The Commissioner for Mental Health Denis Vella Baldacchino has urged for more community-based support for suicide prevention, saying that the current approach lacks the holistic response necessary.
"Time is critical. One day extra for anyone contemplating suicide is unbearable," Dr Vella Baldacchino told The Malta Independent on Sunday.
There has been a concerning spike in suicides reported this year, with parliamentary figures published in July showing that in May and June alone, five people died by suicide They were all males.
In fact, Vella Baldacchino said that from January to May of this year, 14 people died by suicide, 10 men, and four women.
Vella Baldacchino said that there is an urgent need for better community-based mental health support systems, especially for people contemplating suicide.
"We want to provide acute care in a controlled, stimulating environment which supports you, and you leave with dignity, not with a rubber stamp," Vella Baldacchino said.
While acknowledging government efforts such as the national suicide prevention strategy, Vella Baldacchino said that this is still not enough.
"I do not care about numbers. For me, even one person is important," he said.
He said that suicide prevention cannot be a matter for health authorities alone, but requires an inter-ministerial approach extending to education, social care, law enforcement, and local councils.
Prevention, not just reaction
The commissioner criticised the lack of systematic case analysis following suicides, describing it as a missed opportunity to identify red flags or intervention gaps.
"No one analyses to see if there were symptoms or signs that could have indicated that this person was contemplating suicide," Vella Baldacchino said.
"I believe that we should analyse each and every case that we get notified with. In my opinion, there is a gap of information. For example, the Health Ministry only becomes informed about these numbers through the death certificate which they receive," Vella Baldacchino said.
He continued that in some cases, those who die by suicide had never expressed any intention or shown visible signs. On the other hand, others had been discharged from long-term psychiatric care, only to take their own lives shortly after, he said.
"We had people who had been admitted in Mount Carmel Hospital for more than a year, and after being discharged, they committed suicide," he said.
Vella Baldacchino said that community mental health services are still underdeveloped and often offered in inadequate conditions.
Vella Baldacchino recalled a clinic operating out of a garage in Żejtun and others based in basements.
"Unfortunately, there were services offered in a garage. For me, that was unacceptable," Vella Baldacchino said.
He also said that more services should be expanded to operate in afternoons, evenings and nights, with decent facilities and adequately staffed teams.
"We have to aim at first class. We should not accept second class," Vella Baldacchino said.
The government has allocated €4.5 million to develop mental health first aid and community services through local councils, which the commissioner praised as a step in the right direction.
However, he said more resources and faster action are still urgently needed.
"One of the things we have launched is that we have printed this pack of various helplines on flashcards, which can be held in one's pocket, or in one's car, wherever, so that it may come to mind to anyone passing through those critical moments, to contact for help," Vella Baldacchino said.
"We have various helplines, there are good practices, so what the Commission did is organise a seminar between various leaders of the various helplines for them to speak about the problems which they face and to try and share the good practices. This is something which is in progress," Vella Baldacchino said.
He also pointed out a lack of flagging of firearms in households.
"There were a lot of issues this year where the police increased control on the availability or the access to firearms. As a doctor myself, there were a lot of complaints by people, as people would have to go to a doctor so that they can be certified to be mentally fit," Vella Baldacchino said.
However, owning firearms can be something taken for granted, and no one knows what could be going through someone's mind, knowing that a firearm is easily accessible to them, he said.
"Some things are easily preventable, such as cabinets to lock up your firearms, and control on who has access to firearms. This work is being done by the police right now, and it will help," Vella Baldacchino said.
However, if someone is determined to commit suicide, they will find other ways, so the key priority is to increase awareness, not just, "through a slogan, or an advert in the media, but it has to be repeated at grassroots level in our communities."
In a previous interview with The Malta Independent on Sunday, Vella Baldacchino had warned that mental well-being in Malta was being eroded by over-development, traffic and environmental degradation.
Asked if the situation has improved or worsened, Vella Baldacchino said that while one cannot pinpoint a single issue as the cause of eroding mental well-being, it is a "cocktail of what we call social determinants."
"Poverty, unemployment, chronic disease, domestic violence, traffic congestion, road rage, over-development, noise pollution, excessive construction, all these environmental factors contribute," he said.
He praised the government's Project Green, adding that the need to "greenify," the country and its environment is crucial.
"We have to create open spaces which are truly safe and green. It is useless to open up a new garden and after a few days, we let it dry. We have to maintain our environment," Vella Baldacchino said.
He continued that more walks in the community could be organised, rather than bingo events, for example.
"There were two parishes who organised these walks, however, we have to have an environment which is conducive to nice and interesting walks. We have to be more proactive," Vella Baldacchino said, adding that local councils could also commit themselves to such initiatives for the community.
"We have to be more committed, no more talking, we need to act," Vella Baldacchino said.
He also appealed for families and friends to be more attentive to someone who may be displaying signs of contemplating suicide, or even just to check on their general mental health.
Despite this, the situation remains difficult, Vella Baldacchino said, adding that while anyone could be trying to look if there were any signs worth flagging, the solutions are not that simple.
"Admitting a person to Mount Carmel Hospital is also traumatic in itself. One parent had asked why their child was not kept there longer. I argue all the time, why are we keeping people in Mount Carmel Hospital?" Vella Baldacchino said.
Closing Mount Carmel
The Commissioner had recently acknowledged reports of deteriorating conditions in a specific ward in Mount Carmel Hospital, even describing a stench of cigarette smoke during one of his visits.
He was asked about his main concerns about the situation there and what he would recommend to the authorities as a minimum response.
"Authorities already took action. We were alerted and we acted. However, we have to understand that Mount Carmel is more than 100 years old. When it was officially inaugurated it was truly state of art across Europe. In fact, there was even a certificate from the United States," he said.
Vella Baldacchino said that the problem is that over the decades, Mount Carmel, Malta's only psychiatric hospital, has become outdated and overburdened.
Temporary wards created during the pandemic have become long-term solutions due to lack of space and planning, he said.
"Sometimes we take temporary measures, but we forget that they are temporary, and they become permanent," Vella Baldacchino said.
He praised staff at Mount Carmel for their incredible work, but warned that some patients are admitted to Mount Carmel not due to psychiatric issues but due to the lack of alternative care options.
"I see persons who have been admitted to hospital not because of psychiatric problems, but because they found closed doors elsewhere," he said.
Vella Baldacchino said that he is hopeful about the upcoming acute psychiatric wards at Mater Dei Hospital, which would treat people in short-term settings and then follow up with care in the community.
"There has to be a change in mindset, and I do not think that we are ready for that," he said.
The Commissioner said that many of the people who fall through the cracks, including migrants, people with intellectual disabilities, and those with substance abuse problems, require coordinated care that goes beyond hospitalisation.
"It has to be an inter-ministerial approach. It is not just a health issue, or just a social issue. It is everyone's issue," Vella Baldacchino said.
He also called for more attention to excessive environmental stressors affecting mental wellbeing, from over-development and noise to traffic congestion and domestic violence.
"All these environmental factors contribute. We have to greenify our environment. We have to be more proactive," he added.
Moving from 'silo mentalities'
One of the Commission's major recent initiatives has been introducing mental health first aid in all schools for Year 9 students, including Church and private schools, Vella Baldacchino said.
"Children and their educators spend a lot of time together. They are being given this information for more mental health awareness," he said.
He also spoke about perinatal services being expanded to screen all pregnant women and their partners for mental health issues, a project supported by the Social Policy Ministry.
"If we ignore that, that is where we go wrong," Vella Baldacchino said, pointing out that there are those who experience several issues.
Vella Baldacchino said mental health must be treated as seriously as physical health, as doing so requires better funding, less duplication, and more collaboration between ministries and NGOs.
"We have to break silo mentalities. Even between NGOs. We are here to do our duty, but then, collaboration is needed to avoid duplication," Vella Baldacchino said.
"This is about stigma. We have to change our mindsets. Hopefully, the new psychiatric unit at Mater Dei will help us understand and accept that psychiatry is the same as any other physical problem," Vella Baldacchino said.
If you need help...
Thinking, learning, reading, and talking about suicide can be distressing. If you feel distressed, you should be aware that help is readily available. If you need help, please access the support that you need.
Services National Mental Health Helpline
For suicidal thoughts, mental-health problems, loneliness, and emotional support, call the National Mental Health Helpline 1579
Suicide Prevention Outreach and Therapeutic Services (SPOT)
SPOT provides support to people who have been affected by suicide (bereaved individuals), people who have attempted suicide three months prior to service intake, and people who struggle with suicidal ideation. Visit https://victimsupport.org.mt/spot/ for more information or contact Victim Support Malta on +356 2122 8333 or [email protected]
Source: National Suicide Prevention Strategy 2025-2030