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Mental health and well-being for all - John Cachia

Today is World Mental Health Day. Good mental health and well-being is in the interest of society. There is broad consensus among stakeholders and service users that a national mental health reform is required with urgency.

My office has gathered and published grassroots’ insights and provider perspectives on the current state of mental health services accompanied by an incredible richness of observations and recommendations that can be meaningfully utilised to provide a robust way forward.

The pillars of this reform can be summarised under five headings: mainstreaming mental health services; moving the focus of care from institutions to community; moving acute psychiatric care to the acute general hospital setting; supporting rehabilitation through specialised units preferably in the community and providing long-term care in dignified facilities.

The challenge is to translate these recommendations into a coherent strategy and implementation plans that are appropriately funded and accompanied by sound human resource planning.

The availability of adequate human resources is a critical issue which regularly features in feedback with care teams. Robust and resilient leadership is fundamental to bring about the desired changes.

Against this background, the debate about better mental health and well-being for all presents a list of cross-cutting issues which require deeper focus and policy decisions that involve several ministries and departments together with other public and private entities and agencies. 

Around two-thirds of admissions to involuntary mental health care in 2017 were persons aged less than 45 years, confirming the high burden of mental disorder in the younger segments of society.

Investing in the well-being of our younger generations is a policy priority which needs holistic action between health, education, employment, youth services, social welfare, workplaces and employers.

The common intent must be to address the core determinants of poor mental health and move to early intervention using available and targeted services in schools, in educational and training institutions, workplaces and in health and social care services.

Future service planning and forecasting must include relative risk differences within the native population and projected influxes of foreigners when determining future mental health care needs.

In 2017, the relative risk of an acute involuntary admission was much higher for residents of the southern harbour and northern regions compared to the rest of the country. Persons in residential care had an eight-fold higher risk compared with Maltese citizens living in the community.

Local community mental health service development must address the specific needs of various sectors of society.

The soaring levels of younger people and foreigners among acute psychiatric admissions provide additional evidence for effective workplace support

Furthermore, 25 per cent of all acute involuntary admissions were foreigners living in Malta. Persons from medium and less developed countries had a five-fold risk. Persons from very highly and highly developed countries and non-Maltese persons coming from EU/EEA had a two-fold risk.

Nationals from foreign countries are organising themselves into self-help and support groups. Engaging with their leaders and convincing them to take up mental health issues is a step in the right direction.

The soaring levels of younger people and foreigners among acute psychiatric admissions provide additional evidence for effective workplace support. Workplace mental health will continue to feature very highly on the agenda of our office. We plan to reach out to social partners on the importance of focusing on workplace mental health and well-being, as part of Malta’s economic development.

Substance abuse contributed to one-third of all acute involuntary admissions in 2017.

Substance abuse was three times more common among males. Within the 18-44 year age group, 80 per cent of acute psychiatric admissions were linked directly or indirectly to substance abuse. The challenges for addictive disorder services within health and social welfare are considerable and action must continue to be taken in a holistic and co-ordinated manner. Service user empowerment has been one of the initial cornerstones of our role to promote and protect the rights of persons with mental disorders. Compared to recent years, patients and families today appear to be more aware of their condition and their rights and are more ready to speak about their care experience.

More work is needed to tackle stigma and ensure that patients continue to be informed of their rights. Customer care pathways within services and at our own office must improve. This will bring about a further increase in the quality of care.

The #StopStigma campaign, started in 2017, must continue in order to reduce discriminatory behaviour towards people with mental illness and to normalise the difference between physical and mental health within services. The burden of stigma towards mental illness discourages persons from seeking early treatment. #StopStigma must continue to generate goodwill to embrace and implement change.

World Mental Health Day 2018 should be an opportunity for a renewed resolve among all stakeholders to continue to work together and advocate for better mental health and well-being within our society.

John Cachia is the Commissioner for the Promotion of Rights for Persons with Mental Disorders.

This is a Times of Malta print opinion piece

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