Mental health is never an easy subject to write about. 

The stigma that shrouds this issue is immeasurable and heartbreaking. 

Even though so much effort and resources have been dedicated to this matter at policy and service provision level, for some strange reason the mental health agenda still remains an uncomfortable subject to debate.  Unquestionably, a great deal of work has been done in this sector; improvement in community services, appointing of a Commissioner for Mental Health, enactment of a modern mental health legislation and the Guardianship Law, providing for on-going embellishment of Mt Carmel Hospital, improvement in terms of numbers and of quality of the mental health workers, revamping a specialized Ward for young people, amongst other – but yet as a society we still seem to be far-flung from this agenda. 

Last Saturday during my show on Radju Malta, Ghandi xi Nghid, I interviewed Mario Galea on the subject he has been championing for years, namely, ‘eradicating stigma on depressed people’.  

I have known Hon Mario Galea for some time now but the interview with him last Saturday was probably one of the programmes I enjoyed doing most.    

I have never been anywhere close to Mario Galea except that I always admired the fact that he was a politician with a sense of humour and is totally dedicated to the cause.  Since I have been monitoring the political sphere I have always thought of him as a hard-working politician who is convinced in what he believes and holds no resentment towards his adversaries. 

But that is not what captured me this time round as far as Mario Galea is concerned. 

Mario (I’m sure he wouldn’t mind me calling him by his first name) around 2009 hit a brick wall.  He was practically knocked down with depression.  It was absolutely devastating for him. The news had spread like wild fire.  People were speculating about ‘what came to pass’, ‘why it happened’ and ‘because of whom’.  All that people were interested in was to know the dark details – voyeurism at its best.  The irony of sorts is that at the time he was the Parliamentary Secretary responsible for mental health services.

But my admiration towards this man tripled, quadrupled, quintupled and even more when I had seen him sharing his experience on the media.  He looked frail at the time, tired but unyielding. I admired him because he shared his story with an utmost gesture of generosity like no other.  It is probably already challenging speaking about the nice things in life, let alone about those horrid moments that I am sure have left a scar on him, his family and the people around him. 

I’m not trying to make a hero out of Mario, I am sure he would hate that, but facts are facts – he gave of himself in immense quantities.  During the said interview with Mario we revisited this issue.  He even said that he risked his political career. His psychiatrist had advised him at the time to keep his illness all hush-hush because it could mark the end of his political career if people got to know about this illness. But this is the moment when people stand out in my book – Mario still spoke up and how!

People who know of someone who has experienced depression knows the bleakness of that experience, the pain that one goes through.  I have known families who collapse under the pressure because the person changes and loses interest in all that gives color to life.  The individual experiences an irrational sense of guilt, a feeling of tiredness and poor concentration.  It becomes all black and bleak and feels like doom and gloom have taken over – what seems as no light at the end of the tunnel. 

And you know what is the worst thing about all of this? 

People think that it’s all ‘your’ fault, that you need to perk up and take the bull by the horns. 

Wrong. 

Those painful moments, those dark, lonely instances are not out of choice.  It is a chemical imbalance.  It is not just about switching on the ‘will-power mode’ - it is about getting the treatment and the therapy. 

As Mario said, depression can affect anyone.  There are no ages, no gender, no professions and no magic formula that will acquit us from the possibility of getting affected by ‘depression’. 

And that is why we cannot keep shying away from this issue. 

Mario Galea during the interview told me that there are an estimated 350,000,000 people in the world suffering from depression and over 800,000 kill themselves every year (an estimated 20 times more than that, according to the WHO, try suicide but do not succeed).  Every single hour around the World 90 people manage to kill themselves.  Suicide is the leading cause of death in 15-29 year olds. According to Mario an estimated 35,000 Maltese citizens suffer from depression in Malta alone, just to put you into the picture, almost the equivalent of the population in Gozo.

Misunderstanding and stigma can be a cause of death because despite the fact that services for mental health problems exist, the pressure of having to be treated is high.  I know of people who go to visit a psychiatrist after the clinic has closed because of the embarrassment of visiting a psychiatrist. 

As Mario kept insisting during the interview, we need to address this concern and urgently. 

Firstly, we need to start by having more people who have gone through this experience to share their narrative.  The way we have overcome the stigma that surrounded cancer, when we would never talk about ‘it’ and refer to it as ‘ta’ barra minn fuqna’ or CA or some other clinical ellipsis is the same way we need to combat stigma in depression.  When we battle shame people feel more liberated to ask for help, more willing to seek treatment.  In this regard I admire Peppi Azzopardi whom I have heard innumerable times talk about the mental health challenges he had to face and how he overcame the test 

Secondly, we seem to have invested and are investing in acute health services.  We have a new hospital and a couple of new ones on the way including a new cancer treatment facility, revamped clinics and all the rest.

Yet we still have a dilapidated hospital for mental health that has an insignia saying ‘Asylum’ at the gate before one enters this grotesque, ugly and untimely hospital called Mt Carmel Hospital.  I have huge respect for the great work that the Chairman of the Psychiatric Services, Dr Anton Grech is doing together with his team and the efforts being invested by the politicians but I reiterate my invitation to have a new and possibly smaller mental health hospital that does not remind us of the quasi-torture-like unorthodox treatment regimes that were implemented in the past.  We need to mainstream services as much as possible and increase the capacity of the psychiatric services within the Mater Dei hospital network.

Thirdly, we need to stop believing and thinking that people with depression are dangerous, unemployable or need to be removed from their jobs.  Instead we need to see more sensitized employers, a mental health policy should be in place in every place of work and as Mario suggested when people are going through difficult times the employer should have the necessary systems in place to support the employee and not find excuses to throw them out. 

Fourthly, we really need to check how we are living our lives.  I’m not too worried that we pressure ourselves with intense work and long hours but we need to find gaps to recuperate, to have fun, to rest, to get away from it all, to have a laugh, a good meal and share fine company. 

Finally, Mario reminded me we have token people who roam our piazzas in every town and village whom we need to stop treating badly because of their mental health. 

They are not our court jesters.

They are not our free entertainment. 

They are not to be bullied. 

Shameful, shameful - that is so inhuman.  Stop it!

On the other hand we also have lovely communities in Malta, family is generally close and people are interested in each other.  But we need to keep working at this.  Saying the ‘L’ word more often helps and a hug, a word of comfort, some positive feedback and finding time to listen to what people are saying are of the essence.

I won’t be exaggerating if I tell you that I refer to Mario Galea as a bearer of glad tidings. 

If we really take note of what he is saying so many people will feel better.  The commendable comment Tweeted by Minister Chris Cardona when he got to know that I will be interviewing Mario Galea was superb.  A simple statement; ‘Mario Galea = Respect’ – and indeed so.  (Bravo Minister Cardona, this is what politicians should be about).

Oh and you might wonder about the title to this column; ‘A ‘selfie’ from Mt Carmel’. 

Well, Mario at one point during the interview last Saturday said that people seem to find it OK to have a selfie and circulate on social media if recovered at Mater Dei because of some intervention they might be undergoing.  But this doesn’t apply for people recovering at Mt Carmel Hospital because of the shame and disgrace people still feel if they are being treated for mental health. 

Who knows maybe one day we might be getting people sharing a selfie from our mental health hospital as well because we would have overcome this ignominy – ‘feeling hopeful’!

NB: If people need help because they feel they cannot cope or if relatives and friends feel that they need advice on how to handle a mental health issue that someone close to them is struggling with, call 179 (24 hours) - 2295 9000 (office hours).