As World Mental Health Day approached, we started to wear our activist hats. We thought about campaigns, we planned to turn buildings green (as opposed to pink for breast cancer, or purple for autism awareness), we organised charity runs and walks and we continued to talk about stigma. This year, we united behind the theme ‘Mental health is a universal human right’.
Communities strive to improve knowledge, raise awareness and drive actions that promote and protect everyone’s mental health.
Locally, there does seem to be increased awareness. More people seem to be talking. What, in truth, has been achieved?
Back in 2016 (October 9), the Alliance for Mental Health published a position paper entitled ‘Mental Health Services in Malta’. Words were not minced, taking the patients, carers and professional’s perspectives. I highly recommend that readers take a good look at this document, still so relevant today.
In July 2019, the government published the strategy for mental health and, since then, we have seen some growth. More healthcare providers emerging, more helplines and talk of a new hospital. Yet, the approach remains piecemeal, uncoordinated and often in crisis-management style.
In the article ‘Digging a deeper hole’ (Times of Malta, September 3), Andrew Azzopardi is critical but, I believe, fair. He refers to “complete silence” from the authorities and calls to action said authorities to remove mental health from the “back burner”.
Among a number of very valid recommendations, he suggests that mental health should be moved away from “health” and that a separate parliamentary secretariat should be set up. Here I disagree.
While the suggestion seems to be rooted in giving mental health the importance it deserves (rightly so), it is a comprehensive approach that is necessary, not one that separates mental health further from health.
Mental health is an integral part of people’s health. So why don’t we act like it?
A comprehensive approach to mental health recognises that mental well-being is influenced by a complex interplay of individual, social and environmental factors. It seeks to address mental health issues through a combination of prevention, promotion, accessible services, stigma reduction and holistic care to ensure that individuals receive the support and resources they need to achieve and maintain good mental health.
The Health Ministry needs to develop a clear vision
So, mental health should sit squarely where it belongs, in “health”. However, the Health Ministry needs to develop a clear vision and then lead our policymakers and service developers in navigating the complexities within mental health service provision. Public health departments need to spearhead prevention strategies and promotion of resilience and mental well-being.
Services must be accessible and integrated. While we do enjoy some readily available free services with our community mental health teams, it is not so for all.
These could be much closer to home for some – ask St Julian’s residents who need to go to Qormi and/or St Luke’s Hospital. Also, patients from Valletta/Floriana with mobility problems cannot physically access the clinic due to the amount of steps at the Floriana Mental Health Clinic. This is completely unacceptable.
The in-patient service at Mater Dei Hospital closed during COVID, leaving the only option for in-patient care in Malta at Mount Carmel Hospital. While staff have been repeatedly praised for their good work, the hospital structure remains substandard. Closing Mount Carmel Hospital for psychiatry remains a chimera.
Addressing issues like loneliness and isolation are essential components of a comprehensive approach. Substance abuse, migration, poverty and the environment are all factors that need to be addressed holistically and inter-ministerially. This requires collaboration and goodwill.
Research and evaluation of all causes and treatment of mental disorder needs to be well-funded and carefully planned to improve mental health services. This is lacking greatly and we rely on scientific evidence carried out overseas or in other populations.
Finally, an effort should be made by all stakeholders to develop and support advocacy groups. A collaborative approach is nothing without the patient at the centre of it all.
We need patient lobby groups to strengthen and grow, such that no decisions, small or big, are taken without the direct involvement of those who matter most.
Rachel Taylor-East is president of the Maltese Association of Psychiatry and consultant psychiatrist with Malta Mental Health Services.
MAP’s position paper on mental health services in Malta is available here.