The news that Dennis Vella Baldacchino will replace John Cachia as commissioner for mental health is an apt occasion to express gratitude to Cachia for the sterling work he has carried out over the years.
If attitudes towards mental health have perceptibly changed, it is due partly to the commissioner’s efforts to increase the visibility of mental health issues by publicly drawing attention to needs and addressing shortcomings in the services without fear or favour.
The handover in this delicate post also prompts reflection on the current state of psychiatric services and the relationship between mental health and Maltese society, as it is reflected in the sufferings and opportunities of those who struggle with mental health.
The unacceptable state of Malta’s only long-term psychiatric facility (excluding the one in Gozo) has been highlighted on several occasions. The alternative – a promised state-of-the-art facility within Mater Dei Hospital – will take four years to complete. In the meantime, refurbishment at Mount Carmel Hospital is apparently still going on, despite the pandemic. It appears progress has been made in the embellishment of the facility while the number of patients there has been reduced by moving some to outside facilities.
These developments reflect the processes and goals contained within the Mental Health Strategy launched in 2020. It is highly significant that the strategy is part of the overall health strategy for the community. This shows the government has embraced the notion that there can be no health without mental health and that the integration of all health services is the path to follow.
This will, hopefully, put to bed the deleterious dichotomy between mental and physical health which, quite possibly, lies at the root of the stigma which has bedevilled mental health issues over the centuries. This is why the construction of a new mental health facility in the heart of the hospital campus carries a symbolic significance beyond practical and logistical considerations.
Other developments, like the shifting of care to community facilities, are also influenced by the need to break down artificial barriers between mental and physical health and, indeed, between health and ‘illness’. These barriers tend to stress differences and give rise to stigmatisation. Care in the community, instead of in a specialised unit, emphasises the ‘normal’ nature of the difficulties we term as illness or disease.
The pandemic has created stresses that require specialised assistance. The more vulnerable members of the community – the elderly, those living alone and the less technologically savvy, for example – are reacting to the new, often-bewildering circumstances by developing symptoms of depression and anxiety. It is heartening that emergency doctors are now trained to respond to these situations. This sort of training – another pillar of the Mental Health Strategy – will have to become an essential component of the national effort to enhance mental health.
Contracting a psychiatric condition no longer carries the mark of Cain. This is, in part, thanks to the many individuals who choose to speak out publicly about their struggles with addiction, depression, neurosis, psychotic illness or personality problems, helping to normalise what once tended to be hidden away.
While the need to provide timely therapeutic interventions remains challenging mainly because of the human and financial resources required, the community appears more receptive to the need to extend help in a welcoming way. This does facilitate the task, which, however, remains difficult in the face of the sheer numbers of those expected to seek help as social cohesion increasingly weakens when faced with the individualistic thrust of the nature of modern life.
The challenges facing Vella Baldacchino are daunting. He is highly experienced and widely considered to be perfectly capable of rising to the occasion. We wish him luck.