Mental health services have reported a “dramatic increase” in the number of incidents involving aggressive behaviour by patients towards staff, substance abuse and attempts to escape while under treatment.

The number of reported incidents had more than trebled within a five-year period, Mental Health Commissioner John Cachia said in his annual report for 2018.

While in 2014 the incidents totalled 74, the total number of reports recorded last year reached 241. Bar some exceptions, the reports were all filed by nursing staff even though such form of redress is available to other health professionals.

The Mental Health Commissioner said the nature of incidents highlighted the pressures and concerns felt by front line mental health carers.

“Staff and patients are exposed to such incidents more in certain wards than others and this has an impact on both staff morale and quality of patient care,” Dr Cachia said.

While describing the increase reported in recent years as “dramatic”, the Mental Health Commissioner noted that one aspect which required further investigation was that of patients being involved in multiple incidents. It transpires that 49 patients were involved in 129 reports, which in some cases happened within days if not hours of each other.

An analysis of all 241 cases shows that two out of every five, 98 in total, involved complaints of aggressive behaviour mostly from patients diagnosed with substance misuse.

Patients in this category accounted to twice as many cases of aggression involving people diagnosed with psychotic illness.

These two categories accounted for nearly two thirds of all cases of aggression.

The second-highest type of complaint dealt with substance abuse, namely use, possession and even smuggling by patients already diagnosed with substance misuse.

A total of 42 reports fell in this category.

The annual report also lists 27 cases of attempted escape. Less than half of them (44 per cent) were reported at Mount Carmel Hospital wards, with a further 27 per cent from the facility’s main garden.

In 2018, reports of self-harm by patients accounted to 26, with those in the forensic section having a higher incidence.

The majority of cases involved people younger than 40 years of age, and one in every three reports involved foreigners or patients being treated for substance abuse. 

Interestingly, most cases of attempted self-harm happened from noon onwards.

The 241 reports filed in 2018 included one related to an anonymous bomb threat, and four others not involving patients. The latter had to do with another anonymous bomb threat, a relative caught stealing staff belongings, a medication accident and aggressive behaviour towards staff by another member of staff.

All were reported primarily by nursing staff except for one particular case submitted by a physiotherapist and another by a medical officer.