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Balancing Homes to Prevent Psychiatric Hospitalization

Revital Ordan, Psychiatric nurse, Head of the Ambulatory Care Department, Mental Health Division, Ministry of Health
15 June 2025

The balancing home is a framework that provides intensive therapy for people in acute mental distress that is designed to avoid hospitalization in a hospital’s psychiatric ward. The framework aims to balance and stabilize mental health, in a home-like, non-judgmental and containing atmosphere. Therapy in a balancing home is short term, between one and two months, based on the patient’s mental state. Afterwards, and if necessary, the patient is referred for continued care and rehabilitation in community settings.

The balancing home operates as a ‘therapeutic environment’ and treatment includes various interventions that are found in the Mental Health Services Basket based on clinical need and the patient’s consent. The treatments are based on a holistic approach that views the individual as a complete medical, psychological and social being.

The target population of the balancing homes

Any individual who is experiencing severe and acute mental distress that requires hospitalization or an alternative intensive therapeutic setting in the community, agrees to receive treatment and can reasonably cooperate.

Therapeutic efficacy in balancing homes

The therapeutic model of balancing homes is in its initial stages in Israel. At the same time, research findings already indicate that the therapeutic efficacy in balancing homes is similar to that of hospital psychiatric wards. Apparently, over time, therapy in the balancing homes prevents recurring hospitalizations and generates a high level of satisfaction with the service in this framework among patients.

Composition of the professional staff in the balancing home

The multidisciplinary staff includes members of the healthcare professions: psychiatry, psychology, social work, nursing, occupational therapy, nutrition and art therapy. In addition to the professional staff is a large team of counselors accompanying the patients 24/7 who are mentored and guided by the professional staff.

Financing residence in the balancing homes

The balancing homes are a service that is fully funded by the HMOs through prior authorization (Form 17) that involves a deductible of tens of shekels paid directly to the HMO.

The balancing home is a framework that provides intensive therapy for people in acute mental distress that is designed to avoid hospitalization in a hospital’s psychiatric ward. These homes aim to balance and stabilize mental health, in a home-like, non-judgmental and containing atmosphere.

The balancing homes are located across the country, in city neighborhoods as well as the rural outskirts in moshavim and kibbutzim. Patients accepted into the balancing homes receive therapeutic service and are supervised by a multidisciplinary staff and counselors 24/7. Therapy is provided over a short and limited period of time, between one and two months, based on the patient’s mental state. Afterwards, and if necessary, the patient is referred for continued care and rehabilitation in community settings. In the balancing home, between 10-12 people can be treated at the same time, and they generally reside in rooms designed for up to 2 people (separated by gender) or in individual rooms.

Balancing homes can be suitable for any individual who is experiencing severe and acute mental distress that requires hospitalization or an alternative intensive therapeutic setting in the community, agrees to receive treatment and can reasonably cooperate.

Balancing homes are not suitable for patients coping with mental symptoms that pose a danger to the individual himself or to the individual’s environment, severe unrest, aggression or any behavior that requires close supervision in a closed and protected environment. In addition, balancing homes are not suitable for the following populations:

  • Anyone with a mental clinical condition that poses an immediate risk to life and requires constant medical supervision and treatment during hospitalization, such as immediate and tangible risk of suicide.
  • Anyone who refuses to stay and receive treatment in the balancing home or involuntary treatment of any kind.
  • Patients with an uncontrolled physical illness that requires continuous monitoring and intervention.
  • Individuals suffering from anti-social, violent, sexual or severely aggressive behavior that may sabotage the program’s operations or endanger patients or staff.
  • Anyone in prison, who has been arrested or imprisoned, or in a alternative imprisonment framework.
  • Anyone with an active addiction to psychoactive substances (drugs, medications and alcohol), with the exception of maintenance treatment with a drug substitute or treatment with medical cannabis under certain conditions and subject to the considerations of the professional staff at the balancing home and the HMO.

The balancing home operates as a ‘therapeutic environment’ and treatment includes various interventions that are found in the Mental Health Services Basket based on clinical need and the patient’s consent. The treatments are based on a holistic approach that views the individual as a complete medical, psychological and social being. The treatments adopt the latest accepted approaches based on standard medical guidelines, including:

  • Individual and group psychotherapy.
  • Personalized psychiatric and medication therapy
  • Occupational therapy, art therapy, etc.
  • Assistance in advancing recognition of a patient with a mental health disability by the National Insurance Institute.
  • Assistance in recognition and referral of a patient to the Rehabilitation BasketBoard while living in the balancing home.

In addition to these, there are workshops and structured recreational activity such as therapeutic gardening, nature trips, yoga, movement and art. The instructors accompany the patients at all times, in both activities and on trips close to home. The staff of instructors is available to the patients for any need that arises, for a joint discussion or consultation, to remain silent together, etc. To promote normal daily function, the patients actively participate in home care, cooking, cleaning and everything necessary for the operation of the home and daily life.

Therapeutic efficacy in the balancing home

The therapeutic model of balancing homes is in its initial stages in Israel. At the same time, for patients for whom this model is suitable, the therapeutic efficacy in balancing homes is similar to that of hospital psychiatric wards and over time, it appears that therapy in balancing homes prevents recurring hospitalizations. It is also important to note that studies indicate a high level of satisfaction among patients with the service in this framework.

Composition of the professional staff in the balancing home

The multidisciplinary staff includes members of the healthcare professions: psychiatry, psychology, social work, nursing, occupational therapy, nutrition and art therapy. In addition to the professional staff is a large team of counselors accompanying the patients 24/7 who are mentored and guided by the professional staff.

In Israel, there are various types of balancing homes

  • Balancing homes for adolescents (the law requires that minors be kept separate from adults).
  • Balancing home for adults over the age of 18.
  • Balancing homes for treatment of eating disorders, PTSD and comorbidity.
  • Balancing homes with unique characteristics: for women only, for men only, for Arabic society and Ultra Orthodox public.

Important to know

Important to know

Every balancing home must formulate and approve the agenda of home activities with the Ministry of Health. There are differences between the various balancing homes, based on the target population and mental states treated by the home. The agenda refers to the hours of activity and rest, including meal times, hours and types of individual and group therapy, as well as types of activities and workshops.

The therapeutic model of balancing homes

The therapeutic model in the balancing home dictates the approach adopted ion the home: home-like, non-judgmental and containing atmosphere that encourages the patient and family to be partners in the therapeutic process. There are therapeutic approaches in mental health that the therapeutic staff in the balancing homes use as inspiration for therapy, such as:

  • The bio-psycho-social approach

    A holistic therapeutic approach that views all biological, psychological and social aspects of the individual. In addition to viewing the individual in the broader family, social and functional system in which he lives. In this approach, a therapeutic coordinator includes the therapy provided by the multidisciplinary staff to the individual.

  • Soteria

    A model that spearheads an appraoch in which people in psychotic states, including severe mental health crises, need a community-like, warm, loving and accepting space with regular involvement of the patient in every decision pertaining to their treatment. The therapeutic approach of the model spearheads a significant combination of staff known as ‘specialist peers’ or ‘service provision consumers”. These staff members have the requisite knowledge and life experience, and underwent structured training on supervising and supporting the recovery processes. They are not necessarily mental health professionals.

  • Open Dialogue

    The approach is based on a fundamental belief that an open dialogue is required that requires faith, acceptance, respect and equality. These values are achieved through honesty, compassion and discovery of the self and the other, through acceptance, inclusion and remaining non-judgmental of the patient's behavior and feelings. The model promotes the creation of an envelope that combines the patient's therapeutic work with the professionals and meaningful figures in his life such as family members, friends, co-workers and any person who is significant in the patient's life.

Involvement of family and friends in therapy in the balancing homes

Family and other supportive individuals play a critical role in the therapeutic process. If you are a relative or friend of an individual in a balancing home, it is worthwhile and right to demonstrate involvement and willingness to be involved in the process, to maintain contact with the individual and to visit the individual in the home. At the same time, it is important to remain attentive to the ability, needs and desires of the patient in this context as well. In cases where the visits arouse complexity, consult the attending staff on how to proceed.

Visits in the balancing home

Every balancing home establishes a visiting policy for family and friends, and informs the patient of this. It is important to know that guests are not allowed to roam freely in the home and visits generally take place in a designated location and time in or near the home in a way that will not disturb the other patients.

Work and study during the course of treatment in the balancing home

Since this is an intensive setting for the treatment of an acute mental condition that requires hospitalization or an alternative to hospitalization, going to work or school will usually not be possible during the treatment At the same time, towards the end of the treatment in the balancing home and as part of the adaptation and return to function, a gradual return to work or studies will be considered, accompanied by support and guidance from the multidisciplinary staff and with the approval of the attending psychiatrist.

Leaves from the balancing home

Leaves are individually determined according to the policy of each home, in coordination with the patient, based on progress in the therapeutic process and requires the approval of the attending psychiatrist.

The balancing home admissions process

If you or someone close to you is dealing with a mental health crisis that requires psychiatric hospitalization or treatment in a balancing home in lieu of hospitalization, these are the steps you must take:

Contact the staff that is treating you in the HMO and if you have not been treated before, contact your family doctor for an urgent assessment and examination of the need for a balancing home or other intensive care such as outpatient care, crisis team, home hospitalization or hospitalization in a ward.

If a decision is made that the balancing home is the right therapeutic solution for you, the mental health worker who performed the assessment will refer you to an in-network balancing home with the HMO, for a screening and assessment meeting and to examine whether the service meets your needs.

Now you must contact the balancing home and send them the latest detailed psychiatric medical summary with a recommendation explaining the need for hospitalization in a psychiatric ward or balancing home.

The medical summary will be reviewed and an answer will be provided to you as soon as possible, including a date for a comprehensive initial examination ("intake") to assess eligibility for this therapeutic framework.

Highlights regarding balancing homes designated for children and adolescents

  • Balancing homes designated for children up to the age of 12 and adolescents aged 12-18 are adapted to these target populations.
  • The balancing home is a short-term therapeutic framework to prevent psychiatric hospitalization in a hospital's pediatric and adolescent department. This framework does not constitute a solution for out-of-home placement on behalf of the Ministry of Welfare or as an educational framework.
  • Acceptance into the balancing home framework and therapy therein must be with the consent of the child or adolescent, based on the level of maturity, abilities and understanding, and only if the staff of the balancing home believes that the child agrees and is able to stay there and cooperate in the therapy.
  • Expressed written consent in advance of the parents of the minor is required, or if the minor has an appointed guardian, then the consent of the guardian.
  • Parental and familial involvement in the therapeutic process is part of the therapeutic approach in the balancing home. 
  • The balancing home staff includes a significant and permanent adult figure called a "house parent" who accompanies the children every day, cooperates with the instructors, is responsible for fulfilling the significant basic needs of the children and daily conduct.
  • Every child in the balancing home learns according to a comprehensive and individual educational plan that is incorporated into the daily routine and adapted to his age and developmental stage. This plan is compliant with the guidelines of the Free Education for Sick Children Law and in conjunction with the Ministry of Education.

Financing residence in the balancing homes

The balancing homes are a service that is fully funded by the HMOs through prior authorization (Form 17) that involves a deductible of tens of shekels paid directly to the HMO. In most cases, the transfer of the prior authorization will be arranged by the balancing home directly with the HMO, after the patient is found eligible for admission to the balancing home. In this case, no payment to the balancing home itself is required.

You should know that not all balancing homes work with all HMOs. For a list of balancing homes, including information on HMOs with which they work.

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