We will not beg! – Psy­chi­a­trist David Mamo

I must ad­mit that ‘men­tal health’ is one of my pet sub­jects.

Malta Independent - - NEWS -

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.


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