The State of Israel, established 64 years ago, in May 1948, is a country in Western Asia located on the eastern shore of the Mediterranean Sea. Geographically it contains diverse features within its relatively small area. Israel is the world’s only predominantly Jewish state, with a population of 7.5 million people, of whom 5.7 million are Jewish. Arabs, Muslims, Christians and Druze form the country’s additional ethnic groups, and other smaller groups include Bedouins, Circassians and Samaritans.

Israel is a developed country and a representative democracy with a parliamentary system and universal suffrage. The Prime Minister serves as head of government and the Knesset (the Israeli Parliament) serves as Israel’s legislative body. The economy, based on the nominal gross domestic product, was the 41st-largest in the world in 2008. Israel ranks highest among Middle Eastern countries on the UN Human Development Index, and has one of the highest life expectancies in the world. Jerusalem is the country’s capital, although it is not recognized internationally as such, while Israel’s main financial center is Tel Aviv.

Israel is a multicultural state by its nature. Its population includes those of different origins, cultures and religions. Even among the Jews, who compose the majority of the population, one can find a significant variability in terms of origin, society, and cultural and religious background.

The quality of a society can be ascertained through the quality of its prisons. It seems that there is no better mirror of the Israeli society and the State of Israel than the Israeli Prison Service (IPS). This organization was developed in parallel to the Israeli State, and it reflects political, cultural and societal processes that shaped the State of Israel since its very beginning: violence, drugs, sexual offending, corruption and road accidents. In 2009, there were about 23,000 prisoners in 32 prisons (http://​www.​ips.​gov.​il/​Shabas/​tipul_​prisoner/​Prisoners+Info/​prisoners_​no.​htm, last retrieved on August 8, 2010; in Hebrew).

The IPS is a security organization that has a clear social mission and is an integral part of Israel’s system of law enforcement. Its chief roles include the holding of prisoners and detainees under secure and suitable conditions, while preserving their dignity, meeting their basic needs, and providing corrective tools to inmates for whom such tools are appropriate. The function of these corrective tools is to improve the prisoners’ capacity for reintegrating into regular society after their release. The corrective tools are provided in coordination and cooperation with relevant national, regional and municipal authorities and organizations. To achieve that goal, the IPS makes every effort to continually enhance the professional skills of its prison guards and to develop suitable and humane incarceration facilities that meet the demands of the law and the security and corrective treatment needs of IPS prisoners and which express a thorough utilization of advanced technology.

Many ethical dilemmas were prevented as a result of the Israeli government’s decision to distinguish between the functions and the responsibilities of the mental health services of prisoners and detainees, and the IPS. The mental health services are managed by the Ministry of Health, whereas security and logistics are run by the Ministry of Public Security (Silfen 1985). This division enables the psychiatric system to operate according to special Israeli laws that are designated for handling such issues as psychiatric commitment, forced treatment, and patient rights (Treatment of Mental Patients Act 1991; Patients’ Rights Act 1996).

The mental health services of the IPS are supplied by the forensic psychiatric section of the Be’er Yaacov-Ness Ziona Governmental Mental Health Center. The section (also called IPS Mental Health Center) includes two active psychiatric wards (open and closed), located within the central prison of the IPS, and outpatient clinics within other prisons, supplying ambulatory services to the prisoners. The various mental health services of the IPS include ongoing, continuous psychiatric treatment as well as forensic examinations and assessments. The professional staff includes psychiatrists, psychologists, clinical criminologists, nurses, social workers, occupational therapists, and administrative staff. Apart from multi-professional individual and group treatments, the mental health professionals supply the following: ambulatory examinations and expert opinions to courts about mental health and treatment needs of prisoners; risk assessments of various prisoners; assessment of prisoners’ competence for leave and parole; expert opinion about prisoners’ appeals; professional advice to prison authorities regarding prisoners’ treatment; participating in various local multi-professional tribunals and committees (e.g., incest, family violence); and professional connections and co-ordinations with other community agencies (e.g., families, social security, social workers, mental health clinics).

IPS’s mental health center also serves as training and teaching center in multiple clinical areas: psychiatry, psychology, social work, nursing, clinical criminology, and occupational therapy. The center is affiliated with the Sackler School of Medicine of the Tel Aviv University, as well as other faculties at Hebrew University and Bar-Ilan University. Students of the above professions are practicing in IPS’s mental health center in order to get their professional license. The teaching and training facilities are intertwined with the research activities of the center.

It is well known that being in prison causes a lot of stress for almost every prisoner, due to lack of personal freedom and autonomy, removal from support systems, diminished self-value, and sexual deprivation. Research surveys have shown high frequencies of psychiatric disorders among prisoners: the most comprehensive survey was published by Fazel and Danesh (2002). One can appreciate the extent of mental disturbances among Israeli prisoners by data of hospitalizations and ambulatory treatments. Thus, according to the Israeli Ministry of Health Annual Statistics for 2003–2004 (Ministry of Health 2004), 399 prisoners were hospitalized in the psychiatric wards of the IPS Mental Health Center between July 1st, 2003, and 31st July, 2004. 209 (52 %) were new admissions, and 190 (48 %) were recurrent ones. Psychotic disorders were diagnosed in 53.4 % of cases, personality disorders in 25.8 %, organic disorders in 5.3 %, alcohol and/or drug addiction or abuse in 4.8 %, neurotic disturbances in 3.8 %, mental retardation in 0.8 %, and other diagnoses were given in 6.1 % of cases. The data also suggested that about 3 % of all prisoners in Israel (in 2003–2004) needed psychiatric hospitalization.

In Israeli prisons, there are detailed rules regarding the treatment of prisoners who are at risk for committing suicide. Thus, prisoners who are at high suicidal risk are observed every 15 min, and in certain places a closed-system TV is used. It should be mentioned, however, that these measures are no substitute for direct communication with the attending professionals, who prevent suicide attempts by early recognition of signs of stress, and by personal and group treatment for prisoners who tried to commit suicide or are threatening in doing so.

In spite of the distinction mentioned above (between the IPS and the professional mental health services), some ethical issues cannot be avoided. Some of these issues are unique to the State of Israel, which is a multicultural state by nature. In their daily routine, mental health professionals working within the IPS have to be very sensitive to religious and ethnic diversity. They have to be well acquainted with different peculiarities, such as how to address a religious Jew who committed a sexual crime without offending him, and how to motivate him to participate in a sex offenders’ treatment program. They also have to be familiar with the ways in which a distinctive ethnic origin reflects itself in psychopathology and also in criminology.

An important and large group of IPS’s inmates consists of minorities (mostly Arabs, but also Ethiopian and Russian immigrants, and foreign workers from all around the globe and refugees from the Sudan, Eritrea, etc.). Although some of them speak Hebrew, the mental health professionals prefer to communicate with them through an interpreter, in their mother tongue. Another large group consists of security detainees, some of whom have been involved in serious terrorist assaults. With this group the mental health professionals have to maintain a humanitarian and professional approach, and be aware of counter-transference reactions, especially in periods following terrorist attacks.

In this chapter, using case vignettes, the following issues will briefly be discussed: solitary confinement, restrictions and prohibitions, incarceration of prisoners with severe deterioration in mental state, treatment of illegal immigrants, suicide prevention, and treatment of security detainees. Unfortunately, no statistics are publicly available about the scope of the problems. Special attention will then be paid to the issue of treating sexual offenders in Israeli prisons, as reflected in a detailed case vignette that includes clinical as well as legal aspects.