Antonella Sammut, public health consultant
Although mental health care has not always had the prominence that it deserves, progress has been registered in the area. The Mental Health Act, which introduced new modalities of care and established the commissioner for the rights of persons with a mental disorder, was instrumental to provide the legal framework within which care is provided.
The mental health care sector presents several challenges. Although medical care is good, the environment of Mount Carmel Hospital, within which inpatient care is mainly offered, has for many years been left dilapidated and not conducive to protecting the dignity and privacy of the patient. Moreover, Mount Carmel Hospital is fraught with stigma which could deter patients from accessing mental health services.
The government is committed to prioritise funding and investment in the mental health sector through several initiatives. In fact, mental health has been selected as the first key thematic priority of an overarching National Health Strategy for the period 2020-2030. Secondly, an acute psychiatric hospital of around 120 beds will be built on the Mater Dei campus. Also, €30 million are being invested over a five-year period for the refurbishment and repurposing of Mount Carmel Hospital.
Investment cannot be limited to the mental health facilities alone, but a comprehensive approach that engages professionals and stakeholders is required to improve the services that are being offered. Regrettably, mental health care is mainly hospital based, which goes against the spirit of the Mental Health Act that stipulates that patient treatment is to be offered in the least restrictive manner and for the shortest duration of time possible, with voluntary treatment being preferred to involuntary treatment, and community treatment to hospital treatment.
To this end, a shift from hospital to community services is being encouraged through the provision and strengthening of mental health clinics in Malta and Gozo. These will be situated within the health hubs in the various regions thus promoting the integration of physical and mental health, which is the key objective of mental health service reform. This will enhance closer links between primary care and specialist care and improve the physical health of mental health patients.
Improving services calls for further investment in the mental health care workforce and better work practices. Increasing the professional capacity through continued professional development, ensuring the right skill mix and retention of such workers is critical to the offering of quality multi-disciplinary patient-centred care. Further collaboration with NGOs would enhance service delivery, especially in the community sector.
Mental health care is finally receiving the attention it deserves and far from being the Achille’s tendon is taking pride of place. Mental health is critical for the general health of the population and this is reflected in the WHO notion that: “There is no health without mental health”.
Mario Galea, Nationalist Party spokesman on mental health
I don’t have qualms admitting I suffer from depression. I speak publicly about it, to encourage others to seek help. Over 300 million people worldwide suffer from depression. Yet, only 30 per cent receive medical care. The other 70 per cent shy away from adequate care.
Regretfully, stigma still shrouds mental illness. Untreated depression remains the main cause of suicide. In the last 40 years suicide has increased by a staggering 60 per cent. It has become a global tragedy.
According the World Health Organisation by the year 2021, a mental illness pandemic will engulf the world with devastating effects. That is precisely why mental health illness should not be an Achilles’ heel. Being a patient myself, I hate to politicise this subject. Yet facts are facts.
During our time in government we started disseminating mental health services in the community. We set up five Community Mental Health Clinics each with their own catchment area. We also opened five Mental Health Day Centres.
During this administration not a single Mental Health Clinic was opened. We enacted a new Mental Health Act, which was revolutionary giving lots of rights to mental health patients. We set up the Mental Crisis Intervention Team to deal with mental health emergencies including suicide patients and their families. This team was doing a sterling job, yet beyond disbelief it was dismantled.
Incidentally, this government has wasted the last five precious years lamenting that it needs Barth’s University to help set up a mental health strategy.
Our Mental Health Act was hailed by the World Health Organisation as model legislation for other countries to follow. A Belgian delegation enquired with us regarding our Mental Health Crisis Intervention Team to set up one of their own. And all these were drafted and executed by our Maltese experts.
The way forward is to increase psychiatric beds in Mater Dei. A new psychiatric hospital in Mater Dei Hospital has been promised for the last five years. Enough lip service. It’s time for action.
The government needs to immediately follow our initiative and continue to increase more mental health services in the community. The Crisis Intervention Team should be set up again. Screening for teenagers is a must. By the age of 20 years, 75 per cent of teenagers start showing first signs of mental health illness. It is time for the government to put money where its mouth is. It’s time to walk its talk.
I reiterate our plea to government to allow us to help in this area. We have concrete proposals. We can and should work together. Mental health care should be our strength and our medical care showcase.
One departing note. During the few minutes you were reading this piece, every 40 seconds someone has just taken his own life. Please say a short prayer for the lives lost. And a big thank you to our mental health professionals for the many other lives they have saved. They are indeed our unsung heroes.
Catherine Farrugia, executive member of the Democratic Party
On world mental health day of 2013 a reform of Mental Health Services was announced to shift the mental health policy to one which is oriented to community comprehensive care and the building of a 130-bed hospital at MDH health campus.
The implementation of the Mental Health Act was kick-started. However, the much needed focus to deinstitutionalise patients from custodian care to one that leads to more active rehabilitation and to administratively re-organize and structurally upgrade MCH were abandoned. The roadmap set by then Minister of Health Godfrey Farrugia was shelved after he was dismissed.
It may be stated that in the last years a number of good work practices and health protocols of note have been introduced but the real issues were never addressed.
Inpatient and outpatient health care delivery must be community oriented and easily accessible to provide quality care
The recent announcement that a fresh restart is to be addressed is welcomed by the Democratic Party. It is unfortunate to note that this has arisen following a public outcry and not out of a genuine desire to be more political committed.
The objectives of such a strategy should be two-fold: to increase the human health care professional resource and to create a patient-centric experience which is conducive to the well-being of this vulnerable group. This call has to be backed by the right allocation of finances and an effective access to quality health care.
The PD also notes that inpatient and outpatient health care delivery must be community oriented and easily accessible to provide quality care, with acute and rehabilitative quality care in mind.
The Democratic Party notes that more deserving attention should focus on specific cohorts that include: stress created by poor life-work balances and poor family relations; failed youth; neuropsychiatric patients; secluded migrants and patients who misuse illicit drugs. This calls for a robust, co-ordinated, preventive strategy that runs across the ministries of health, of education, employment and youth and of social policy and elderly.
It is high time that the repeated cautions voiced by the Commissioner of Mental Health no longer fall on deaf ears. His direction is consistent and clear.
The Democratic Party will continue to champion the dignity, rights and social dilemmas of these patients and their families and thanks all NGOs and the various foundations for their valid contribution to the well-being of these patients.
If you would like to put any questions to the parties in Parliament send an e-mail marked clearly Question Time to editor@timesofmalta.com.
This is a Times of Malta print opinion piece