The psychiatric liaison service in Malta

American actress Mariska Hargitay had said that “healing takes time, and asking for help is a courageous step.”

Since the onset of the COVID-19 pandemic, doctors have observed a considerable number of people requesting psychological or psychiatric help at Mater Dei Hospital.

Liaison psychiatry is a psychiatric sub-speciality offering a mental health service to Malta’s general hospital, Mater Dei Hospital. Psychiatrists review individuals present at the Accident and Emergency Department. The service also extends to Mater Dei Hospital’s in-patient population, which currently stands at around five hundred. Once closed services reopen, we expect the in-patient population to go back up to nine hundred as it was prior to the pandemic.

Receiving approximately fifteen to twenty referrals daily, the psychiatric liaison service has seen a marked difference in individuals’ presentation, following the onset of the COVID-19 pandemic. Most notably, persons have presented much more unwell than they did a few months ago.

The persistence of alcohol and substance abuse has been particularly striking. Approximately thirty-five percent of our patient cohort presents with an alcohol or drug problem. Often times, persons present are either with aggressive behaviour following alcohol intoxication which the service has seen despite social distancing measures, or in withdrawals from not drinking the same amount of alcohol; with a long-standing history of alcohol consumption. The latter can be a life-threatening condition which requires medical treatment in a monitored environment such as a hospital.

Apart from the medical complications of longstanding alcohol and drug abuse, we have noted a significant number of psychotic presentations. By definition, psychosis is a mental health condition whereby the person misinterprets reality. This misinterpretation can take the form of feeling suspicious of others’ motives and will therefore result in that person thinking, feeling and acting in different ways to their usual way of being. Very often, the person would have current or past use of drugs. The commonest substances we come across are cannabis, cocaine and synthetic drugs. This has resulted in a spike of admissions to Mount Carmel Hospital for further observation and treatment, including the provision of a safe environment.

With the onset of the COVID-19 pandemic, many people have experienced major life stressors including loss of employment, which has brought about financial difficulties and increasing rates of marital dispute and domestic violence. Many turn to alcohol or drugs to cope with the mental distress that ensues. Too much free time on one’s hands can be dangerous, if not used wisely. Jane Addams, an American settlement activist and sociologist, had once declared “of all aspects of social misery nothing is so heart-breaking as unemployment”.

In other media outlets, both locally and abroad, a number of factors have been identified to explain the rise of admissions to psychiatric hospitals. From our own observations, these have included persons defaulting their treatment for fear of going to their pharmacy or attending clinics for treatment which require professional administration, changes in social contacts, and a heightened degree of anxiety related to the transmission and effects of COVID-19.

We must also keep in mind the needs of elderly population. Social isolation has led to loneliness and depression. Depression can culminate in both suicidal considerations and attempts to take one’s own life. These account for almost half of the psychiatric workload at Mater Dei Hospital. We have observed persons who developed mental illness in view of the current pandemic.

Albert Einstein stated “the measure of intelligence is the ability to change”. People need a healthy frame of mind to adapt to this new norm. We recommend the continuation or adoption of healthy lifestyle changes, including exercise, yoga, mindfulness, eating healthily and avoidance of excessive alcohol consumption. Use of social media to contact family and friends is advised. Overuse of social media and repeated searches for articles about COVID-19 are discouraged, particularly if that person might get stuck into a web of increasingly anxious thoughts and feelings. The situation is rapidly evolving although most of us get feelings of being stuck in a reality which none would have dreamt of a few months ago.

There are many voluntary organisations offering help and support during these times. We advise anyone who is feeling unwell to contact a trusted healthcare professional. Reach out and speak out.