Commissioner for Mental Health Dr John Cachia. Photo: Jonathan BorgCommissioner for Mental Health Dr John Cachia. Photo: Jonathan Borg

Commissioner for Mental Health John Cachia is calling for a radical approach in the mental health sector: providing the mainstay of care in the community.

“Early care in the community – whether at home or health centres – would save us a lot of anguish, pain and hardship,” he said, reiterating a call he has been making for years.

“I will continue insisting on the mainstreaming of mental healthcare, as I think it is a justified cause and we need to push for mental health to be at par with physical health in all senses,” Dr Cachia said.

Dr Cachia was speaking to the Times of Malta five years since he officially took on the role of Commissioner for Mental Health.

One of the issues he has been trying to hammer home is that elderly Mount Carmel Hospital patients, whose psychological needs have been addressed, should be moved out of psychiatric wards and into a more adequate environment.

In his 2014 report he noted that wards where social care only is required should be declassified as psychiatric facilities and re-classified as residential accommodation for long-term care.

Asked about the dated conditions of some wards at the hospital, Dr Cachia noted that the country could not continue to depend on the goodwill of the staff, who make up for the shortcomings in the environment. 

In his latest report, issued last year, the commissioner noted that safety measures and the physical environment were in dire need of improvement in most wards in Mount Carmel and the Gozo General Hospital.

Last week, the Times of Malta reported that a man had died after contracting legionnaires ’ disease from the water system at Mount Carmel.

While insisting on short-term measures to improve the environment for patients who need acute care at Mount Carmel, Dr Cachia believes the mainstay of care should be in the community.

“We need to shift the focus of mental health service from a hospital to a community-based service. But in order to do that, we need a structured community service for the whole island.”

This requires specialised teams of nurses, psychologists, occupational therapists and social workers, backed up by psychiatrists and doctors, to provide support for anxiety, depression and mood disorder symptoms, among others, at people’s homes or at health centres.

Unfortunately, such a service is only provided in Qormi, Cospicua, Floriana and Paola.

Asked about the Crisis Intervention Service, Dr Cachia said the team should be able to go on site to tackle mental health crises, while also providing support to those patients in the emergency department who need someone to talk to.

“The unit cannot be detached from the physical emergency services,” he said.

“Mainstreaming means that we treat a psychiatric emergency as we would a physical one – through different people, of course. Currently, there isn’t anything along these lines, and the unit should be re-established on these principles.”

Although Dr Cachia seems to have been pointing out the shortcomings for years, there have been improvements in the sector. Firstly, patients kept against their will are being cared for within the time frames stipulated by the Mental Health Act.

Secondly, in the past four years, his office is not aware of anyone being subjected to what would be, in Council of Europe terms, torture or inhumane or degrading treatment.

Awareness of mental health issues is gradually increasing.

However, it needs to be backed by a formal strategy and action plan that is costed and resourced properly so that we know the way forward from a mental health perspective, he added.

Involuntary admission to a psychiatric facility

▪ Asylum seekers and those hailing from war-torn countries have seven times the risk of being admitted.

▪ Other foreign workers, most of whom are residing miles away from their families and do not have social networks, are three times more likely to be admitted.

▪ Having spent years in childrens’, elderly or prison facilities, the risk is tenfold.

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