מבקר המדינה

מבקר המדינה

מבקר המדינה נדרש מספר פעמים לסוגיות בתחום בריאות הנפש בכלל ובתחום שיקום נכי נפש בפרט.

מתוך דוח 57 ב':

בשנת 1998 בדק משרד מבקר המדינה את נושא שיקום נכי הנפש בקהילה, וממצאי הבדיקה פורסמו בדוח שנתי 49 של מבקר המדינה (1999) עמ' 135 (להלן - הבדיקה הראשונה). בשנת 2001 ערך משרד מבקר המדינה בדיקת מעקב בנושא, וממצאי הבדיקה פורסמו בדוח שנתי 52ב של מבקר המדינה (2002), עמ' 212 (להלן - בדיקת המעקב). בחודשים אפריל-אוגוסט 2006 שב משרד מבקר המדינה ובדק את נושא שיקום נכי הנפש בקהילה (דוח 60 ב').
בשנת הבדיקה, כחמש שנים לאחר שחוק השיקום נכנס לתוקפו, רק כ-12,000 נכי נפש, שהם 14%-22% מכלל הזכאים לשירותי שיקום, אכן קיבלו אותם. זאת ועוד, הביקורת העלתה שנכי הנפש שוועדות השיקום אישרו להם תכניות שיקום ניצלו רק כמחצית ממסגרות השיקום שאושרו להם. יש לבדוק מדוע רק חלק קטן מנכי הנפש מקבלים שירותי שיקום ומדוע שיעור הניצול של תכניות השיקום נמוך; הדבר יכול להעיד על כשל ארגוני במערך השיקום.

לקריאת הדוח המלא לחצו כאן

עיקרי הממצאים בדוח 60 ב' הראו ש:

1. שיעור הלוקים בנפשם בישראל דומה לזה שבמדינות מערביות. אולם חלקו היחסי של התקציב לשירותי בריאות הנפש בישראל מסך ההוצאה הציבורית לבריאות נמוך בהשוואה למדינות אלה: בעוד שבחלק ממדינות אלה ההקצאה לשירותי בריאות הנפש עומדת על כ-10% מסך ההוצאה הציבורית לבריאות חלקם של שירותי בריאות הנפש בישראל הוא כ-5%.
2. מדינות רבות במערב משקיעות את רוב התקציב של בריאות הנפש בטיפול בקהילה ולא בטיפול באשפוז. לעומת זאת בארץ ההוצאה לטיפול בקהילה ולשיקום גם יחד היא רק כמחצית מתקציב בריאות הנפש. זאת אף על פי שחל צמצום ניכר במיטות האשפוז ואף על פי שבבתי החולים מטפלים רק בכ-10% מאלה המטופלים בקהילה.

לגבי יישום חוק שיקום נכי נפש בקהילה ציין המבקר:

1. פעילות המשרד למען יישום חוק השיקום: המשרד טרם יישם את כל הדרישות שקבע חוק השיקום: (א) ועדות השיקום לא בחנו מדי שישה חודשים את תכניות השיקום שנקבעו לנכי הנפש כדי לבדוק את התאמתן לצרכיהם; (ב) מספר מתאמי הטיפול שהיו אחראים ליישום ותיאום מתן כל השירותים הניתנים לנכי נפש לא היה מספיק; (ג) למועצה לשיקום הוקצו מעט משאבים להערכת היעילות והמועילות של תכניות השיקום , כך שמעת החלת החוק נעשו רק מחקרים מועטים.
2. אי-ניצול שירותי שיקום: בביקורת הקודמת ובביקורת הנוכחית הועלה שנכי נפש רבים לא מימשו את תכניות השיקום שאושרו להם. המשרד לא בחן את הסיבות לכך.
3. היעדר מסגרות שיקום מתאימות לנכי הנפש: לא נמצאו מסגרות מתאימות עבור מאות זכאים לשיקום. מדובר למשל בנכי נפש הסובלים מן הבעיות האלה: אלימות, נטיות אובדניות, הפרעות אכילה ובעיות קוגניטיביות. כתוצאה מכך, עשרות פגועי נפש נמצאו במסגרות שלא התאימו לצרכיהם.
4. פעולות פיקוח ובקרה על מסגרות השיקום הפרטיות: המשרד כרוכש שירותי שיקום אינו מקיים בקרה על כל נותני השירותים כדי לוודא שהם פועלים בהתאם לכללים ולרמה שהוא קבע. גם כשהתקיימה בקרה תדירותה הייתה נמוכה, אף על פי כן המשרד לא קבע מהי התדירות הדרושה לביצוע פעולות הבקרה. המשרד אישר בשנת 2008 גיוס כוח אדם נוסף לביצוע פעולות בקרה, אולם רק לאחר מועד סיום הביקורת הנוכחית, אוגוסט 2009, החל בגיוס העובדים הנוספים. עד ינואר 2010 גויסו עובדים רק ל-2.25 משרות (מ-15).

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