We will not beg! – Psychiatrist David Mamo
I must admit that ‘mental health’ is one of my pet subjects.
Dr Andrew Azzopardi Dean Faculty for Social Wellbeing, University of Malta & Broadcaster – Għandi xi Ngħid www.andrewazzopardi.org
Some years back in my role as social worker when I used to visit Mt Carmel Hospital on a regular basis I remember the infamous and illreputed Ward 10 where all the hardened cases were ‘placed’ (in the absence of a harsher word). This particular ward looked more like a prison division than anything else – with worse conditions. Doors were barricaded with massive wooden beams, the service offered was piteous, staff were hardly trained let alone motivated and clients were sedated like zombies out of a Hollywood movie.
Since then, this situation has improved considerably and to a large extent but that doesn’t mean that the mental health sector is out of the woods. The stigma that the hospital and community mental health services still face is unbelievable. The fact that this sector lies at the bottom of the heap of the health services, even though the high level of professional competencies are there for all to see, only confirms that this field of practice needs a good revamp (to say the least). Some half-hearted, half-baked reforms have been attempted over the years but the resulting outcomes were unsuccessful and the sector still looks disjointed, fragmented and disorderly.
Recently I met representatives from the Alliance for Mental Health to discuss this matter; Psychiatrist Prof. David Mamo Vice-President of the Maltese Association of Psychiatry, Godfrey Borg President of the Mental Health Association, Pierre Galea, President of the Maltese Association of Psychiatric Nurses and Daniela Calleja, COO of the Richmond Foundation Malta. It is a first that these four entities have come together sharing a common voice and presenting a joint position on this sector. What all these stakeholders are claiming in their shared Position Paper on Mental Health is that there needs to be decisive action that will raise the bar that one expects in this day and age.
In fact, during my conversation with the members of this alliance, it was made increasingly clear that there are a number of building blocks that are not in place. Education, or the lack of it, seems to top the list. The results are in our face and people still see the mental health services in an abhorrent and repugnant way. The effect of this is that this thinking spills on the way people react to mental health services when they need them. The concern is not limited to hospital and residential provision but relates to gaps in the services that are not being addressed across the service continuum. Moreover, new services that are being introduced lack any service user and professional involvement even though they are the primary stakeholders. To compound all of this, professionals are finding it increasingly difficult to operate because there isn’t the serenity to manoeuvre and to give direction to such an important field in our health system.
This alliance is calling for a clear direction on how, where and by whom this sector needs to move forward. They are demanding improved recognition of mental health. They are commanding more financial and human resources dedicated to this sector, and improved community and residential services. They are not satisfied with promises of a new acute psychiatric facility, but expect that such a facility be within and part of the state-funded general health services provided at Mater Dei Hospital. Such developments must be carried out within the context of a strategic plan for mental health reform that ensures that any acute services are adequately supported by comprehensive community support services. The alliance expressed serious concern about talk of privatisation of the mental health services as this would further widen the divide between physical and mental health services and ultimately hurt those most severely affected by mental illness.
Godfrey Borg claimed that WHO and EU surveys confirm that one in every four persons (25%) of the population suffers from some form of mental health condition in their lifetime, which can be just a depressive episode to full blown paranoia and with the complex and demanding lifestyles we are leading, it has become multifarious and increasingly easy to get trapped in some condition or other.
Daniela Calleja said that ’policy makers and politicians are listening to us but this can only be the first step’. She continued saying that, ‘People with depression might wait some four years before going for help because of the embarrassment of asking for support. This needs to change quickly if we want to avoid more pain’.
The archaic nature of the institutional mental health services and the serious deficits in community services paint a poor picture of what mental health services can offer. This makes people hesitant to seek help in a timely manner often presenting themselves for mental health services when absolutely desperate. Prof. David Mamo said: ‘Our dream is that persons experiencing mental health difficulties will seek out state mental health services confident that they or their loved ones will be treated with the same level of dignity and professionalism that they expect from general health services at Mater Dei’. This makes the relocation of the acute psychiatric facility to Mater Dei grounds key to any reform process, and will in and of itself make for one giant leap in the elimination of stigma and enhancement of standards in mental health services in Malta. Prof. Mamo adds: ‘Politicians are listening, but this is no time for supplication – the more than 13,000 persons per year individuals seeking mental health services, their carers, families and mental health professionals have come together for the first time to demand their right to be treated equally and at par with general health services – hence we expect politicians to take our position on board – we will not beg!’
The alliance spoke about the work and the challenges entailed if they are to get away from the status quo that might sit comfortable for them. Having professionals who are engaged is crucial but as Pierre Galea said, ‘Having a country with a strong mental health is economically and socially good for the country’.
The burden of mental ill health in Malta is borne primarily by the individual and the family, but additionally by the workplace, the health services and society at large; however, the current mental health care system is archaic, poorly structured, isolated from the general health care services, largely ignores the needs of the individual and contributes to stigmatisation and social marginalisation.
Richmond Foundation, the Mental Health Association, the Maltese Association of Psychiatry and the Maltese Association of Psychiatric Nurses, respectively representatives of the patient, the caregiver, and the professionals working within the national mental health sector, are in agreement that a thoughtful, holistic and stakeholder-driven reform process is urgently required, and are also in agreement on the goals of the required reform process, as set out in this document.
This document outlines the minimum standards which are necessary in order to achieve the minimum acceptable level of mental health care that is expected and available in other socially mature countries. The recommendations in this position paper would bring Malta to a position where the needs of people in need of mental health care and their carers can find the professional help that they need and deserve. Furthermore, implementation of these recommendations would allow Maltese mental health professionals to sit at the table with European counterparts and not feel embarrassed to discuss the local situation.
Falling short on even one of the identified needs would be falling short on our duty to the people who encounter mental ill-health every day, as patients, carers or professionals.