When I read that the Psychiatric Outpatients Department at Mater Dei hospital (MDH) was closed, my first reaction was to think that it wasn’t true.

Unfortunately, the news was real.

Indeed, not only this Department but even the Psychiatric Unit have been removed from Mater Dei, effectively meaning that there currently are no mental health services at Malta’s national general hospital.

According to the Alliance for Mental Health (A4MH) which comprises the Malta Association of Psychiatry, the Richmond Foundation, the Mental Health Association and the Malta Association of Psychiatric Nurses, this decision runs contrary to Malta’s National Health Strategy 2020-30, which was approved only last year. The Malta Association of Social Workers and the Faculty for Social Wellbeing have also spoken up against this decision.

The reasons for these concerns are related to the fact that the shift of these services to community care does not seem to come with any transition plan, nor is it receiving the required investment and the necessary resources. Hence, many psychiatric outpatients who were receiving care at Mater Dei have had their appointments postponed and will be added to the list of patients in community clinics, increasing the strain on an already overstretched service.  

Considering that Malta and the world are currently experiencing increased anxiety due to Covid-19, this decision couldn’t have come at a worse time.

Here one must keep in mind that for persons who require urgent outpatient psychiatric care, the prolongation of an appointment could have tragic repercussions, particularly because of the possibility of increased desperation, self-harm, and suicide. Given the current lack of resources in community care, the significant others of such persons such as close family members may end up shouldering further responsibilities, even though they may lack professional training and expertise.  

In the meantime, a cursory look at the official website of the Ministry of Health, tells you the following “The Psychiatric-Out-Patients Department is situated in Mater Dei Hospital. This newly located service is managed by a team of nurses and care workers and provides scheduled and urgent appointments with a consultant psychiatrist as well as nursing and social work interventions. The service is designed for; individuals who are new to psychiatric services, those who have recently been discharged from in-patient services or who have ongoing complex care needs.”

Malta’s very own national mental health strategy states that “everyone has an equal opportunity to attain mental well-being throughout their lifespan, particularly those who are most vulnerable or at risk.” 

The same national mental health strategy adds that “community and hospital mental health services will become more tightly integrated. The mental health service framework will be transformed such that community services become the mainstay of care, treatment and rehabilitation of persons with mental health problems in Malta.”

Nowhere in the text does one read that psychiatric outpatients at Mater Dei will be shifted to another strained sector without a transition plan or the necessary investment. Indeed, the same national mental health strategy states that “Community-based services are inequitably distributed geographically and are not available in the northern part of the island. The existent services vary in their quality, but all are generally understaffed and their provision is very inconsistent. Some single services do provide outstanding care with good multi-disciplinary teams and functioning links with primary care. The Outreach Services where help is given at home level, the Public Private Partnerships with Richmond Foundation and Suret il-Bniedem provide much needed supported-community living programmes. Most programmes are insufficient to cope with escalating needs and the full potential of these satellite mental health services is therefore not being attained.”

The national strategy also envisages that “mental health services are to be co-located within mainstream health facilities wherever possible”. Whilst Government’s future plans for a psychiatric facility at Mater Dei and the restructuring of Mount Carmel are commendable, the current reality on the ground is that many psychiatric outpatients are situated in a service limbo.

It is particularly striking that the remit of this policy area falls under Deputy Prime Minister Chris Fearne, who is erstwhile one the best performers in the Labour Government, and who provides a weighty balance to Robert Abela’s Trumpian narratives in the Covid19 crisis.  

May I suggest to Dr Fearne to take a leaf of his own national strategy, which states that “Government recognises the importance and expertise of persons with lived experience of mental illness, their significant others, civil society and NGOs as partners in the implementation of transformative change in the sector.”

Inclusive and evidence-based policy making thus require that the government heeds to the advice of experts in the field. Psychiatric outpatients already have their own crosses to carry. They do not deserve to be treated as second-class citizens.

Dr Michael Briguglio is a sociologist and senior lecturer at the University of Malta