Ronen Shalev's family survived the Nova music festival attack on October 7, 2023. Both his children were there. His son Roee was shot but lived; Roee's partner, Mapal Adam, was killed in front of him. Shalev's wife Gavriela later took her own life, unable to bear the aftermath. Two years on, Roee followed. His final message on Instagram read: "I'm alive, but I'm dead within." The Shalev family's trajectory is a microcosm of a systemic failure that now touches millions. Israel's State Comptroller reported in February 2025 that roughly 39% of the Israeli public — some 3 million people — suffer from post-traumatic symptoms, depression, anxiety, or a combination at medium or severe levels. Of those, an estimated 600,000 are severely affected. Yet the number of people actually receiving mental health treatment rose by just 1% since October 7, 2023, a gap of around 60,000 additional patients. The math is devastating: millions need help, tens of thousands are getting it. The bottleneck is structural and pre-dates the war. Researcher Noga Dagan-Buzaglo of the Adva Center, a think tank focused on Israeli inequality, documented a public mental health system already in crisis before the attack. The core problem is workforce: public-sector therapists earn less than private-sector counterparts and carry crushing caseloads. Waiting times through the public system exceed six months, sometimes stretching past a year. Dagan-Buzaglo describes the public system's response as "simply bad." The crisis extends to the caregivers themselves. University of Haifa research found that 84% of therapists who treated October 7 survivors developed traumatic symptoms, and 45% reported mental exhaustion. The Health Ministry registered a 13-17% rise in prescriptions for sedatives, sleep aids, and antidepressants — a pharmaceutical stopgap where therapeutic infrastructure should be. NGOs and volunteers scramble to fill gaps, burning out in the process. Military personnel face their own escalation. Before the war, reservist suicides peaked at one per year over the six preceding years. In 2024, that number hit 11 confirmed cases. In 2025, nine additional cases are under investigation as suspected suicides — and these figures exclude former soldiers who ended their lives after discharge. Even within the army, where mental health professionals receive better pay and conditions, Dagan-Buzaglo says treatment length and quality remain "by far not at an adequate level." The structural diagnosis is clear: Israel's mental health system operates as a two-tier market where ability to pay determines access to care. Those who can afford private therapy get it. Those who cannot — including evacuees from Israel's south and north, survivors, and combat veterans — enter a queue that may last longer than their capacity to endure. The budget increase the government authorized was, in Dagan-Buzaglo's assessment, too little and too late, layered onto an already failing system. Shalev now lectures to soldiers about mental health and speaks publicly about his family's losses. His message targets the cultural taboo around suicidality, particularly among those who present as strong. "They're the scary ones," he says, "as they're less likely to receive treatment." The policy question is whether Israel will treat mental health infrastructure as a long-term investment or continue managing a mass psychological injury with a system built for peacetime volumes it was already failing to meet.
