The local mental health sector is still subject to high degrees of stigma, and the failure to revise the Mental Health Act has heightened this. Dolores Gauci, CEO at Richmond Foundation explained how often, people kept silent about their mental health problems and delayed seeking assistance which in turn resulted in having the conditions worsened.
“Unfortunately Malta has a great lack of statistics and research in the area of mental health is practically nonexistent,” Richmond Foundation CEO Dolores Gauci said. “Thus, we do not know whether one particular mental illness hits the Maltese in particular, which types of difficulties these are, how they manifest themselves in people and their impact on the Maltese society, its families, the individuals themselves, and the economy.” She said that this was one of the areas which the Richmond Foundation would really like to delve into if funds were available.
Meanwhile, although the National Statistics Office did issue some form of statistics, the information that existed in the sector may not be accurate enough and did not depict a clear picture of what was happening. This is often the result of people being reluctant to report in matters concerning mental health problems. “I believe that in Malta no family can say that at one point or another it did not come into contact with someone who is experiencing mental health problems, be it a family member, a friend or a neighbour” Ms Gauci explained. She also pointed out that a number of situations in which a death caused by suicide took place, did not get reported as a suicide but that the final cause of death is given. “Something definitely needs to be done on the issue of lack of research and statistics,” Ms Gauci said. While a lot of research has been carried out in other areas of health, mental health has never been given as much importance as diabetes or obesity for example.
Meanwhile stress and pressure were increasing and mental health problems could only increase. In fact the World Health Organisation has predicted that by the year 2020 mental illness will be the second major group of illness worldwide.
“Although a great improvement was registered along the years, a lot still needed to be done for Maltese society to realise the importance of the sector,” Ms Gauci explained.
Richmond Foundation and others in the sector therefore work towards providing society with more information and more services on the whole spectrum of mental health.
Another very disturbing issue was that the Mental Health Act has not been revised since its introduction in 1976. This had been based on the UK Act of 1959, Ms Gauci said. In 1976, the Act was already not addressing the needs of Maltese society as 18 years had passed since the UK Mental Health Act was introduced and its introduction in Malta. While the English Act was reviewed several times since then, the numerous attempts at reviewing the Maltese Act have never yielded actual result.
“I cannot understand how it is possible that we are in 2008 and our Mental Health Act has not been reviewed yet,” Ms Gauci said. In fact, Ms Gauci pointed out that when the government launched the Mental Health Reform in February 1995, the revision of the Mental Health Act had been envisioned in the reform strategy and it actually said that the Act was old fashioned. “This was 13 years ago,” Ms Gauci pointed out.
“The current Mental Health Legislation is archaic and emphasises the traditional concern of protection of the patient or the public through compulsory custodial treatment,” the government document said. “Certain laws are counter productive to the social economic and mental well being of these citizens,” it added.
The solution then was for the Act to be revised “in accord with ethical human and civil rights as promoted and practiced under international law in Europe,” according to this document. This means that there was recognition of the need for the law’s revision, Ms Gauci said. “Why is it that 13 years later, despite various attempts, the law has not yet been revised?” Ms Gauci asked.
There is nothing to stop the law from being passed through parliament and it could then be “implemented in phases”. If we want the law to make an impact on the Maltese society and really help people with mental health problems there may be a need for more resources. “We can say that in the next five years so much could be implemented and the rest would be implemented within ten years,” Ms Gauci explained.
This way the government would be committing itself to have the necessary resources in place over a period of time. In implementing green initiatives among other legislation, the government has planned to reach its aims within a stipulated stretch of time however there has never been a similar plan for enacting the revision of the Mental Health Act in Malta.
“If we wait for resources to be in place before the legislation is passed, the law itself will never be ratified,” Ms Gauci said.
“I do believe that there are committed people at different levels within the government who want the law to be revised according to the times but somehow and somewhere, there are obstacles which are not being overcome,” she added.
However though, the Maltese public was still not fully aware of the importance of this law and perhaps this was the reason for not exerting enough pressure on the authorities.
Furthermore, Malta does not have a strategy to reduce suicide rate. It is a known fact that northern European countries have a higher suicide rate than southern European countries. Most Northern European Countries therefore developed a strategy to reduce suicide. While suicide was recognised as a major problem in these countries, in the Mediterranean countries and of course in Malta there does not seem to be the same focus.
This could possibly have a historical basis to it. Countries such as Spain and Italy historically from a religious perspective could have viewed suicide as a “sin” and that it went against the catholic religion; adding stigma on the victim’s family, Ms Gauci pointed out. As a result, society does not know how to treat families grieving the loss of a member whose cause of death was suicide. Often people choose not to bring up the subject. This often added to the feeling that they were in the wrong whereas if someone died after a road accident, the family was shown the necessary support and sympathy.
Stigma, Ms Gauci believed, stopped people experiencing mental health problems from seeking help. The lack of information and clarity on the professions of psychologists and psychiatrists for example, frightened people. Automatically people believed that when they visit a psychiatrist or psychologists they would have to take medicine and this was not always the case. Moreover, psychiatrists only prescribe medication if and when necessary and often starting in small doses.
In the case of mental illness the problem of stigma was much greater and there were always negative connotations when the issue of mental health came up. “Nowadays, society has developed, and medicine has made great steps forward. We do have the necessary scientific knowledge to manage mental illness quite well,” Ms Gauci affirmed. There were also several types of therapies including talking therapy before professional persons resorted to medicine.
Ms Gauci noted that it was not only the person who suffered from mental health problems who was affected by stigma but also the family, friends and everyone in the mental health sector “because we always talked about extremes and illnesses,” Ms Gauci said. “Ask yourself the first thing that comes to your mind when thinking of mental health and you realise that it is always the illness you think of and not your well being” she explained. “This means that we have such a narrow view of mental health.”
To add insult to injury, Ms Gauci pointed out how the media used words like “schizophrenia” over and over again in contexts which did not have to do with the disorder. “This should by no means be used to refer to anything but the actual illness because it is really unfair on people diagnosed with this disorder and their families.”
The media has “a very important responsibility to educate people and not to reinforce negative images connected with illness.” In many cases a diagnosis was being used as an adjective, often being derogatory and this did not happen in cases of other illness diagnosis such as cancer or diabetes to describe anything but the actual thing.
“Society must learn to be more respectful as it learned to be respectful in other situations,” she said. There must be more knowledge across the board and powerful key figures in the media must be very careful of what they publish and broadcast. “We must also teach children who would become society’s adults in 10 or 15 years time,” however even educators themselves are not “sensitised” to be careful and stop children from using certain terminology when needs be. So, even educators themselves must “be educated” in this regard. Furthermore, members of parliament, bureaucrats and society in general must be careful in the type of language which they use. There must be a “watchdog” which monitors the use of language on a day to day basis. The problem was that the Broadcasting Authority for example, was again the product of society so “if you don’t have education across the board, we can never get to where we want,” Ms Gauci explained.
“We need to take care of our mental health as we care for our physical health,” Ms Gauci said. When it comes to physical health we are proactive by for example trying to have a healthy diet to avoid hypertension, diabetes or obesity and not wait until we get ill. “Similarly, we have to become aware of the importance of our mental health and to learn what we need to do to maintain it and so live a healthy lifestyle,” she added.
Education and information will make society more “resilient” giving us the necessary tools towards a healthy “psychological immune system” which help us face problems. Furthermore, people must be informed on mental health problems such as depression and suicide for example, and information must be free from sensationalism. People in the risk of attempting suicide must be given space and the opportunity to speak to a friend and discuss their feelings. If properly informed, the friend would ask for assistance from professional people and encourage him or her to seek help. “Speaking to the family doctor may help a lot in any case,” Ms Gauci said.
Meanwhile, Malta lacks a wide range of services including “crisis intervention services” to assist individuals who experience mental illness and their families and give immediate help were needed so there may not be a need for the person with mental health difficulties to leave home and enter an institution. “Assertive outreach services” by which assistance is given by professional persons at the sufferers’ home and within the community, were also needed. “This is what community care is all about and the proposed Mental Health Act deals with this, ensuring the provision of assistance in the early stages of the disorder,” Ms Gauci said.
At the end of the day, persons who manage their mental health problems must be re-integrated into society and the work force. Although the government had a lot of incentives for employers in such cases, not all employers were open and flexible to integrate these persons and give opportunities. Mental health problems are different from physical or intellectual disabilities, Ms Gauci explained. The lack of functionality of a person suffering from depression for example, may be quite high however; benefits to sufferers of mental illness were not equal to benefits for other disabled persons. Here one can clearly see discrimination against people who experience mental illness and who as a result are functionally challenged.
Richmond Foundation is playing a major role in the general regard of mental health both in terms of media exposure to raise awareness, the promotion of mental health, as well as the prevention of mental illness. It is also playing an important role in the fight against stigma. “However there is still a lot to be done,” Ms Gauci said.