Exemption on mental health grounds
If you feel you cannot serve in the military due to mental health reasons and therefore want to receive “Profile 21,” below is a short and general description of the process you should follow, which is relevant for youth designated for service, for regular soldiers, and for reserve soldiers:
- Obtaining documents from civil mental health professionals which describe your mental health situation. These documents usually help in fixing an appointment with a military mental health officer (“Kaban”) and in promoting exemption on mental health grounds.
- Meeting a military mental health officer (“Kaban”).
- If the Kaban will look at your problem seriously, s/he will refer you to a psychiatrist, who will decide if to exempt you from service.
- In this case, the psychiatrist will refer your request to a medical committee, which approves the decision and actually serves as a rubber stamp in the process.
If your commanders haven’t transferred your request, or if the Kaban didn’t deal with your case seriously, you may submit a complaint. If the Kaban behaved in a harassing or offensive manner, your complaint might lead to you being assigned a new Kaban. Take in consideration that sometimes submitting a complaint might result in harassment by military officials.
Along the process there will be various points of uncertainty. Officials may not believe you or attempt to frame you as a liar. But if you know your mental health doesn’t enable you to serve, do not let their behavior confuse you and remain confident in the fact that nobody else knows what you are going through as you do. If one attempt doesn’t work, you can try again and again.
Most importantly, under no circumstances hurt yourselves and do not try to forge a suicide attempt or self-injury. These are not good ways to cope with the difficulties the military raises. It is dangerous, it won’t help and it will just create new problems without solving existing ones. In some cases, a suicide attempt might even result in forced hospitalization. We encountered quite a few cases in which the military itself referred a soldier to emergency room following a suicidal attempt, but the matter was covered up by the commanders and the soldier remained in the military, without receiving mental health exemption. In short–this is neither efficient nor recommended.
Documents from civil mental health officials
Professional documents from civil mental health officials like psychiatrists, psychologists, social workers, and other certified caregivers can greatly assist in gaining profile 21. The documents should be in Hebrew or translated into Hebrew by a professional. At the end of each meeting with a professional you will receive a “summary of treatment,” a document which details the symptoms a professional noticed during the meeting with you. If it is a psychiatrist, the summary will include your psychiatric diagnosis, based on the mental and behavioral symptoms s/he identified according to professional guides such as the DSM, the American Diagnostic and Statistical Manual of Mental Disorders (you can read about the various diagnosis and symptoms by googling DSM and the name of diagnosis). According to the law of patient rights, it is your right, and your parents’ right if you are under 18, to receive any medical document related to you. After the meeting, ask to receive the summary from the clinic office. The psychiatrist will decide how many meetings are required in order to provide a diagnosis. There is no point in rushing a diagnosis, but you should tell her/him if the situation is urgent.
The meeting summary is not supposed to mention the military, and better it won’t, because this might create an impression that the documents are “pre-ordered,” decreasing their credibility in the eyes of military officials and perhaps even evoke antagonism. It is also better that the document not include recommendations to the military officials, inducing Kabans and psychiatrists on the military’s behalf, who do not like to be told by civil officials what to do. Any professional document referring to your mental situation and reflecting severe enough mental distress ought to be sufficient, and it will be perceived as more credible if it does not mention the military, but is limited only to the mental situation of the patient.
How to get these documents?
- The cheapest option, which is also perceived as the most credible by the military, is to go to your family doctor in ’kupat holim’ and ask for a meeting with a psychiatrist. It should cost around 100 NIS. After the meeting you can ask the clinic for the meeting summary.
- You can go to a private psychiatrist and pay at least 600 NIS per meeting and additional 1000-3000 for a document s/he will prepare (which, again, should not mention the military).
- You can go to an emergency room of a general hospital (not psychiatric hospital). If you have documents from kupat holim you will not have to pay, otherwise it will cost you 800-1000 NIS during the day, or 200 NIS at night. In most cases, your kupat holim will pay this sum in retrospect. At the end of the visit you will receive a “release letter” containing a medical impression of your situation. Emergency rooms are very crowded, and out of consideration for other patients, you should go there only in difficult and urgent cases, or when you don’t have any other choice.
- You can meet a psychologist and ask for a meeting summary. If you’re already being treated by a mental health professional it will be best to ask her/him for documentation, as a continuous therapeutic relationship might strengthen the value of the document. For youth designated for service, a letter from the school teacher or consultant may also help, but it might not be enough for fixing an appointment with a Kaban and you may have to insist.
- A soldier in regular service or a deserter for up to 60 days is supposed to receive medical services from the Israeli Military. During this period your kupat holim’s medical insurance is not valid, so in order to meet a psychiatrist you have the more expensive option of meeting a private mental health professional in order to receive a document testifying to your mental health situation.
- After 60 days of AWOL or desertion you are again entitled for medical treatment in your kupat holim, where you can fix a subsidized appointment with a mental health professional.
- Under urgent circumstances, where there is not enough time to fix an appointment with a psychiatrist, or when the situation is severe (for example during an anxiety attack) you can go to the nearest emergency room. The release letter you’ll receive there can serve you vis-a-vis the military. Please note: it is important to go to an emergency room of a general hospital and not to a psychiatric hospital, because only there you will receive a medical document testifying to your situation without hospitalization. It is also important to go there independently and not through the military in order to receive a serious medical treatment. You will be required to sign a commitment to pay the hospital, but if it was medically justified, the military is supposed to cover the cost.
When you go to meet the professional, especially in emergency room, it will help to be accompanied by a relative or a friend who could help explain your situation and distress, ensure you are treated decently and respectfully, ensure that you are not forced to do things against your will, and be with you while you wait for your turn since a wait in emergency rooms can last long hours. Having a supportive person with you can help out you at more ease and also help professionals realize there is a serious problem here.
The procedure of exemption
The procedure of getting exempted on mental health grounds can be exhausting and last months, but it does not entail risks such as imprisonment. Please note it is very important to keep trying: if it didn’t work once, there’s a big chance it’ll work if you repeat it and don’t give up. Many discontinue their military service by this type of exemption.
1| Getting an appointment with a military mental health officer (“Kaban”)
You can try to send medical documents with a clearly documented diagnosis to the recruiting office before being summoned for preliminary military checkups. However, the military will most likely insist that first you’ll go through checkups, regardless of your condition, and only rarely will they be willing to look at those documents beforehand.
Upon being summoned for preliminary military checkups, you will receive a medical questionnaire which you and your family doctor are required to fill out. It is important to mention any medical problem to the full extent, without forgetting or hiding information. If you have a history of psychological therapy, make sure to mention it where relevant, as it will usually prompt the military to summon you for a conversation with a Kaban, usually on a separate date. If you haven’t been treated psychologically, but you have a psychological distress you want to bring up, there is a benefit to meeting a civil psychiatrist or a psychologist ahead of time, if you can.
During your preliminary military checkups, it is important to mention your psychological distress, and even explicitly ask for a meeting with a Kaban. Beyond that, remember that through these checkups, (psychotechnical, reading comprehension, and more) the military intends to estimate the level of your compatibility to be a soldier and to match you to various possible positions within the military. They are trying to gain an impression of your level of motivation to serve. If you have no intention to prove that you’re going to be an excellent soldier, whose service the military won’t likely miss, you do not have to invest in the checkups, which results are used only by the military. Usually, the more the military estimates you are going to be a soldier of “high quality,” the longer and more complicated your exemption process will be, The less the military wants you, the greater the chance they will prefer to grant you exemption due to psychological distress, which under other circumstances might not be enough for an exemption.
Send Meitav documents from civil professionals (psychiatrist, psychologist, and any other mental health professionals) which testify to your mental state. Also an opinion on your psychological situation from your school consultant or teacher can help. Attach a letter to these documents, which summarizes the diagnosis and includes a request to meet a Kaban. After sending the documents in at least one of the ways mentioned in Meitav’s website, it is very much recommended to make sure they were accepted and being treated. It is important to contact Meitav as early as possible before enlistment date, because military procedures tend to be slow. This way you’ll also be relieved of pressure and enhance your chances for exemption. When needed, repeating and assertive letters to Meitav, and phone calls to Barhan Tel Hashomer (Mental health department of the Israeli Military, 03-9489999) can assist you in meeting a Kaban before conscription.
This is your last chance to meet a Kaban while still outside the military system. After becoming a soldier, the procedure becomes much more complex. If you can help it, don’t wait until enlistment day with your request to see a Kaban, but do it earlier by contacting Meitav, even if it is just a few weeks before enlistment. Take into consideration that contacting them only a few days before is too late to arrange a meeting with a Kaban on enlistment day. At the same time, make sure you have documents from civil professionals (psychologist, psychiatrist, social worker, emergency room documents) describing your distress.
In order to have a meeting with a Kaban with less complications and risks, you can arrive on your enlistment day to your local recruitment office and not to the Tel Hashomer recruitment base (Bakum). It is important to have professional documents with you, and you’ll have to insist in order to enter. In the recruitment office, they will usually postpone your enlistment day and fix an appointment with a Kaban for you, without risking arriving to jail or basic training (Tironut).
If you do arrive at Bakum on your enlistment date, the conscription process does not include a mental health check, so it is important to ask to see a Kaban from any official along the conscription process, and even before this process starts. Express your distress and present your medical documents diagnosing your situation if you have them. The recruitment soldiers will try to refer you from one soldier to another and from one officer to another. Give them all a feeling that the reason for your being there is meeting a Kaban, until you’ll encounter one who will allow you to actually meet a Kaban. It’ll happen only if a commander would understand you really need it and cannot go through the conscription process due to real difficulty.
Possible reactions of soldiers and commanders along the conscription process:
- “First go through the conscription process/preliminary interview/basic training, and then you can see a Kaban.” This is not true. There is a possibility of meeting a Kaban before basic training, and those telling you otherwise simply do not want to make the effort.
- Promises (“do X and you’ll get what you want”) or threats (“if you won’t do X, we’ll put you in jail”). Usually these are lies meant to manipulate you, make you obey the standard regulations, and get drafted. Don’t be alarmed. Think about if what you are asked to do makes sense, and do only what you can do given your situation of distress.
After the meeting (see more below), the Kaban will decide if to refer you to a military psychiatrist, and from there, if to refer you to a military medical committee, or to fix you a new enlistment date. If it is the latter, you have time to meet with another Kaban, and it is necessary that beforehand you’ll obtain more documents from civil professionals regarding your psychological situation. The key here is insisting, and clearly this is not simple in the mental condition you may be in. Stay in contact with us for support in the process.
In any stage during your regular service, you can ask your personal commander or your base clinic to see a Kaban. According to military regulations, you have to meet a Kaban within 14 days from the day you requested, even though usually it takes commanders longer to deliver the request. In such cases, it can help if you could let them know you are aware of the regulations and of your rights. In cases when commanders have the impression a soldier is in psychological distress, for example, if someone is at real risk of hurting herself, they have to let her meet a Kaban within 48 hours. Make sure your request isn’t being ignored, and when needed repeat it again and again, while expressing your functional difficulty in service.
Basic training is the hardest period in which to receive exemption. You might be allowed to meet a Kaban fast due to the fear you’ll carry a weapon, but often you’ll be told there isn’t a Kaban available for meeting. You may be told: “it is difficult for everybody during basic training, first finish it and then we’ll see,” or “it’ll be easier for you to meet a Kaban after finishing basic training and move to a permanent position/base.” In reality, there are Kabans in the training basecamps, and if your psychological situation requires so, insist upon meeting one already during training. You might receive such reactions in any stage of your military service. Later, they may say: “finish your course and then it’ll be easier to meet a Kaban.” It is their way of creating obedience. If you are sure you cannot make it, continue to insist upon seeing a Kaban now, as urgently as possible. Perhaps even the Kaban you’ll meet in basic training will tell you: “basic training is difficult for everybody, finish it and you’ll see you’ll be fine,” or “finish basic training and then we’ll talk about exemption.” Here, too, if you insist, and manage to convey your distress to the Kaban, they may exempt you from service.
If your commanders don’t respect your request and don’t fix for you an appointment with a Kaban, contact the Israeli Military’s Public Inquiries Officer or its Medical Corps’ hotline (03-9489999), better equipped with a document from a civil mental health professional. In these cases, it will help if one of your parents will call and describe your situation and why you are worrying them.
If your psychological situation made you go AWOL or desert service, it is very important to take care of it as soon as possible due to the risk of imprisonment. The right you had as soldier to meet a Kaban is not valid anymore, but there is another option: you can go to the mental health center (Barhan)* in Tel Hashomer (or if you’re in the air force, to Yarpa in Tel Hashomer), and insist on meeting the Kaban or Kapas (psychology officer) on duty, without pre-appointment. In this case, it is necessary to have documents testifying to your psychological situation. You might have to wait a few hours until your request will be met. Perhaps they won’t enable you to meet a Kaban, but will contact your unit and ask them to arrange such a meeting for you upon your return, prior to your trial. If you are in a situation of AWOL or desertion, it is very much recommended to be in touch with New Profile’s Counseling Network.
* Arrive in Tel Hashomer main bus terminal, go towards the main base gate (North/Kidron gate), and 20 meters before it you’ll see a guard. This is the entrance to Barhan.
2| Meeting the Kaban
A Kaban is a social worker, psychologist, or psychiatrist who is also an officer working for the military. He has the authority to conduct support and consultation conversations with soldiers or with youth designated for conscription, and to recommend giving them exemption from service or easier service conditions. It is recommended to arrive at the meeting with the Kaban with documents from civil mental health professionals, presenting the difficulties you cope with.
The Kaban diagnoses situations of mental distress based on symptoms known in modern medicine, for example according to DSM, the American Diagnostic and Statistical Manual of Mental Disorders. For example, s/he will diagnose a person as suffering from depression based on symptoms such as lack of appetite, sleep disorder, slow movement, lack of energy, tired appearance, lack of interest in the surroundings, etc. It is clear to us that not everyone suffering from mental distress fits exactly to all known symptoms of a certain disorder, and some Kabans understand it, too. In order for the Kaban to diagnose the mental disorder you suffer from you don’t have to have all the symptoms, but some of them.
During the meeting with a Kaban, which lasts usually between 20 minutes and an hour, you’ll be asked about the nature of your distress, the way you function in various fields of your life, former background, family history, and more. You don’t have to answer questions which embarrass you, overload you emotionally, or to which you don’t know the answer.
At the end of the day, the Kaban doesn’t expect you to explain rationally why you cannot be in the military, and there are no “right” answers to questions on your mental state. His/her impression from you doesn’t depend only on the information you give him/her, but is determined mainly in the intuitive level of non-verbal communication: your manner of speech, the atmosphere you induce, the clothes you wear, the way you sit and behave, eye contact (and its absence), and his/her general impression of you and your situation. If the Kaban asks you, for example, how many friends you have and you answer 2-3, your eyes might light up thinking of your wonderful friends, transmit distress due to the loneliness you feel, or convey fear from the loneliness you might experience following enlistment. There is no right or wrong answer and your number of friends doesn’t really interest the Kaban–this question is just his/her way to understand how you perceive the world and what your psychological situation is.
The Kaban diagnosis depends on him/her identifying signs of distress or of mental health difficulties, so remember that only what is related to your mental situation should be discussed with him/her–not your consciousness, your political beliefs or your family economic difficulties, unless they relate to your mental situation. The Kaban should only refer to mental distress and difficulties, and based on them decide if there is a reason for exemption.
You might have to meet the Kaban more than once in order to be summoned for a meeting with a military psychiatrist, which is the next stage in the exemption procedure. In any case, after each meeting ask to know its conclusions, whether there is going to be another meeting, and when. Despite your difficult psychological situation–and due to it–what is most important in this procedure is to persist and insist.
3| Meeting the military psychiatrist
The military psychiatrist is supposed to approve or reject the Kaban’s recommendation to give you profile 21 and exempt you from service, or give you certain service conditions. Meeting him/her usually lasts 15 minutes and takes place after s/he reads the civil professional documents you have delivered, as well as the Kaban’s recommendations. The psychiatrist will ask you similar questions to those you were asked by the Kaban. It’ll help if you maintain a consistent line in your answers and refer to the same points we detailed earlier regarding meeting the Kaban. In addition to the content of your answers, the psychiatrist too will take into consideration non-verbal signs, such as your body language and your clothes, and will diagnose your situation based on the symptoms s/he notices during the meeting. This meeting is important and crucial in the exemption process, since it is there the final decision is usually taken. If the psychiatrist decides on exemption, you will be referred to a medical committee which would approve the exemption.
4| Medical committee
If you were sent to the medical committee following the recommendation of a military psychiatrist for an exemption, you have nothing to worry about–you’re out. In the committee meeting, which lasts a few minutes, committee members will ask you a few questions in order to check and verify the information you presented for the Kaban and will approve the exemption. You might also be offered to volunteer to the military. Sometimes, especially if you’re not 18 yet, you will not be asked to attend the committee but rather to sign a form which enables it to meet without your presence. You’ll receive the exemption by mail.
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Exemption on physical health grounds
If you have a serious medical problem that you think prevents you from serving in the military, you can try to receive exemption from service on this ground.
If you are before conscription or in reserve duty, you can contact your family doctor and a medical specialist. Send the medical documents you’ll receive from them to Meitav (if before conscription) or to your liaison officer (if you are on reserve) and ask to see a military doctor and a medical committee. It is important to contact them as early as possible, because military procedures tend to be slow. This way you’ll also be relieved of pressure and enhance your chances for exemption. After sending the documents to Meitav, it is recommended to call and make sure they were accepted and being treated, otherwise they may be ignored.
If you are a soldier in regular service, you’ll have to contact the military doctor and ask to meet a medical committee. There is a high probability you’ll be required to bring medical documents from private expert doctors who will confirm your diagnosis. Please note, as regular soldiers, the military is supposed to financially cover your treatments and medications, but it doesn’t always happen and it might require insistence. The process includes comprehensive checks by military doctors and a meeting with a medical committee, where you’ll go through further physical checks, as well as be questioned on your physical condition. You should prepare in advance and base all of your answers on your medical documents. The Committee is authorized to give an exemption from service or change the medical profile already assigned to you. It is important to arrive at the committee equipped with as many organized and accessible medical documents attesting to your condition so you can easily access the relevant document at any moment. Perhaps the committee members will not be very nice, but don’t be stressed– their pressure might confuse you and make it hard for you to answer to the point.
The committee can decide to change your profile to 21, which will grant you a permanent exemption from service, or to profile 24, meaning you are temporarily unfit for service. If you are convinced your medical problem prevents you from serving permanently, you can appeal the latter decision within 30 days and insist on getting fully exempted. It is your body and you know better than the committee what you are capable of. Even if your problem might be temporary, it doesn’t matter. Military service is temporary too, and if you insist on putting your health at a higher priority than a duty to serve, it is very likely the committee will be convinced and that you’ll receive profile 21. If you received profile 24, tried to appeal and didn’t succeed–don’t worry. You can return to the committee when your temporary profile ends and ask again for profile 21. You’ll have to bring all medical documents again, which should be up-to-date.