Mental health is low on the totem pole – Andrew Azzopardi

A couple of days ago, I went to visit some friends on a farm situated close to Mt Carmel Hospital.

It was around 8pm and the only way to access the venue was by driving up the road leading to Mt Carmel Hospital. To access this road, you have to turn right from the notorious Central Link. As I was heading to the off-road around the Hospital complex to arrive at the small holding, I was thumped in the face.

This well-travelled road goes past a number of houses currently serving as an extension of services to the main hospital, all drab and cold (can you imagine minors receiving a service in one of those houses, away from home?).

You then skim close to a building on the left which is derelict and forsaken. Across, you see the odd façade of the Hospital, a witness to the seemingly centuries old model of treatment people still have to succumb to, notwithstanding the endless appeals to move away from that eyesore.

It is scary.

Now imagine yourself being dragged there, possibly, against your will or because you know there is no other option but to get yourself some in-patient treatment. Mind you, being treated as an in-patient is not anything to be embarrassed about, but being chauffeured through a gate that says ‘ Asylum’ and secured by police officers and security guards, my god, that is disquieting.

What would go through your mind as you are clasped by the building? How would you feel? I would personally go cold with anxiety. My nervousness and fretfulness would shoot through the ceiling. I would cry my heart out. ‘Take me away’, I would shout with all my strength, ‘I want to go. Please do not leave me here.’ Now just imagine, for one moment, how the family members accompanying you would feel as they drive out of the complex, and you see the security bar closing down in your rearview mirror.

I can’t, I just can’t fathom, even remotely, having to live in that tattered high-walled compound analogous to a run-down neglected prison rather than a state-of-theart therapeutic center.

I do understand that mental health care at times requires treating people within a clinical and residential setting. But not there. That place had stopped dead in its track’s years ago. It doesn’t fit the bill by no stretch of the imagination.

As I drove by the front entrance and turned to the left to steer round the hospital, it felt even more disconcerting thinking to myself how people could cope living on the other side of those walls.

Now, I’ve been to this Hospital countless times over the years, whether it was to visit friends and service users, or I would be supporting as a social worker, to attend case conferences or other meetings. It hit me how the place still looked eerie and verging on spooky and ghostly albeit time has passed. Imagine being placed in a ward in the middle of the night. Not that being admitted in this architectural antiquity model based on Bentham’s 1800s panopticon design in the morning would feel any better.

The inadequacy of this hospital is terrible through and through. Yes, sporadic attempts have been made to try and repair the building – an unsuccessful feat. Yes, patchy services have been developed but this is nowhere near decent. The Hospital structure is symptomatic of a mental health strategy which is kaput. Look at one news report after another and on what is allegedly happening in the confines of the building. Drive around the hospital parameters. The area is derelict and derisory and has been that way since the infamous Ward 10 was at its crowning. This is the way I remember this institution and this is the way it still is.

The endless and pointless promises by politicians, that people needing residential treatment will get a new hospital, has gone down the pecking order. Naturally and without having to labor on this point, there are people who have tried to steer the ship in the right direction, but the currents are way too strong. Nurses, doctors, psychiatrists, psychologists, psychotherapist, physio therapists, occupational therapists and administrators have often spoken with me about the mess the system is in. But as expected, at one-point disheartenment creeps in and saps and debilitates all efforts.

Issues around mental health services are not only dysfunctional from a ‘hospital’ point of view, but there is a whole mélange of failures and slip-ups. This Hospital, the heart of this sector is indicative of a system, that has imploded. A culture of medical therapy above all else, a forensic ward managed by the prisons which is all but governed by the regime instead of the professionals, dubious treatments that have been pushed to the side by other countries are still applied, use of isolation rooms still proliferating, gaucheness and patronization still at the center of the orderly’s discourse (‘ aw sabiħa’ should become the motto of that place), lack of activity and no importance given to ancillary therapies.

Let’s admit. Mental health is not a priority for politicians – and hardly features as a main concern amongst the health professionals. The frequent appeals of unions have been disregarded.

Gauging by the commitment shown towards the fitful mending of a structure which is collapsing bit-by-bit is for all to see. People with mental health problems are still slurred in our communities. The lowly services we offer is telling of the way we see this population. Thankfully an NGO or two and the occasional adept professionals are filling in with some quality services, but they just cannot do it on their own.

It keeps falling to bits.

How do you expect that people who need residential services don’t get panic attacks knowing they need to go at MCH? How aware are we that if people refuse their treatment, they might die? What importance are we giving to the environment that people are getting their treatment in? Don’t we realise that it is practically at the same level of importance as medicine and bedside support?

How aware are we that people who work in that place deserve to operate in a safe and healthy environment? How conscious are we that people working in that sector are deflated and demotivated, seeing this sector being relegated to the bottom of the heap? How aware are we that a segment of practitioners in this sector have more hours dedicated to private practice than actually working in the hospital? At times fees of €75 for a follow up consultation (not clocking beyond 20 minutes) have been flagged. This is barbarism. Is this anywhere near ethical and suitability of practice?

How aware are we that some professionals use the hospital as their treasure trove which comes in the form of people unable to wait? People have no option but to resort to private services because access to government services is laden with delays - an oxidized sys-tempar excellence. Should there be some sort of record on who is going where? Is there an SoP on how professionals are accessing information of the patients they see outside Hospital precincts? Is privacy safeguarded and is the vulnerability of these people being milked?

In a way, the lack of belonging of professionals is understandable. I am sure that it turns into disinterest very quickly as it takes a great deal of energy for some of the professionals I know to maintain high standards of care.

Let’s admit. We are not really concerned about this segment of the population. Politicians have been promising an alternative mental health hospital on the Mater Dei campus for ages but nothing is forthcoming except for frivolous words.

Since the new hospital dedicated to mental health patients has been promised; we have developed a hospital specialized for Covid-19 patients (which was the right thing to do), added on some 500 units of residential bed spaces at SVPR, developed a specialized service at SVPR for elderly disabled people, spent something in the region of €3.5 billion on health care (over 4 budgets), improved residential services for disabled people and oh, designed and built a network of flyovers – but no psychiatric hospital was built!

People with mental health keep waiting. The reason is simple. They are at the bottom of the pile and simply nowhere near close to being a priority.

The impact of this building on the people who need to use it is immense.

Do you know what the current building does to people?

That building nullifies people. It removes any motivation and strength of those needing the services to go any further in their life. These are people whose psychological treatment requires that they are motivated and emancipated and instead the current hospital services strips people from their dignity and humanity.

The purpose of treatment should be first and foremost for individuals and their families to embrace their condition and try and learn to live with this situation without feeling embarrassed. But the building simply serves to undo people, anonymizes them, creates a power relation that amplifies the ‘us’ and ‘them’, the professionals and those in neediness.

This institution does nothing to ensure that the humanity people are owed is safeguarded. Unfortunately, this building keeps promoting mental health as a disconcerting situation, and this shouldn’t be the case. It strips down people of decorum turning them into faceless ‘cases’ (I hate that term) and helpless individuals who have no say in their own care plan (if there is any).

The Commissioner of Mental Health, the psychiatrists and other professionals who are at the front line, the NGOs and the academics should resist this pounding on the dignity of these people. Their reticence will become part of the guilt.

It is our duty to stand up and be counted.

Let’s resist this disregard.

I drive off after my pleasant visit to some friends once again, pass by that grim building feeling terribly sore knowing that our brothers and sisters are curbed in this obnoxiousness .