Over the past decade or two, one very welcome development within the area of mental health in Malta has been the decrease in the level of social stigma associated with psychiatric conditions.
Although we are not yet quite at the optimum level of social acceptance, many more people now speak openly about their conditions and employers are more understanding and willing than ever before to extend the necessary support to workers who may require periods of hospitalisation and other forms of care.
Stigma thrives on the notion of a perceived distinction: the assumption that those who suffer from lack of mental health – which very often is a temporary state of affairs especially in its more acute phases – are so different from the rest that they should be considered as somehow inferior. This is manifest nonsense.
Yet, the way society has historically reacted to mental illness, including the way treatment was offered, has both reflected and reinforced this notion of a stigmatising difference between sufferers and non-sufferers. Mental hospitals were often built away from inhabited areas (Mount Carmel Hospital, built 150 years ago, is the perfect illustration).
Nurses and other care-staff were selected on the basis of characteristics like physical strength rather than empathy and medical knowledge. The better resources were reserved for treatment of physical illnesses which the majority of the population considered itself to be prone to. People with mental health difficulties were shunned and ostracised if not actually bullied and maltreated. Suffering was often immeasurable.
While conditions and attitudes have improved markedly, it is unlikely that the lot of those who face psychiatric difficulties will improve sufficiently unless the question of stigma is tackled head-on. One very effective way of doing this is encourage mainstreaming, that is, doing away with the distinctions bet-ween physical and mental illness in the way treatment is offered.
The plans to build a psychiatric hospital within the grounds of Mater Dei Hospital are clearly an important step in this direction as is the availability of an emergency psychiatric service on 24-hour basis at Mater Dei.
The Mental Health Strategy which should shortly come into operation clearly recognises the need for continued de-stigmatisation of psychiatry and its patients through integration of psychiatric services within physical care services.
One of the most effective means of combating stigma is the empowerment of psychiatric patients. The concept that all individuals should, as far as possible, take control of, and assume responsibilities for, their actions, their welfare and their future is, in reality, a process which has already started being actuated in some non-governmental and governmental services. This process encourages users to be self-reliant and participate in decisions which affect their well-being and their future as well as contribute towards the wider community through voluntary work and participation in civil society.
The services must ensure that users are well-prepared to assume a more active role in their lives. Educating patients is a top priority. The recently-launched glossary of terminology from the Mental Health Act is an excellent example of an indispensable educational tool which can empower mental health service users and help them claim and assert their right to self-determination and ensure that their dignity is worth are recognised and respected.
May many other similar initiatives aimed at enhancing psychiatric service users’ efficacy and self-esteem follow.