Many avoid speaking about mental illness. But as the 2016 Annual Report of the Office of the Commissioner for Mental Health was presented to the general public I was struck by feedback received which brought to mind the time-honoured movie masterpiece 'The Good, The Bad and The Ugly'. To these three statements I decided to add 'Hope'.
The Good: The Mental Health Act was intended to lead to change knowledge, attitudes and perceptions regarding mental disorders. It increased the focus on universal upholding of human rights and the protection of vulnerable individuals. It is with satisfaction that during the evaluation exercise,88% of respondents reported that they were treated with dignity and respect whilst 97% stated that the patient was never subjected to abuse whilst in care. This was also confirmed from our overall evaluation that we found no evidence of torture or cruel, inhuman or degrading treatment within all licensed facilitiesin 2016. Among commendable good practices are the Mental Health Day Centres run by Mental Health Services, the facilities offered by Dar Kenn Għal Saħħtek and the Community Hostels run by Richmond Foundation through a service agreement with Mental Health Services.
The Bad: This is the third consecutive annual report from my Office wherein we stress once again the need to empower patients to exercise their rights and be active participants in their care decisions. Basic medical care is not sufficiently complemented by other interventions and activities which help the patient maintain or regain any lost skills. Privacy is not always being respected. Only half of the patients claimed that the relevant care process had actually been explained to them. Patients, responsible carers and staff members interviewed have provided widely contrasting views on the basic right of eliciting free and properly informed consent for treatment.
The Ugly: Apart from Mount Carmel Hospital, there is no other institution which offers specialised care required for mental disorders. Needy patients have no choice or alternative. Until other facilities are set-up to offer the equivalent specialised care, Mount Carmel Hospital needs to be given all the necessary resources to function fully and meet the needs of service users. Unfortunately, the perception disseminated throughout society and reflected in the media gives a very glum and negative view of what one is to expect from Mount Carmel Hospital, reinforcing the ugly brunt of stigma.
Hope: Throughout the last 6 years as Commissioner, I have seen positive changes which unfortunately often go un-noticed. Initiatives targeting mental health and well-being at the workplace and maternal mental health merit continued support. Improvements in services delivered in the Community are helping patients maintain their place in society. This should be the way forward: primary care services and family doctors complemented by specialised and community rehabilitation facilities. It is only then that beds for mental health services can be reduced. Mental disorders must be mainstreamed within the health sector. The mental health component of other illnesses such as Cancer, Rare diseases and Chronic Pain need to be taken more in consideration to provide truly holistic care. Acute psychiatric care must move to the acute general hospital setting. We will keep advocating for a properly functioning outreach service and an effective crisis intervention team. We recommend that there should be specialised care services for children, adolescents and youths with psychiatric problems. Similarly, specialised services are needed for addictive disorders to be managed adequately as other chronic medical diseases such as hypertension, diabetes and asthma.
Mental health is everyone's business. Nobody chooses their illness but everyone is free to choose how to contribute positively to society. Supporting people with mental health problems, often the most vulnerable amongst the vulnerable, is the least we can contribute to our society.
John M. Cachia, Commissioner for Mental Health