Mental health is still not getting the attention it needs in order to move forward and be at par with other EU countries as well as with the physical health service provisions, according the Maltese Association of Psychiatry, for which the third council has just been appointed for its next two year rotation, this time headed by President Nigel Camilleri.

Speaking to The Malta Independent, the Association’s treasurer Dr Etienne Muscat said that the biggest problem in mental health is that “nobody prioritises it”.

“Mount Carmel Hospital and similar hospitals around the world are a result of lack of prioritisation,” he said, adding that when it comes to available treatments in Malta “we are significantly behind the rest of the world.”

“When it comes to the services needed, people are always saying the right thing – that we need to move towards community services (as opposed to inpatient services),” he continued. “But I have been working for 25 years and hearing this for 25 years,” implying a prolonged lack of change with regards to this issue.

What is meant by community services? The services would entail better follow ups by bigger and more established teams in order to offer more holistic treatments for patients.

“We need a gate keeping system to prevent people from being admitted to hospital,” said executive commitment secretary Dr Rachel Taylor East. “All this would reduce the number of people being admitted into Mount Carmel Hospital. Strong community services would also mean that our patients would not be admitted into hospital for so long,” she added.

“In advanced countries, they use 80 per cent or more of the allocated budget for community and the rest towards inpatient, and in Malta it is the other way round,” said Muscat. “When we talk about reform, we know that the government has promised a €30 million refurbishment, but that is not prioritisation of mental health. Prioritisation is setting up new services to change the focus and to put people and support on the ground where they are needed.”

“We are using a type of mental health medical care that is very antiquated,” he remarked, adding that Malta needs to be at a level where it is able “to react to changing times and changing pressures in a timely manner.”

Supporting Muscat’s argument for further community focus, Camilleri said that the €30 million refurbishment investment “is not prioritization, but rather crises management; the ceilings are falling and hence need fixing, so it is not really a fuel injection of cash to improve mental health services…we are never going to move out of Mount Carmel if we don’t have additional budgets for the community.”

 

Against legalization of non-medical marijuana

The association has presented their stand on the question of legalizing non-medical marijuana, or recreational marijuana to the Health Minister, disagreeing with the legalization of the drug.

“We do not agree with the recreational use of such substances,” said Vice President Dr Aloisia Camilleri, explaining that as psychiatrists they encounter many problems with users of the drug. She listed psychosis and affecting performance at school, socializing and relationships as potential long-term effects.

Dr Nigel Camlleri added that the association does agree that the drug has been decriminilised. However, he called the habit “a coping strategy which is a negative one.” He added that if it is legalised, regularizations should be taken into consideration in order to identify safe doses. “We also need to be aware that synthetic marijuana is causing a lot of damage and is very difficult to treat,” he said.

Age is another important factor within the debate. “The brain is still developing until the age of 25, and using the drug before is known to have long term effects on brain development,” informed Dr Nigel Camilleri, listing lack of motivation, depression, and an effect on the individual’s cognition as long-term side effects.

 

Association’s aims include bettering environments, staffing, communication

Turning to the objectives of the newly-formed association, the members stated that a lot has already been done by the previous members, including the creation of a post graduate psychiatry training program by the post-graduate training committee, which is now at par with other EU countries.  Formal links have also been made with the U.K royal college of psychiatry, as well as the amendment the recently-approved psychotherapy bill.

The association are now optimistic about bettering the sector by focusing on a number of factors, including bettering communication with the top management, the environments for patients, the amount of staff and quality of the services.

“As an association and as professionals we feel somewhat in the dark,” said Dr Nigel Camilleri. “What is the strategy plan for mental health on the island?” he asked. “Things seem to happen and we find out through newspapers.” Making this communication more transparent from both sides is one of the objectives going to be worked towards by the association. “We are a young group of professionals who have a lot to give to the mental health sector,” he said. 

Turning to bettering the clients’ environments, Camilleri said that the quality of the hospitals and outpatient and community clinics must “meet the needs and be appropriate for young people and adults.”

“An adolescent would not want to walk into a room full of teddy bears,” said Camilleri, “or with falling paint and walls with mould.”

When it comes to staffing numbers, psychiatrists in Malta are some of the lowest represented in Europe, with 3 per 100,000 people compared to 25 per 100,000 as in the United Kingdom, Norway and other European countries.” This problem is also present when it comes to psychologists, where there is a waiting list of over 200 children and adolescents when it comes to child psychologists.

The association also wants to give priority to the quality of services by creating sub-speciality interest groups. “As an association we will be lobbying to make sure that such standards are being carried out at the workplace,” said Taylor East. The aim of the groups are to identify lacunae in standards of psychiatry in comparison to services of excellence in other EU countries, and then, as an association, communicate these to the mental health management to improve changes in their own practices and workplace.

“We want patients and carers to understand what quality and standards they should expect. We are making the public more aware of this.”

Moreover, the association wants to close the gap between psychiatrists in training and those post-training in order to make the transition without interruption. A trainee representative, Dr Giovanni Grech, forms part of the association to facilitate this.

Caption - From left to right: Dr Aloisia Camilleri, Dr Giovanni Grech, Dr Etienne Muscat, Dr Rachel Taylor East and Dr Nigel Camilleri.

Photo:  Michael Camilleri