February was dedicated to cancer prevention. In an e-mail communication entitled ‘National Cancer Prevention Month’ issued on February 3 and addressed to all employees, the Corporate Social Responsibility (CSR) Committee within the ministry for health and active ageing listed various prevention tips to raise awareness about cancer prevention, early detection and healthy lifestyle choices.
I commend this initiative. As Commissioner for Mental Health, my thoughts take me to those with mental health difficulties and the increased hardship when facing other health issues like cancer.
These prevention tips may sound obvious to most of us but may not be so for persons with mental health difficulties because of concomitant vulnerabilities. Their physical problems sometimes end up as second priority.
In the fight against cancer, a one-size-fits-all strategy might not resonate well with those struggling with a mental illness. A more targeted and personalised approach is required to factor in the additional vulnerabilities.
The Office of the Commissioner for Mental Health has long advocated in this regard. We need concrete action if the fight against cancer is to truly incorporate persons with mental health problems.
I shall reflect on a few of the prevention tips that were listed.
Staying active
During a visit to any licensed mental health facility, one cannot not notice the general inactivity of inpatients or residents with mental health issues.
Psychiatric problems, as well as side-effects of medications, can impede physical activity for these patients through no fault of theirs.
Despite the availability of gym equipment at Mount Carmel Hospital and the possibility for patients to participate in different forms of physical exercise on a regular basis, patient inactivity remains very pronounced.
Various reasons try to justify this, namely relevant logistical arrangements, constrained resources and the cramming of most ward duties in the morning, leaving little time for physical activity.
Furthermore, participation in physical activities is also, in part, dependent on permissions granted by the respective responsible specialist. In Gozo General Hospital, a section with gym equipment was closed and the equipment stored.
Physical activity hardly ever features in patients’ multi-disciplinary care plans and might not be given its due importance in the patient rehabilitation plan.
Staying active helps fight against cancer but it also has a positive therapeutic effect on the person’s mental health.
The open spaces on the hospital grounds in both Malta and Gozo should be better optimised to encourage patient mobility and physical activity under the supervision of sport professionals with experience in mental health.
These opportunities should also be extended to the afternoon hours instead of having persons staying idle in the wards.
It is important to highlight that some wards have separate gardens, access to which is prohibited for various reasons.
Physical activity hardly ever features in patients’ multi-disciplinary care plans
Avoiding tobacco
The prevalence of smoking in people with mental health issues and in mental health institutions is much higher than that in the general population, and urgent and specific action is needed to address this.
Because of long periods of inactivity, hospitalised mental health patients may smoke more; if not actually start smoking there. Smoking in mental health institutions is often used to relieve boredom, as a reward or incentive for appropriate behaviour or to help build relationships or to avoid confrontation.
Health promotion and awareness training, access to Quitline services, free nicotine replacement therapies and smoking intervention services (including yoga sessions) should urgently be considered for those suffering from mental health problems, both inpatient and those in the community hostels.
Caring staff should be fully trained on the dangers of smoking and provide brief intervention sessions themselves as appropriate.
Passive smoking in these situations must be urgently addressed and designated smoking areas should be professionally designed, equipped and maintained without exposing other patients and staff alike to passive smoking.
Failure to address smoking among persons with mental health disorders and, especially, those living in long-term mental health institutions, is a gross perpetuation of health inequalities and unfair treatment and can further increase the risks of cancer.
Every encounter with mental health services and admission to a mental health facility should be perceived as an opportunity to reduce smoking and to offer support to quit smoking.
Sun protection
Leading an active lifestyle and making the best use of outdoor areas need to be promoted because of the therapeutic benefits which help improve mental health.
Notwithstanding this, patients and carers alike should be aware of the damage associated with prolonged sun exposure, especially during peak hours.
A high protection factor sunblock together with the provision of headgear should be given to all patients who enjoy the outdoors.
Scheduling of regular screening
I end this reflection on a positive note.
Rather surprisingly, an analysis of data from the National Screening Programme and Pharmacy of Your Choice (POYC) carried out in January 2023 revealed that persons taking medications for chronic psychiatric conditions through the POYC scheme were more likely to participate in the national screening programmes for breast and colon cancers (72.5% and 57.8% respectively) when compared to the general population (58.5% and 46.1% respectively).
While these results need to be interpreted with caution and monitored over time, this finding augers well and should give us the impetus to sustain these results while working on areas that merit more attention.
More research needs to be done to determine whether the stage a cancer is diagnosed in persons with mental health problems is different from that of the general population and whether the cancer survival rates are any different.
The fight against cancer is indeed national but it must specifically target persons with mental health problems.
Denis Vella Baldacchino is Commissioner for Mental Health.