“Anyone raising two chickens calls Itself a therapeutic farm”: the unregulated market for PTSD treatments
Since October 7, hundreds of organizations have been established to treat post-traumatic stress, some of them providing care to trauma victims without the necessary knowledge or training. NATAL, an organization specializing in trauma treatment, warns that the lack of regulation is causing serious harm to patients and is calling on the government to regulate the field
Anarchy among hundreds of organizations providing care to people with post-traumatic stress disorder has emerged in Israel during the three years of war since October 7. Some of these organizations are causing serious harm to patients - either through harmful, unprofessional treatment or through treatment that led to improvement but was not followed by professional monitoring. This is the warning issued by the Back on Track Forum, which brings together more than 50 treatment organizations and associations of military-unit veterans.
The forum is coordinated by NATAL - Israel Trauma and Resiliency Center. It is calling on government ministries to formulate a set of criteria determining who is authorized to diagnose and treat people with post-traumatic stress disorder, as well as the appropriate methods of diagnosis and treatment. The forum has published an online self-assessment tool that enables nonprofits to evaluate their suitability for treating people with PTSD and make necessary improvements, while allowing patients to assess where they are seeking help.
The proportion of Israelis suffering from PTSD symptoms surged in the wake of the war, from 16.2% of the population to 29.8%. By comparison, the global average prevalence of PTSD is 3.9%. More conservative estimates put the number of people with PTSD in Israel at 625,000. All adults suffering from PTSD face a condition that is highly likely to impair their ability to work and reduce productivity, while also causing broader harm such as road accidents, serious illness, addiction and domestic violence - and leading to enormous costs. Some 80,000 are at high risk of losing their jobs.
A review by the Back on Track Forum of Guidestar, the Justice Ministry’s nonprofit registry website, found that since 2023, 215 new nonprofit organizations have been registered in Israel whose target populations include soldiers, reservists and discharged soldiers in the fields of trauma, mental health and resilience. Of these, 141 were registered in the past two years alone. Only 60 have received a certificate of proper management. A broader mapping of all new organizations operating in the PTSD field - including those focused on communities near the Gaza border and survivors of the October 7 music festivals - shows that roughly 400 new nonprofits are currently active in the field. Associations of military-unit veterans have therefore developed a need for tools and guidance on where they can refer those affected.
“Since the start of the war, a great deal of money has been poured into post-trauma,” says Ella Bokovza, director of the Back on Track Forum. “Anyone with good intentions and a few connections to overseas donors set up a nonprofit, and anyone with two chickens and a patch of mint calls themselves a therapeutic farm.”
There are 25 farms recognized by the Defense Ministry, but many more therapeutic farms operate nationwide, and waiting lists at the recognized facilities are long. The problem of treatments delivered without professional supervision is particularly acute in complementary fields, such as trauma-informed yoga, acupuncture and breathing workshops; nature-based therapies including therapeutic gardening and animal-assisted work; and activities ranging from surfing to sailing.
One of the central problems is the operation of programs without professional supervision - creating a serious risk in the event of an episode. “Suppose someone with PTSD experiences a flashback - a return to the traumatic event - in the middle of surfing in the sea,” Bokovza says. “If there is no therapist there, who is responsible for them? And who is responsible once they return home?” A second problem she identifies is the absence of follow-up support after the activity ends.
Shaked Arieli, director of the Personal Development and Career Unit at NATAL - Israel Trauma and Resiliency Center, explains: “If a group of people with PTSD spends several highly emotional days in the Alps, reaches an emotional peak, and is then dropped back at home without support or follow-up, some will end up harmed. Sometimes lifting someone up without taking responsibility can also cause harm.”
According to Bokovza, “Quite a few patients went through workshops and treatments and ultimately ended up in crisis-respite homes, even though before the treatment they were not in a condition requiring such facilities. A crisis-respite home is a therapeutic residential setting that serves as an alternative to psychiatric hospitalization for people undergoing an acute mental-health crisis. Its purpose is to provide professional medical and psychological care within a real, warm and respectful home environment, avoiding the difficult experience of hospital admission.
“There are many young people with good intentions who have founded organizations. Some are themselves dealing with PTSD. But regulation is extremely lax, and it is the same whether you establish a synagogue or a nonprofit that treats PTSD. Sometimes they take the name of a well-known professional and put it on the website. Sometimes that person is genuinely active in the organization, and sometimes they are not. Some of these groups are very good at marketing themselves on Instagram.”
Another problem, she says, involves group facilitators who run workshops intended to process combat experiences. “Even if someone studied group facilitation for two years, what do they know about processing the experiences of someone who spent 90 days in Gaza?” Bokovza asks. Alongside them are therapists trained in psychology or social work but not in trauma. “The fact that someone completed a master’s degree in social work and is a psychotherapist does not mean she can treat trauma. Organizations have a great deal of misunderstanding on this issue,” she warns, adding: “The problem is that such therapists can also supervise other people.”
According to Arieli, an expert in employment support for people with PTSD, “The sheer number of vocational-training and job-placement programs for soldiers with PTSD, soldiers, residents of Gaza-border communities and survivors of the music festivals is impossible to control.”
She estimates that 70% of these programs operate without mental-health support. “I had a case that reached me after a member of the security forces who had completed vocational training died by suicide. In another case, a relative of hostages suffering from PTSD was placed in a dream job with a high salary, without any consideration of his PTSD, and was fired because he was deemed unsuitable. Nobody took into account that he had PTSD.”
She says that affected people need support in reacquiring skills such as patience, as well as workplace accommodations, including breaks during the workday or part-time positions. “People with PTSD are not a sector that can simply be placed in jobs. They are people in psychological distress. Even mentoring can cause harm. In many places, a mentor is assigned to a person coping with PTSD, functioning like an older brother. He may offer relationship advice without understanding that relationship difficulties are part of the symptoms of PTSD.”
According to a study by the Israel Women’s Network, the rate of physical and sexual violence doubled among couples in which one partner served in the war, reaching 6% - twice the rate among couples in which neither partner served. Bokovza says: “People turn to fly-by-night organizations that do not solve the problem. If there are so many organizations, yet the number of domestic-violence cases, divorces, road accidents and suicides continues to rise, then something is not working effectively. People officially recognized as having PTSD will generally be referred to established, professional organizations. But most people experiencing post-traumatic distress are not recognized by any system, and do not know that they are suffering from PTSD. If they receive the wrong response to their distress, their symptoms may worsen.”
NATAL warns that Israel currently lacks a comprehensive regulatory system that clearly defines the boundaries between the different fields, training and certification requirements, who is authorized to diagnose and treat trauma, and the standards required for treating vulnerable populations. According to Bokovza, “Countries including the United States, France and Australia have clear regulations governing PTSD treatment. We are calling for Israel to bring its standards into line.”
NATAL’s research team, led by Dr. Yifat Reuveni and Helena Adam-Ashkenazi, developed a set of criteria for the forum to clearly define the type of care an organization provides, its target population and its screening process. Bokovza says: “An organization’s boundaries need to be defined. It is not possible for a single organization to treat everyone - those affected, spouses and children. Every organization must know its limits, and when it lacks the expertise, it must refer the person to another organization.”
NATAL also proposes criteria for matching practitioners’ level of training and experience to the treatment and type of intervention they provide, alongside ongoing supervision; systematic monitoring of the service provided and treatment outcomes; clear and accessible information; organizational ethics and privacy safeguards; the ability to respond to risk events such as acute episodes; collaboration with complementary organizations; and sound organizational governance. “Another question is how strictly confidentiality is maintained: Are the details of PTSD patients kept in an Excel file that any hacker can steal? Is information being uploaded to unsecured AI systems?” Arieli says.
She adds: “We did not propose giving organizations a seal of approval. We are proposing that organizations assess themselves, and that government ministries establish transparent, clear criteria. This would give nonprofits a tool for evaluating where they refer patients, as well as providing one for families and patients themselves.”
The Health Ministry said: “Treatment for PTSD has been at the center of the Health Ministry’s work since October 7, and mental-health services have been significantly expanded during this period. At the same time, the ministry is active in prevention and in promoting mental resilience, including through the ‘Body-Mind’ initiative in local authorities, under which professional standards have been set for service providers. The ministry is responsible for licensing mental-health professionals, but does not supervise nonprofits or private services that are not part of the public system. Members of the public seeking treatment in the private market are advised to ensure that the provider is a licensed professional with appropriate training.”
The Rehabilitation Department at the Defense Ministry said: “All services and support programs offered by the department to wounded male and female IDF veterans are regulated and supervised accordingly.”
