[TREATMENT ISSUES IN PSYCHIATRY IN THE MANAGEMENT OF THE HAREDI SUBPOPULATION]

In recent years, the importance of cultural sensitivity and the adaptation of mental health services to diverse populations has been growing. Simultaneously, awareness of psychiatric illnesses and treatment is increasing, even among the Haredi (ultra-orthodox) population in Israel, with specialized services developing. Many studies have emphasized the central role of religion and belief in the coping styles of those with mental illness and their healing processes. These characteristics are especially evident among the Haredi population, where religion is present in behavior, in thought, both within the individual and in the community, and throughout life. In the encounter between a religious Haredi patient and the professional, many issues arise regarding religion and the patient's socio-cultural affiliation. Being familiar with this world, including unique concepts and sensitivity to these issues, can promote treatment that is provided to ultra-orthodox individuals with mental-illness in a manner that is culturally sensitive. These issues include specific expressions and manifestations of psychiatric illness in the religious Haredi patient, and issues related to the specific Haredi community to which the patient belongs. Discussions in the literature and halakhic rulings are divided into issues concerning the patient, religious law observance by the patient with mental-illness, issues regarding treatment coercion, pregnancy, and issues relating to therapy, such as "privacy" and "life and death" dilemmas. Unique expressions of psychiatric disorders in the Haredi patient may be noted in eating disorders, psychosis and OCD, both in clinical terms and in prognosis and disease processes. Factors related to society and the ultra-orthodox community to which the psychiatric patient belongs include issues of stigma and secrecy that are maintained by the community in relation to mental illness; interference by non-professional individuals involved in treatment; as well as the distinctiveness of treatment and rehabilitation adapted to the Haredi population and finally cultural sensitivity to the needs of the religiously observant patient (such as avoiding desecration of Shabbat, rehabilitation in unique areas such as Torah study, etc.).