The COVID-19 pandemic has brought about many unplanned challenges and changes. One of those challenges is to meet the needs of mental health patients.

The Office of the Commissioner for Mental Health has been closely following the changes currently under way in community mental health, day care and outpatient services. These changes came about in the aftermath of the pandemic months, where due to public health concerns for both patients and staff, the psychiatric outpatient service became a 100 per cent online/telephone service for urgent cases only.

From March to June, nearly all out-patient appointments were cancelled. Review of urgent cases and services to those requiring monthly injections were continued through video consultation and one-to-one appointments where necessary. This was a sudden change aimed at meeting the immediate needs that arose due to the crisis. There are undoubtedly patients who have slipped out of the system but I believe that efforts are going on to reach out to these vulnerable persons.

This effort has been hampered by the actual closure of the premises at Mater Dei Hospital and the redeployment of its staff without effective replacement through equivalent clinic infrastructure in the community.

Increasing services in the community is in line with the Mental Health Act. I cannot object to services that keep patients in the community as far as possible and resort to hospital only when necessary.

My immediate concern however is that some stakeholders seem to have forgotten that changes in community mental health, day care and outpatient services and their implementation were agreed to by consensus in the Mental Health Strategy 2020-2030.

My expectation on behalf of patients was, and still is, that professionals and staff join forces and push management to expedite the reform.

There are patients who have slipped out of the system

This office wholeheartedly supports the development of referral guidelines and systems between primary care, community mental health services, specialised outpatient services, emergency services, acute inpatient treatment, rehabilitation and community home treatment. This should be a matter of priority and there should be no further delay.

This office has consistently reminded the members of the senior management team, both collectively and individually, that it is their primary responsibility to see through the changes required by this outpatient reform.

The concerns and complaints of patients and staff have been escalated for appropriate follow-up. Individual staff members are regularly encouraged to support the changes they themselves have advocated for over 20 years.

This office is aware of the numerous challenges linked to having adequate premises and improving human resources for community mental health teams in certain parts of the country. I hope that solutions are found quickly in the interest of all. This office has also advised that management communicate clearly with staff, patients and families.

With regard to questions raised by psychiatrists about medico-legal responsibility, this should be viewed in the context of the collective responsibility for the care of persons with mental health problems enshrined in the Mental Health Act and the challenges that COVID-19 has brought concerning clinical practice.

This joint responsibility applies also to the handling of the situation that has ensued following the closure of the psychiatric outpatient service. Management, professionals, patients and responsible carers must work together to provide a quality service.

Management is bound to offer an adequate and safe clinical environment from where professional staff can provide services to patients.

Professional care teams are bound to monitor patients entrusted to their care and offer services as needed. The lack of an appropriate clinical infrastructure must be remedied forthwith to sustain efforts to help those in need.

Patients and responsible carers have a duty of care and those who feel overwhelmed by their personal situation are encouraged to reach out and contact the respective caring teams or the emergency services at Mater Dei Hospital, Gozo General Hospital or Mount Carmel Hospital in case of deterioration.

John Cachia, Commissioner for Mental Health