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Real change in mental health - Stephania Dimech Sant, Godfrey Borg, Etienne Muscat and Pierre Galea

Mount Carmel Hospital is constantly in the news. This is reflective of a very difficult state of affairs in the mental health services. But it is not a situation that has suddenly appeared, and it is not a problem amenable to a quick fix.

Traditionally, the national health service has separated mental health from general health, perpetuating a sense of isolation and of being different (and, hence, easier to sideline). Mental Illness is nonetheless a major source of distress, includes or is involved in a vast array of conditions, from school difficulties to substance use to dementia, and it is fast becoming the greatest cause of disability and lost productivity in the workplace.

In essence, mental illness in its multiple ramifications will become the biggest problem facing our society in a very short while.

And yet, mental health continues to be pushed under the carpet.

This is not a problem that was created or exacerbated by the current administration. This has been developing for decades, and generations of lawmakers have contributed equally to the present pitiful state of affairs. But pitiful is what they nonetheless are today.

The mental health services are crumbling physically, with outdated facilities and institutionalised patients. And they are crumbling functionally, swamped by surging demand, loss of traditional social networks and supports, woeful levels of staffing and an inability to prioritise service distribution in a manner that recognises international trends (such as prioritising community care over hospital-based treatment).

There are probably hundreds of thousands of people in Malta who are directly affected by this unacceptable state of affairs.

First and most obviously, the people who have a mental illness, who must struggle with the condition but also suffer judgement and ignorance, often for years.

Next, and too often conveniently forgotten, the caregivers or the family members, including spouses, parents and children, who share the real daily burden of care with patients.

Thirdly, the professionals who work in this field, who can see the devastation of the illness on people and families, who must work in environments that are not fit for purpose and whose hands are tied by the limited options they can offer in a country that is doing so well economically but spectacularly failing its people in this area.

Finally, the employers, the backbone of our economic resurgence, who can see – but struggle to comprehend – people they have trained, highly skilled and productive individuals, laid low and ineffective by conditions that are very hard to understand or to target effectively in the workplace.

In an unusual but hugely hopeful step, these parties have come together.

Mental illness in its multiple ramifications will become the biggest problem facing our society in a very short while

Recognising that the people ‘in the trenches’ are actually far more in agreement than they differ, representatives of the patient (Richmond Foundation), the carers (the Mental Health Association) and the Associations of Psychiatric Nurses and of Psychiatry came together in the Alliance for Mental Health (A4MH) a year ago and published a position paper on the prevailing state of the mental health services and where they should be going.

In the meantime, other NGOs, including the Malta Employers’ Association, joined the A4MH. But there has not been a palpable shift in the structure and function of the national health services or in the national attitude towards responsibility for mental well-being. This is not acceptable.

To be well-intentioned but to be out of one’s depth is perhaps understandable. But to be handed, on a plate, the combined expertise of the relevant stakeholders and to continue to flounder while ignoring the A4MH is unconscionable.

It is also surprising, because the silver lining to the current crisis in mental health is that the present ministry is actually recognised as being a particularly efficient, proactive and practical institution. It probably has not yet prioritised mental health. But, in all this morass, where to start?

The A4MH has identified areas that need to be addressed.

The main shift that we need from the administration, however, is the recognition that we can no longer think of mental health as separate from physical health, since that mindset keeps us stuck in a stigmatised corner, as an afterthought.

There must be a new hospital. It must be leaner, so that only the truly, acutely ill will use it and it absolutely must be located within the footprint of Mater Dei Hospital and physically connected to it in the way that the oncology hospital is.

The ministry may change the CEO, the head of psychiatry, the head of nursing and the heads of all the departments. This will not help us.

The administration may change all the names of all the wards and put new blocks within the MCH complex. This will not realistically improve the lot of mental health patients at large.

Real change has to have a focus.

This focus must be the new hospital linked to MDH, and the community services must evolve in the time the hospital is being built, so that, on opening day, we are functioning at a level that is no longer the shame that mental health care is today.

Stephania Dimech Sant is CEO of the Richmond Foundation, Godfrey Borg is president of the Mental Health Association, Etienne Muscat is president of the Maltese Association of Psychiatrists and Pierre Galea is president of the Maltese Association of Psychiatric Nurses.

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