The first time I set foot in Mount Carmel Hospital (MCH) as a doctor was in 2005. I was excited to finally work in psychiatry, the branch of medicine that deals with illness of the mind. It brings together the biology of the brain and the lived experience of the person.
In psychiatry, care is focused on the three domains of biological, psychological and social; treating the person as a whole and not as a cluster of symptoms. For most psychiatric problems, there is no physical tests that can be used to reach a diagnosis; blood tests and scans help us to exclude other diagnoses that can mimic mental health problems. So how do we diagnose and treat? We listen, we watch, and we apply the knowledge of psychopathology, neurobiology and pharmacology.
On that first day, when I walked into MCH, my eyes and ears were wide open. Indeed, I was utterly shocked! There and then, I immediately thought that there is no way that I will be doing this for the rest of my working life! But here I am, 15 years later, still wanting to be a psychiatrist and still burning to bring about the much needed change in this department.
My eyes might have gotten used to the sight of ill-looking wards and leaking roofs, my ears might have become less sensitive to the sounds of this ancient hospital but my heart remains committed to my mission: helping my patients. This is no easy task of course. When I need to admit a person to MCH, I do it not without a heavy heart.
For those who come from a comfortable home with a caring family, an experience in this hospital will definitely be a shock. How can a person be expected to share a room with at least five other total strangers, especially at a point when they are at their most vulnerable?
What happens to people when they are stripped of their identity, when forced into the routine of an institution? Then again, the only thing scarier than Mount Carmel itself is the experience of living severe mental illness. Such an experience needs to be lived in a safe place: this is indeed what most of the time justifies our decision as psychiatrists when referring patients for admission.
There is then another group of persons who do not come from a comfortable home; of course one might argue that in some cases, this is by choice because the person has burned all bridges with their loved ones. But may I ask you: do we ever stop to wonder why?
We are quick to hitch a ride on the train of moralism and judgement; probably because we feel uncomfortable being around what we cannot make sense of, such as those with mental health problems and substance use disorders. These persons oftentimes are not shocked by the physical environment of MCH, indeed they have known worse: being homeless, being roofless, being dehumanised by abusers, feeling numb and wanting more of that numbness to dull the pain.
Society is quick to judge these people: “they chose to follow that road”. So, for these persons, it is not just the physical environment of the hospital that is unwelcoming, it is the extra stigma they are faced with, even when leaving the hospital after their recovery. Then again, these people have probably known worse and are not as appalled by this as I am.
Is Mount Carmel Hospital a suitable environment to provide care anymore? Definitely not- Aloisia Camilleri
Before COVID-19 made its grand entrance, patients with substance use disorders in MCH were segregated in separate wards and not allowed to receive care in acute wards.
Indeed, they were not eligible to benefit from community mental health services. COVID-19 made us reorganise our admission system at MCH, which meant that finally we had an opportunity: we could provide equal care to any person regardless of the diagnosis.
A few months down the line, we are once again at a point where patients with substance use disorders and mental health problems are not only being faced with a decrepit environment in MCH but also with lack of empathy, a lack of a safe place where to live during the darkest of their times.
Might I clarify at this point that this is not true of all wards in MCH that care for this patient population. It is also not true of all professionals working in these wards. Certainly though, it is true for some who feel that they can choose which persons deserve care and which ones deserve further rejection and ostracisation.
Where am I going with this? What is my point? Simple: is MCH a suitable environment to provide care anymore? Definitely not. Is the level of care provided at MCH good?
I must admit, there is no definite answer.
Of course, each professional brings with them their own baggage and the unwillingness to treat persons with substance use disorders comes from this baggage. Maybe too moralistic a stance, possibly an excessively concrete way of seeing things, probably stemming from a sense of unsafety. As for the latter, what role does the physical environment of MCH have in all this? Is it that there are too many people in too small a space? Is it that there are not enough activities to keep patients meaningfully engaged during the day? Is it the fact that people feel dehumanised in such a system?
We surely are pained to listen to patients’ experiences, but it is also worth listening to the experience of those providing care in this system. I myself feel angered that I have nothing better to offer these people. I feel enraged that because of all this, colleagues in different specialisations deride my work.
Like them, I have studied, I have trained, I strive to provide best quality care, but that is simply not good enough. Why? Simple, I am part of a system which is failing its customers. No matter how good I believe my intentions to be, how wide I try to open my ears and eyes, and how strongly passionate I feel about my work as a psychiatrist, I feel that this is all lost in the cold walls inside of MCH.
Aloisia Camilleri is a consultant psychiatrist and also vice president of the Maltese Association of Psychiatry.