Sixty nurses will retire from Mount Carmel Hospital over the next five years, and only 14 per cent of the hospital complement is trained in mental health nursing, according to the director of nursing services of the Health Division, Jesmond Sharples, outlining a plan of action, in conjunction with the Institute of Health Care, to prioritise and deal with the shortage of specialised nurses.
Mental health is the "number one" disease in Europe and the affluent world, so policymakers need to ensure that patients do not suffer due to a lack of vision on the policymakers' part, he said.
Mental health is "the issue of the 21st century and still considered a taboo: societies are becoming increasingly complex, life more stressful, and social cohesion is on the decline, with more and more people leading solitary lives. All this is affecting mental health adversely, with depression topping the World Health Organisation's list of diseases, together with cardiovascular disorders," Mr Sharples said.
Although mental health is usually associated with Mount Carmel Hospital, the vast majority of people with such problems - a large chunk of the population - are in the community. In fact, one in six people in the Western world have a mental health problem. "Even if it were one in 10, it would mean that 40,000 Maltese have such problems and, clearly, not all of them are being treated."
Among the measures to avoid an imminent sharp dearth of mental health nurses and in order to raise the profile of a dynamic career in psychiatric nursing, the division, in collaboration with the IHC, is introducing a mental health programme for the preparation and education of nurses "in the belief that the mind is as important as the body".
The plan is to develop mental health nursing, for which there is a strong need - today more than ever, said Grace Jaccarini, coordinator of nursing/midwifery studies at the IHC.
"We are already late because 60 nurses have already retired over the past five years. Our mission is, therefore, to strategically plan ahead and create opportunities," said Mr Sharples.
Since October 2003, 19 nurses were deployed to Mount Carmel for a much-needed injection, but only two of them were psychiatrically trained. Those who are learning the ropes vicariously - which is not ideal - would need to be targeted and trained, Mr Sharples said, adding that the lack of psychiatric nurses at the hospital was a "major drawback".
Mental health coordinator Martin Ward will be embarking on practice development initiatives at Mount Carmel, and the setting up of a conversion course so that ordinary nurses would become registered mental nurses.
The plan is to educate psychiatric specialists from scratch, or upgrade existing nurses, Mr Ward said.
Twelve students are undertaking a conversion from diploma to degree level in a three-year part-time course, which started in October, while a new university course - the first direct-entry degree course in mental health - has already been devised and has been submitted to the senate for approval.
This summer, the health division is looking to recruit individuals interested in mental health care for the four-year course. No limits have been set on the number of students, but the selection process has to be careful, Mr Ward said.
The Health Division is promoting the "challenging" career in psychiatric nursing, which would guarantee a job, also in view of increasing unemployment and the lack of opportunities in teaching.
Psychology graduates would be ideal candidates for the course, Mr Ward said.
It is no novelty that Malta lags behind in the provision of community mental health for which nursing is the backbone. Despite attempts, mental health nursing has not been developed due to a lack of resources and skills, making it impossible to launch a fully-fledged community rehabilitation system.
"Community health nurse practitioners need to be independent and able to make their own assessments, acting as gatekeepers for psychiatrists and anticipating problems" - skills that require education.
"If you have a low skills base, who teaches what to the next generation of nurses? The reality is nothing gets taught because nothing is known," Mr Ward said.
Stressing the importance of a career in psychiatric nursing, Mr Ward said there was "no health without mental health".
"Nurses make a definite contribution to the fabric of society, offering something other professions do not - an indefinable quality that has an impact on people's lives."
"Two hundred years ago," Mr Sharples continued, "we were helpless and could not do anything, but today we can, and that is why psychiatric nursing is taking a leading role.
"It is increasingly and inherently complex because it deals with the mind. And the more complex it is, the more academically prepared the nurses have to be."
Hence, the health division is all for the training and education of nurses, to become part of a multi-disciplinary team in conjunction with psychiatrists, social workers, NGOs and others. They need to be trained to lead the service, together with other health care professionals.
"We need to think of a multi-disciplinary approach to mental health nursing because, while nurses have a pivotal role, they cannot do it on their own."
The task of the health division is to provide the groundwork for a better-educated workforce ready to take on the job, said Mr Sharples. "The time is ripe to sit around the table and take action before the situation gets out of hand."