Barriers to accessing ambulatory mental health care for children in Israel: a multi-centre cross-sectional and retrospective study

Despite increasing psychiatric disorders and awareness, outpatient mental health care for children and adolescents remains limited worldwide. In Israel, a major reform a decade ago aimed to improve access and equity, but disparities and long waits still exist. This study examined service use patterns and parent-reported barriers to identify current challenges in accessing outpatient child and adolescent mental health services. A two-phase multicenter study was conducted. First, a retrospective analysis of 3,446 children’s records from 2015 to 2019 at a Jerusalem outpatient psychiatry clinic compared demographics and service use with regional census data. Second, a prospective survey of 300 parents from 2020 to 2024 across three clinics in Israel assessed delays in help-seeking and perceived barriers in structural, informational, attitudinal, and stigma domains. Service use rose over time but showed disparities. Boys, Jewish children, and higher SES families were overrepresented. Parents reported a mean delay of approximately 25 months from initial concern to first contact with the clinic; Major barriers included long waits and limited access; stigma was less common. Delays and barriers varied little across groups. Structural and systemic barriers, notably waiting times and limited service capacity, were the most frequently identified factors delaying families upon presentation at participating clinics. While stigma was less apparent at the point of clinic contact, our findings highlight barriers solely as delaying factors; their relative significance as deterrents among families who do not seek care may vary. The findings emphasize the necessity for policies aimed at expanding the workforce, reducing waiting times, and enhancing equitable access to services.