The Alliance for Mental Health (A4MH) has called on the government to include critical stakeholders to make a real difference to the way mental health treatment is provided, and eventually bring people out of mental health facilities and into community care.

A4MH is an organisation of the major stakeholders that combines patient representation, family caregiver associations, and professional associations. Several arguments have been made in the international medical sector, backed up by peer-reviewed studies, showing the benefits against institutionalising in favour of community care, for both health care providers and the patients themselves.

Reacting to an interview carried on The Malta Independent on Sunday in which Health Minister Chris Fearne outlined the government’s five-year plan for Mount Carmel Psychiatric Hospital (MCH), A4MH outlined its hopes and concerns to this newsroom.

Mental health awareness was propelled into the limelight in recent weeks due to the tragic suicide of a young man who escaped from MCH; ill-conceived graffiti on a van during the Carnival festivities at Nadur, Gozo, depicted in a macabre way, and a series of media stories exposing the conditions in the central facility that is MCH.

During the meeting, this newsroom was joined by representatives from the Richmond Foundation, the Mental Health Association, and the Maltese Association of Psychiatry who form part of A4MH, an organisation made up of representatives from various backgrounds, with the unifying factor being mental health.

Collaborating with government for a better service

Representatives of A4MH quickly stressed that the fact that the Minister devoted an entire interview to mental health was a huge step forward, as was the information that a national strategy is being put in place looking at 10 or 20 years down the  line. Given the fact that they singly and collectively represent the main stakeholders in Malta’s mental health services, however, the A4MH also expressed some concern that it has not yet been invited to participate in these proposals and strategic planning or consulted about the upcoming five-year plan.

Fearne said that MCH will undergo a complete refurbishment, that an acute psychiatric facility is being built at Mater Dei Hospital and that a “holistic approach” will be taken when formulating the upcoming National Mental Health Strategy,

While the A4MH wholeheartedly welcomes the attention the sector has been given of late, it urges the Health Ministry to engage with the organisation because they are people on the frontlines and know the strengths and weaknesses like no other on the island.

 

Changing antiquated practices

One of the greatest concerns is that MCH will be turned into a shiny new facility, but work practices will remain as they are.

Etienne Muscat, representing the Maltese Association of Psychiatry, stressed that simply talking about upgrading community services is not enough.

“Unless you slash patient beds in MCH, and unless you physically divert man-power and resources to the community services, people will continue to head to hospital as their first port-of-call.”

All representatives at A4MH stressed that valuable man-power – nurses, carers and other specialised staff – could be used more efficiently across Malta through community services. “There are limited specialised personnel being taken up by in-patient services. These valuable nursing hours could be put to use that is more efficient.

“Nonetheless, it is clear that care provision is ultimately a numbers game and there needs to be a significant increase in the number of professionals providing services across the board, from consultant doctors to nurses, psychologists, social workers and occupational therapists for any system to have a chance of working well.”

 

Institutionalisation of patients

MCH has long been used as a ‘dumping ground’ for cases that society did not know how or where to manage, whether or not the individuals required mental health hospitalisation. Unfortunately, this system is a lose-lose situation, since it takes up resources from critical cases, adds to the stigma of the psychiatric hospital, promotes institutionalisation, and discourages professionals, administrators, patients and families who clearly are not being managed appropriately.

Another major issue which the A4MH highlighted is the lack of statutory services of crises intervention for people suffering an acute episode. Currently, a person would have to try to convince a loved one going through a mental health crisis to physically go to Mater Dei Hospital and see specialised doctors there.

A more community based approach means that the services would be available to the patient in their home environment, and in their localities. These are simply minor examples of the changes that the A4MH feels must be put into place long before the proposed opening of the new mental health facility; in fact, the A4MH fears that the upgrading of all MCH will drain resources that are urgently required elsewhere in the mental health services.

 

Early intervention

Fearne spoke of introducing early screening for infants and young children who exhibit unusual behaviour, as research has shown that people who suffer from mental health issues often exhibit red flags early on in life.

A4MH representatives support this enthusiastically, adding that ideally a national strategy would involve multiple agencies and departments that start from schoolchildren and extend to the elderly, while emphasising that the most critical period for development of established mental illness is from the late teens to mid-twenties.

In contrast, Etienne Muscat said that currently, in the children’s outpatient service there is not even one full-time psychologist equivalent for the whole country.

He repeatedly stressed the need for more consultants in the national health care service. Each consultant-led firm includes more junior doctors and even junior specialists who have the training to become consultants. Each team is also supposed to have immediate access to a psychologist and a social worker as a minimum. Muscat said there are simply not enough consultant doctors available to run the services needed to cater for the exploding numbers of patients and problems being faced. He added that there are enough young doctors completing training and graduating as specialists, but the “country desperately needs them to keep climbing up the ranks and take the post of consultants”.

In conclusion, it was stressed that the most important thing is that a holistic approach be taken that is not fragmented in any way.