The news agencies are quoting the Minister for Health, Mr Chris Fearne as stating;

‘A request for proposals for the construction of a new 150-bed acute mental health hospital will be issued by the end of this summer and adjudicated by the end of the year... The project, a public-private-partnership, will also include extensive refurbishment of Mount Carmel Hospital.’ (independent.com.mt – Accessed on 3/7/2016). 

This is great news indeed.  Fingers crossed that words turn into actions and we really manage to walk the talk.  

Let’s face it.  Mental wellbeing has for too long been the Cinderella of all health services.  It seems that finally we are attempting to take the services dedicated to this population a notch-up.  Mind you, a lot has been done in terms of community services and a number of NGOs, notably Richmond Foundation, have contributed extensively to this sector. 

However, when it comes to in-patient care, going to Mt Carmel Hospital, even to simply visit or for a meeting is utterly depressing (apologies for the pun).  This Victorian building merits to be used for anything but psychiatric treatment.  The same offices of the staff are derisory, treatment rooms, leisure areas and wards are in the main ludicrous and mediocre even though effort and resources have been forthcoming.  But this is what you get without a proper long-term plan and piece-meal solutions to a very complex issue. A bit of a white-wash here and there and we think it’s done.  For example, indeed there has been a push for Mt Carmel Hospital not to remain a ‘dumping ground’ of young homeless people but we still need to give clear direction to our work with young people.  Even so, having good residential and community services are not the only loop in the services continuum.  There are many facets to this complex issue that need to be addressed.  

In this regard I caught up with Dr Nigel Camilleri, a consultant psychiatrist for childlen and adolescents and Dr Kristina Vella, resident lecturer in neuropsychology at the University of Malta.  

During my meeting with Dr Camilleri and Dr Vella, it transpired that at times we tend to overlook the complexity of ‘child and adolescent mental health’. Indeed, there are two main issues that kept surfacing during this interview. Firstly, we need to have improved and on-going empirical data flowing into our policy so that Government and private services can respond to the real needs that children and young people with mental health issues are facing.  Secondly, there is a need for professionals to strengthen their collaborations with each other especially when they are offering services to the same child and family.  Each individual’s expertise is invaluable.  After all, everyone’s main goal is to improve the children’s mental health and quality of life.

Nigel Camilleri spoke at length about the pressing need to improve child and adolescent services in the area of mental health. He says that even though there is an abundance of service provision, as yet child and adolescent mental health services lack clear standardised procedures and measures.   According to Psychiatrist Camilleri, even though we have well-trained, qualified and capable professionals, they tend to work individually and in isolation.  This is not good enough.  We need to emulate a model whereby professionals, whilst they can appreciate each other’s discipline at the same time are able to respond to the pressing needs they are faced with.  In fact, this is what triggered the setting-up of a multi-disciplinary team both within the Government service and the private sector focused on child and adolescent mental health because, as both Dr Camilleri and Dr Vella insisted, ‘we need to put our heads together’. 

Camilleri and Vella said that in Malta whilst University training is rigorous it should not end when ‘we’ achieve our formal qualifications.  Vella states that, ‘CPD is a very important part of our practice in order to ensure that we are providing up-to-date and the most recent clinical practice.  This will ensure we deliver gold standard treatment otherwise our practice will be obsolete.’

That is why, Dr Camilleri explains, why he has worked incessantly to bring over to Malta the Association for Child and Mental Health (ACAMH), which is the largest organization for children and young people with mental health issues.  There are 16 branches in England and Northern Ireland but the Malta branch is the first out-post.  ACAMH is about educating professionals.  It is an organisation pitched for professionals.  Top clinical academics present data and this research is there to be transformed into (improved) practice.  He believes that even if this Association is not involved in social policy it will influence social strategy. 

What governs ACAMH is the need to explain and educate on the benefits and effectiveness of working in multi- and inter-disciplinary teams.  The purpose of this Association is to update people (mainly professionals) on the most recent research.  This happens through video conferencing and other forms of seminars and conferences - ACAMH is about educating professionals. 

Both Dr Camilleri and Dr Vella reiterated that we have an enormous challenge in the professional culture in Malta to overcome this sense of isolation and inability to team-up.  There are so many benefits of working collaboratively and this could be strengthened in the local context.  We don’t work well-enough together and we are finding it quite hard to change this mentality.  Professionals need to recognise that whilst they have different skills-set all have an equally important role in supporting children and young people who are struggling with mental health.  Camilleri stated tenaciously that, “We need to be more structured, more efficient”. 

Camilleri and Vella were adamant that there is a need for more research in child and adolescent mental health. 

For example, Kristina told me that we don’t even know how many children in Malta are suffering from depression.  She said that we might have an estimate but we don’t know exactly in terms of statistics and analytics what is the real problem ‘out there’ which means that we cannot have the adequate services in place due to this lack of data.  Nigel confirmed this by rhetorically asking, ‘How many children with ADHD and children on the autistic spectrum do we have on the Island.’ He says that, ‘we don’t have that estimate.  We have a number of services for we don’t know how many people, and don’t know whether the services are effective or not. Outcome measures are what we are trying to identify.  We don’t know how to measure success of therapy and how long the therapy should take.  This is all very important for policy makers, for professionals and for service users themselves’.  Kristina Vella anecdotally said that ‘recently I was engaged in a piece of research on Obsessive Compulsive Disorder and the statistics I found were very much higher than in other countries.  I don’t know whether that is a consequence of my sample or whether that reflects the Maltese population – I have nothing to compare it with‘.  

So in other words we literally do not know the prevalence of mental illness in Malta, especially in children and young people which is simply shocking to hear. 

The relevance of ACAMH is clear. 

It is filling a void in this sector.  We need to have a structured system, whereby professionals within the social support structure are trained in their respective roles.  Professionals need to attend CPD and appraised yearly to ensure they are reaching the expected standards and practice should follow customary EU or UK guidelines. 

The characteristic of professionalism lies in an ongoing commitment to review practices, upgrade clinical proficiency and work in partnership – this will guarantee improved services to children and young people with mental health issues