I. HOW WILL ISRAEL RECOVER AND HEAL?

Unprecedented Collective Trauma. The tragedy and ongoing crisis of October 7, 2023 has affected every home and every resident of the country and, thereby, their families, friends and allies around the world. Millions of Israelis have experienced a collective trauma and loss, made worse by ongoing existential threat and uncertainty.

A Mental Health Crisis. Consequently, a mental health crisis is fast emerging, with unprecedent incidence of PTSD, depression, anxiety, and suicidality, and their destructive consequences for Israeli families and children. It is estimated that this is the single largest public mental health crisis in the history of the State of Israel and among the Jewish community since the Holocaust.  

Social Radicalization. Worse yet, we also know that human-made collective trauma, particularly when tied to a national, ethnic and religious conflict, will amplify social radicalization, polarization and inter-cultural conflict. These dynamics threaten the future stability of Israeli civil society and any hope for an inclusive shared society. The mental health crisis must be addressed effectively.

The Treatment Gap. Unfortunately, the mental health workforce in Israel was very small, under-funded, and unable to effectively address the national mental health burden, even before the crisis. Consequently, an unprecedented number of people will need care, but will not be able to access it, when and where they need it. There is a national imperative to develop a scalable portfolio of evidence-based therapeutic programs with reach and access across Israel and its social sectors. This is where we can be of help.

II. THE MOMENTS OF REFUGE PROJECT: HOPE IN INNOVATION

Our Mission. For over a decade, my group has conducted research to discover and develop therapeutic methods to promote recovery and healing among survivors of individual and collective trauma, loss, and existential uncertainty. Our work and findings led to the Moments of Refuge Project – a global social impact- and research- initiative to empower survivors of conflict, trauma and forced displacement, to heal and thrive. The initiative is a uniquely Israeli innovation – motivated by our ethical obligation to care for diverse communities locally and globally, who much like our own ancestors, now struggle with collective trauma, uncertainty and forced displacement. Thus, following the tragedy of October 7 and the war and uncertainty in its wake, we are now launching Moments of Refuge for Israel.

Mindfulness & Compassion as a Tool. To understand the Moments of Refuge Project and our approach, it is important to first understand that we innately have, within each of us, all that is needed to heal and recover from trauma and loss. Yet, research has also documented that to access this pre-wired capacity to adapt and recover post-trauma, we must be able to experience a subjective sense of refuge and safety within our lived experience. This is why mindfulness- and compassion-based mental training is central to the Moments of Refuge mission. Indeed, mindfulness meditation practices are designed to empower and enable people to experience moments of refuge and safety and connection within their lived experience, and thereby  – facilitate our innate capacity to adapt, to heal and to recover. Moreover, in the past decade, a large scientific evidence-base has demonstrated the therapeutic stress-buffering effects of mindfulness and compassion training, therapeutic effects that are equivalent to much more intensive, costly and less scalable psychotherapeutic and pharmacological interventions. Our own randomized clinical trial research has documented that mindfulness- and compassion-based training is safe and effective, even among highly vulnerable trauma survivors facing adversity, injustice and uncertainty. Finally, mindfulness training has broad reach and access, can be delivered to groups of participants and flexibly via digital platforms, is relatively low-cost, and its benefits can be sustained over time within and by communities. This scalability is critical to getting effective science-based care to those that need it, when and where they need it, even in complex and uncertain conflict-affected and post-displacement settings – much like Israel today.

Science as a Tool. Our approach to the implementation of Moments of Refuge is also unique because we use science as a tool to most effectively and responsibly implement our intervention programs. What this means, practically, is that we not only deliver therapeutic programs, but we use scientific monitoring and evaluation methods to ensure the ongoing intervention programs’ safety, therapeutic efficacy and impact, individual personalization of care, and ongoing therapeutic innovation and development. Most NGOs and mental health care providers, that do not have this type of scientific expertise or capacity, must rely on clinical judgment rather than scientific data to guide their implementation. In the dynamic and unprecedented context of the mental health crisis in Israel post-October 7, we believe that our approach is now not only optimal clinically but is necessary ethically.

III. MOMENTS OF REFUGE FOR ISRAEL: OUR PLAN

National Reach Through a Hybrid Digital Platform + Group Support. The Moments of Refuge for Israel program will be delivered through our online digital mobile health program, in Hebrew, Arabic, and English. This ensures broad reach and access, utilization flexibility, and geographic mobility for displaced Israelis, with an unlimited capacity for scaling-up. For the many Israelis who will be in need of greater support and clinical personalization, our digital mobile Mindfulness-SOS program will be supported through community-embedded instructor-led groups, in-person or by zoom. This hybrid in-person group-supported intervention format also provides participants with greater access to connecting and recovering, together with a group of community peers. Groups will be led by trained and certified mindfulness instructors with clinical experience in trauma and mental health.

The Mindfulness-SOS Intervention Program. Mindfulness-SOS entails 8 brief training session modules and 10 complementary meditation practice exercises), that participants can flexibly access whenever and as frequently as they need. The hybrid in-person group-supported intervention format includes eight weekly 60-90-minute sessions (10-15 participants/group), designed to support the Mindfulness-SOS digital training session modules and meditation practice exercises. The intervention program entails: (1) Formal and informal mindfulness meditation practice exercises, as well as loving-kindness and self-compassion practices to cope with trauma-related feelings such as fear, self-judgment, guilt, shame, and hostility. (2) Psychoeducation to facilitate understanding of stress and trauma, to normalize and de-stigmatize common mental health difficulties, and to normalize difficulties in mindfulness training. (3) Trauma sensitive adaptations and exercises to help ensure safety and efficacy of mindfulness practice exercises among highly traumatized individuals. (4) Socio-cultural adaptations (e.g. metaphors, idioms) to communicate intervention principles and practices, and thereby optimize intervention efficacy among diverse communities.

IV. PHASED & PARTNER-BASED IMPLEMENTATION: THE NUTS & BOLTS

National Multi-Site Open-Trial: Aligned with our scientific approach to intervention program implementation, Mindfulness-SOS will be implemented through a multi-site open clinical trial, among Hebrew- and Arabic-speaking adults. To do this, we will partner with a network of mindfulness instructors and mental health service organizations across Israel.

Phase I: Multi-Site Pilot Implementation. Initial implementation will involve 1-2 training workshops delivered to 10 instructors, who will then implement the program in 10 pilot sites across Israel. To those in need of less support, Phase I will also offer Mindfulness-SOS without the additional instructor-led groups.

Phase II. Initial Scaling-Up. The second phase of the project will focus on initial scaling-up of implementation via recruitment and training of 10-20 additional group instructors. At Phase II, program capacity could reach and impact 930 or more participants every ~8-10 weeks (i.e. 20-30 instructors, each delivering ~3 groups/week, to 10-15 participants/group).

Phase III. Scaling to Sustainability. Depending on the scale of need in Israel and in mental health care service systems in the many months to come, it is likely that there will be further scaling-up of program implementation – e.g. additional training workshops, additional instructors, additional groups. Within 3 years, we expect that our partner mental health care organizations will have the capacity to implement the programs independently from our Moments of Refuge for Israel team.

Monitoring and Evaluation: Impact Goals & Outcomes. Using our established digital measurement platform, we will systematically evaluate, quantify and optimize program delivery and its therapeutic impact on trauma- and stress-related mental health symptoms of program participants as well as on their family members and children; empirically identify individuals who need additional mental health care or other services; and thereby generate a novel therapeutic capacity as well as empirical evidence-base to share with mental health care providers in Israel and around the world.

Outcome  metrics among participants include improved capacity to cope with the trauma and stress following October 7, reduced rates and severity of trauma- and stress-related symptoms (e.g. PTSD, depression, anxiety, suicidality), and thereby, improved family and child outcomes. By impacting thousands of Israelis, the program will also contribute to  collective social resilience as well as help buffer social radicalization and polarization within their respective social networks and communities around the country.

V. SUPPORT MOMENTS, SUPPORT ISRAEL

We are now reaching out to partners who identify with our mission and evidence-based strategy in order to help support year 1 of the initiative (Initial Target: $500,000). Funding is needed primarily to support team personnel, including a national project coordinator, clinical care and training coordinator, community partnership coordinator, a software programmer, intervention group leaders, monitoring and evaluation support staff, and logistical expenses. Additional personnel resources from our team, including from Prof. Amit Bernstein, will be provided in kind. We foresee that Moments of Refuge for Israel will be needed, for at least, the next 3 years. If you are interested and would like to discuss how you may join and support us, please contact Professor Amit Bernstein: abernstein@psy.haifa.ac.il