On 22 of July 1946, Malta became an accepted signatory to the Constitution of the World Health Organisation. This constitution declares a number of principles that are basic to the happiness, harmonious relations and security of all peoples. And what more, should people resident in Malta; natives or foreigners alike, aspire for? In so doing, Malta has correctly ratified that health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. The achievement of any State in the promotion and protection of health is of value to all.
Today, the World Health Organisation re-affirms that mental health is a universal human right and is pushing to improve knowledge, raise awareness and drive actions that promote and protect everyone’s mental health as a universal human right.
Within the Maltese context, the journey of Mental Health Services has been long and interesting. In 1861, mental health patients from Villa Franconi in Floriana who were previously secluded from society, rather than supported and reintegrated in the community were transferred to the then newly-opened Mount Carmel Hospital . Today Mount Carmel Hospital as originally purposed has surpassed its lifespan and often fails to provide a physical environment that is conducive to patient mental health care and well-being. Some efforts can be noticed in moving patients out of hospital and into the community; an effort that has reduced the number of in-patient beds in Mount Carmel by nearly a half and with some being relocated to various hostels. On the other hand, the number of persons on Community Treatment Orders, which allow for mandatory treatments in the community instead of inpatient care, has increased eightfold from 25 patients in 2015 to 199 patients in 2021. But is this enough?
Mental Health Services have taken up the challenge and invested in setting up of various specialised services such as the Young Persons Unit, Child and Young Persons Services, Dar Kenn għal Saħħtek for eating disorders, the Dual Diagnosis Unit, Perinatal Mental Health Clinic, the various community clinics and outreach teams, the rehabilitation centres, the liaison psychiatric services based in Mater Dei Hospital, the Crisis Resolution Home Treatment Team and the National 1579 Help Line, just to mention a few.
During the 35th session of the Human Rights Council held in June 2017, a special rapporteur presented a report on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. At that time unaware of the impending global COVID-19 pandemic, mental health was already being considered as a global health priority. As rightly stated by the World Health Organisation, there is no health without mental health. Can Malta really say that mental health is a national priority? Does mental health enjoy parity with physical health in national policies and resource allocation; whether budgetary, human resources or facilities? Despite the increase in total budgetary allocation over the years since 2012, the percentage of recurrent budget allocated to Mental Health services has remained 6 -7% of that allocated to the Health Ministry in total.
Meanwhile, the number of persons taking free medications from the Pharmacy of Your Choice Scheme since 2011 show an increase across nearly all chronic psychiatric conditions listed on the fifth schedule of the Social Security Act. Is this because of a progressive deterioration of our population’s mental well-being across the years or because of increased awareness of mental health and greater access to the government health services? Various local research studies show what could be a worrying situation of increasing mental health problems across all ages and sectors.
A study carried out in 2021 by Richmond Foundation amongst young adolescents showed a substantial number of the sample population suffered from anxiety, sadness and loneliness, at such a young age. In 2020, a study commissioned by Fondazzjoni Dar Kenn Għal Saħħtek amongst 10-16 years olds showed that 5.5% suffered from an eating disorder. A MISCO study carried out in 2021 on employee well-being at the workplace showed that 63% of the sampled population experienced mental health issues, such as stress and anxiety related to work.
Another study titled The prevalence of loneliness in Malta: a nationally representative study of the Maltese population (Marilyn Clark et al.) carried out in 2019 showed that “a total of 43.3% of individuals residing in the Maltese Islands experience some degree of loneliness”. In 2021, 60% of persons being admitted involuntarily to Mount Carmel Hospital were less than 45 years of age and 27% of persons were foreigners. Looking into official data, nearly 300 persons have completed loss suicide since 2011.This is a great to their loved ones,and to our nation! Can this pass unnoticed? The list of research studies on the current mental health of our population becomes long but possibly all give the same picture.
So today, whilst acclaiming that mental health is a Universal Human Right and also a global health priority and coincidentally days away from the presentation of the 2024 Government national budget, brings to fore the pressing need for more financial allocation to mental health initiatives across all government. I reiterate my previous and long-standing appeals to relevant government headships in this regard. Why should we still encounter instances whereby persons are kept in Mount Carmel Hospital despite having a stable mental health problem because there are no alternative and appropriate accommodations in the community?
Who is ensuring that mental health and well-being are being promoted and implemented across the whole of government, in all educational settings, at all workplaces and in the community? How much are we supporting the non-government sector working in the field of mental health and social care? How much are these organisations collaborating together for maximisation of the limited resources available? How much are we supporting the informal carers and the persons with severe functional disabilities and who are unemployed? As a signatory to the WHO constitution, the State is obliged to support all these efforts and should be actively co-ordinating all the resources available to ensure the highest attainable standard of mental health.
On a positive note, some patients have been relieved to hear that as from the 6th October 2023, fluoxetine oral solution has again been made available on the formulary. However I am still deeply concerned that until other new psychiatric medicines are introduced on the national government formulary, other persons with mental health problems and their families, through no choice of theirs, are advised to procure medicines privately, increasing their financial burden. Should government procure these medicines on an exceptional basis as an interim measure?
The stigma surrounding Mount Carmel Hospital still haunts service users and may frighten people who need to access care. What is the patient experiences telling us? Service users are eagerly waiting for the building of the new acute psychiatric hospital on the grounds of Mater Dei Hospital, today not tomorrow. The same holds true for all the other facilities offering mental health services in the community. The new Ċensu Moran hub will be a move in the right direction. When are we going to have a 24-hour, seven-day week interpreter service available in the acute settings of Mater Dei and in Mount Carmel Hospital to enable our specialists and health workers in the field to better communicate with foreigners seeking mental health care, within the context of a substantial foreign working population in Malta.
Today is the day when all of us need to sit down and decide how we can better ensure that mental health is truly a Universal Human Right. This day provokes a joint declaration by all political parties in Malta, that in all institutions where they are represented, they are going to ensure that Mental Health is genuinely placed on the top of the agenda; that they pledge all their efforts, financial and otherwise, to guarantee mental health does not lack the required resources; that the initiatives targeted towards mental health in their respective electoral manifestos are not seen as space fillers ; and that a national consensus to eradicate the stigma affecting sufferers from mental disorders should be a pillar of national government policy. The time for sweet talk on the 10th day of October is over. We owe it to all those suffering from mental illnesses. These are not second-class citizens. Our nation is duty-bound to promote mental health, protect sufferers and secure all the necessary tools are made available to empower each and every patient. Over the years, various governments have invested heavily in Mater Dei Hospital, Sir Anthony Mamo Oncology Centre and now Primary Health Care and the forthcoming new Palliative Care St. Michael’s Unit. Mental Health Services should have been on the same platform yesterday and not tomorrow. This will truly make Mental Health a Universal Human Right
Dr Denis Vella Baldacchino is Commissioner for the Rights of Persons with Mental Disorders