The Malta Independent 22 May 2019, Wednesday

Misinterpretation of statement increased stigma of mental health: Alliance for Mental Health

Giulia Magri Tuesday, 5 March 2019, 11:00 Last update: about 4 months ago

Last week, former policeman Mario Portelli made the headlines after he posted numerous videos on social media.

Portelli was the star witness in the HSBC heist court case, and recently posted videos of him claiming he knew that Prime Minister Joseph Muscat owned Egrant. In his most recent video, Portelli filmed himself being taken away to Mount Carmel hospital by several police officers, saying "they are saying I am mad" and "there are no doctors here".


Following the publication of the video, the Alliance for Mental Health (A4MH) published a statement and wrote to the Mental Health Commissioner, Police Governance Board and the CEO of Mount Carmel Hospital to ascertain that correct procedures required by the Mental Health Act were followed.

Earlier this week, The Malta Independent on Sunday met Dr Etienne Muscat, member of the Maltese Association of Psychiatry and Stephania Dimech Sant, Chief Executive Officer at the Richmond Foundation, to discuss the work of A4MH and how sections of the media had reported the statement in a different context, which made matters worse.

The interview was held before Health Minister Chris Fearne told The Malta Independent that, according to information he had, a psychiatrist had indeed initiated the procedure for the involuntary admission of Mario Portelli to Mt Carmel Hospital. Fearne said he was informed that "the Commissioner for Mental Health, like every other case of involuntary admission, is investigating the case and I asked him to send the report to me once it is completed."

The statement was kidnapped and misinterpreted

"We are worried and concerned by the media's response to the Portelli case, especially the way the A4MH statement was misinterpreted," Dr Muscat said.

He said that the one of the advantages of the Alliance is to reduce tension between various stakeholders, but such cases that end up in the public sphere without sufficient context or information make both services users and professionals in the field feel threatened, either because their work is being attacked or that they cannot trust the system.

"The statement was intended to reassure the public that there is much more to what they saw on the video clip and although it might have given the wrong impression that certain procedures and measures were not followed, we want to let the public know that involuntary admission to hospital is governed by well-established procedures," Ms Dimech Sant said.

The Mental Health Act of 2012 dictates what can and cannot be done when someone needs to be taken to hospital against their wishes. They must be ill, the illness is making the person dangerous to themselves or to others, and there is no safe alternative. At that point, according to law, both doctor and next of kin (or trained mental welfare officer) must endorse the admission. "The public are unaware that such involuntary admissions to hospital happen on a daily basis, and work like clock-work and are well coordinated," Dr Muscat commented.

He said the video clip gave the idea that police just come and take the person, which is far from the reality. "Just because we were given a particular scene does not mean that nothing else happened leading up to it."

A4MH not part of investigations of Portelli's case

Dimech Sant said that the Alliance does not know the specific details of the Portelli case and it is the Commissioner for Mental Health that conducts the investigation and not the Alliance.

"We are not an executive body which is involved in the investigation, nor do we have an interest in looking into the case; what we want is for the Commissioner to carry out the investigation and publish their findings to reassure the public."

Both Ms Dimech Sant and Dr Muscat wish to make it clear that the main goal of the Alliance is to reduce potential tension between different stakeholders in Mental Health institutions and ultimately reduce the public's anxiety on mental health. "We feel that the misinterpretation of the statement was unfair to the whole Mental Health family and also made it worse for those trying to reach out for help," Ms Dimech Sant said.

Dr Muscat explained that those in the medical and mental health fields are aware of the prevailing procedures and legal actions but it is also important that people are informed and educated regarding such procedures so that there is no form of misinterpretation to feed into the stigma of mental health. "Since 2013, the Commissioner for Mental Health reviews every involuntary hospital admission, to make sure that each case has been followed and if not to investigate."

We are light years away from what we consider basic acceptable mental health services

The standard of mental health services in Malta is light years away from what we would consider acceptable, Dr Muscat said. "It is not a question of the individual or doctors or nurses or the latest medication, but the country's concept of mental health is stuck in the past." He said the public is not aware of how unique the A4MH as a body is, in that people from different parts of the mental health sector can come together and break down the differences and misunderstandings between one another. The A4MH further functions as a lobbying group to enable individual partners to discuss different viewpoints and help each other.

A4MH is made up of the main stakeholders in the Mental Health sector including representatives of patients, service users, their families and professionals working in the field. The lobby came about in 2016 with the main purpose of promoting awareness on the expected international standard of mental health care. "As experts in the sector, we inform the government on how mental health can improve as we believe there are standards which must be adopted locally in order to reach what is internationally acceptable" Ms Dimech Sant said.

"One of our biggest achievements has been to get across the message that the mental health hospital should be part of Mater Dei, just as the Sir Anthony Mamo Oncology Centre is," Dr Muscat said. Ms Dimech Sant added that over the past years, the government drafted a National Mental Health Strategy which is another step in the right direction and is currently open for consultation. "We are encouraged by the fact that mental health service development is something which is open for discussion since there is still so much we can do. We remain motivated to keep up this process so that the local population will finally have mental health services that match those abroad."

Photos by Alenka Falzon


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