Only nine of the 159 patients who were seen by the Crisis Resolution and Home Treatment team (CRHT) were deemed to need further treatment at Mount Carmel Hospital, the hospital’s CEO Stephanie Xuereb told this newsroom.

Around eight months ago, Deputy Prime Minister and Minister for Health Chris Fearne launched the CRHT, a new mental health service, in an attempt to improve mental health care in the country.

The CRHT service is part of a chain of services offered by the government’s Mental Health Services. It is aimed for individuals in crisis who seek assistance at Mater Dei Hospital and who are not yet benefiting from psychiatric care. When such a case arises, the psychiatrist at Mater Dei can opt to refer the individual to the CRHT team for urgent and effective follow-up.

The decisions of involving CRHT must be done collaboratively with the individual in crisis and is completely voluntary. Referral is specifically and only through Mater Dei Emergency Psychiatric Services.

The Malta Independent on Sunday reached out to the respective authorities for information on the progress of this newly established team and on how its services have been received in the community.

Mount Carmel Hospital’s CEO explained that after receiving a period of intense intervention, the majority of patients using the CRHT service (110 patients) were referred for further follow-up to the various Community Mental Health Clinics.

Xuereb highlighted how patients looked at this treatment with a positive attitude as she mentioned some of the comments made by the patients.

“They are very understanding and in my three weeks of treatment I got full support from them. They called to make sure I am OK even on a Sunday. Without their help and advice I wouldn’t have made it,” one patient said.

Another said: “I recommend CRHT because they help people feel that they are not alone and support is always their main priority. I thank each and every individual who helped me in my case. I really appreciate their work.”

Xuereb explained that the team performs two primary roles.

The team intervenes rapidly and assertively with the intent to prevent hospitalisation. It also acts as a mediator between the individual in crisis and the current local services, such as rehabilitation services, social workers, emergency physicians and general practitioners, Xuereb said.

By involving professionals from multiple disciplines and agencies, the individual receives personalised interventions that mitigate for the crisis at hand.

She explained that while hospitalisation can be essential and life-saving, most crisis cases can actually be resolved without the commitment and impact of hospitalisation.

“To avoid hospitalisation, our staff perform numerous home visits, phone calls and clinical reviews throughout the day as often as necessary to ensure that the individual is safe and supported during this difficult period,” Xuereb added.

The hospital population of Mount Carmel Hospital varies according to admissions and discharges, and it fluctuates between 210 and 220 patients. Meanwhile, at any point in time the CRHT provides service to between 20 and 30 patients.

Currently, the clinical team is made up of eight nurses, two psychiatric specialists and two psychiatric consultants.

Each member of the team plays a unique role in patient care and the team make it a point to develop an engaging therapeutic relationship with clients who benefit greatly from this level of interaction.

Xuereb highlighted a number of the benefits that are reaped from this service.

The CRHT service establishes a sense of trust between the client and the professionals delivering the service. The team is committed to assertive and in-depth management and this encourages the individual to be open and honest about their crisis, resulting in better outcomes, Xuereb said.

“Quantifiably, we are also reducing unnecessary hospitalisation and the associated burden on the individual, their family and the health sector,” she added.

Meanwhile, it was also mentioned that a recent satisfaction survey carried out among persons who have made use of the CRHT service has shown that 98% are extremely satisfied with the service.

Xuereb explained that the service has helped individuals to identify their problems and be more knowledgeable about the therapy and treatment available. Service users felt that their concerns were addressed, they felt welcomed and safe during clinic visits and that they received good quality care and support through the CRHT service.

Asked on whether this service reduced cases of suicide, Xuereb said that “while it is not easy to quantify the exact impact of CRHT on suicide incidence in Malta, we estimate that through early access to care and assertive humane treatment, we have been able to support numerous individuals who would have otherwise resorted to suicidal behaviours.”

The incidence of suicide is difficult to predict accurately due to the ever-changing unprecedented global situation.

“In our practice, we routinely enquire about risk (both to the individual and their loved ones) and we believe that through candid discussion, we are more in touch with the individual’s abilities to remain safe or otherwise,” Xuereb said.

One might question how the team distinguishes whether the patient requires care at Mount Carmel Hospital or whether treating them at home is enough.

Xuereb explained that the decision to hospitalise is always difficult to make and physicians are constantly mindful of the positive and negative impacts of hospitalisation.

“To offset any risks in making the decision, the CRHT looks at the individual’s support network and coping strategies when deciding whether treatment at home could be conducted with sufficient safety and efficacy,” Xuereb said.

She added that the role of the CRHT is to increase the possibility of successful treatment at home, thus making the process of recovery more comfortable and achievable for the individual in crisis.