactions were normal, provide coping tools, and explain when professional support should be sought.

The tools include links to a site run by Kol Zchut, an organization that provides information on social rights, entitlements, and services, and to the Invisible Album, which collates rehabilitation programs for combat soldiers. It also links to Nafshi (Spiritual), a major initiative of the Joint Distribution Committee.

Efrat Stern, responsible for disabilities and mental health and well-being at the JDC, prefers to use the term “mental well-being” rather than mental disability in connection with the war.

Already before October 7, the JDC partnered with Reichman University’s Maitiv Center for Research and Application of Positive Psychology to develop basic standards for preventive care initiatives.

Today, the JDC is a partner in the Community Mental Health and Well-being National Network, the biggest initiative of its kind in Israel, according to Stern. Also involved are the Health, Finance, Interior, Education, and Welfare ministries, the Prime Minister’s Office, the National Insurance Institute, and the local councils.

The initiative will see NIS 72 million, or $22.6 million (from the state and philanthropy), distributed this year and next to 85% of all local authorities. The funds will enable each council to pick mental well-being initiatives from a digital library, without the need for tenders. Out of 180 organizations that applied to be on the list, 80 passed professional vetting, Stern said.

The program funds health coordinators in each authority, who are trained to map stakeholders and needs, run a steering committee of local representatives, and build a work plan.

Three weeks after the Gaza war started, the JDC established Nafshi. This is a digital library, in Hebrew, of some 800 pre-vetted tools that any citizen can access for tailored help. Stern said over 200,000 Israelis had used it so far.

While the JDC wants to create a seal of quality for mental well-being, to prevent distress worsening, ICAR will focus on the standards needed for hospital clinics treating PTSD, eating disorders, addiction, and suicidal tendencies, whether sparked by war or other traumas.

Stern said, “There are not enough funds for the need, and there are many great initiatives. This will be long-term. That’s why we’ve gone into trying to organize the field.”

She added, “Crises don’t end in Israel,” she added. “So we have Nafshi that gives answers today, but we also want to build an infrastructure to be better organized for tomorrow.”

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