The personal and the national: Lessons learned in the aftermath of the October 7 attacks in Israel

•The October 7 attack and the subsequent war present a unique set of challenges.•A major issue is the continuous stream of prior and new country-level trauma.•Integrative interventions provided were guided by psychological first aid principles.•We discuss the mental health response in the context of past disasters.•We present new lessons learned at the individual and system level. On October 7, 2023, terrorist organizations led by Hamas, launched an extensive attack on Israel. Within days following the initial attack, there was a clear need to provide psychological support to individuals who were exposed to the horrors of the October 7 attacks. Tel-Aviv Sourasky Medical Center – Ichilov, a tertiary medical center, launched an emergency mental health service to provide psychological first aid to the first-line victims of the war. As the fighting spread, the services were extended to the entire population. The intervention we provided was guided by an integrated approach that promotes introspection and connectedness to one's environment and community, enhancing cognitive functions, emotional regulation and utilizing available resources to reduce distress. The main themes that emerged shifted between feelings of helplessness and a sense of agency; a breach in basic trust and renewed trust, guilt and self-compassion; anger, abandonment and alienation versus solidarity and connecting to the present and the future, despair versus hope and loss versus acceptance and connectedness. The following account reflects our experiences from the unique cooperation between the Mount Sinai Medical Center in New York and the Tel Aviv Medical Center in Israel starting from the days following the October 7 attacks, as well as lessons learned at the individual and system level discussed in light of previous literature and experience.