When talking about mental health you are not just talking about the individual; You are talking about a family, about a community and about the nation. Doris Gauci tells Claudia Calleja how the nation's mental health needs to be looked after.
The time is opportune for a political commitment to be made and for the authorities to give mental health the priority it deserves.
Sitting at her desk, the Richmond Foundation's chief executive officer, Doris Gauci, speaks with a tone of determination as she explains that such a commitment is absolutely essential if we are to have a healthy society.
There is no health without mental health.
While mental illness is a general term referring to a group of psychological illnesses and/or disorders, Ms Gauci explains, minor mental health problems may affect everyday activities to the extent that individuals cannot function as they would wish, or are expected to, within their family and community.
Ms Gauci further explained that a person is mentally healthy when s/he is generally able to handle day-to-day events and obstacles, work towards important goals and function effectively in society.
On the other hand a person would be experiencing mental ill-health when his/her thinking, feelings, perceptions and reactions to everyday circumstances are affected.
"What people don't appear to understand is that there are a lot of people around us who experience mental health problems. Statistics indicate there are about 100,000 people in Malta who may be suffering from a mental health problem at any one time.
"The burden of mental health problems continues to become heavier when we consider the repercussions such problems have on family, friends and colleagues," she said.
Neuropsychiatric disorders are the second biggest burden of disease in Europe. They account for 19.5 per cent of all disability-adjusted life years.
The burden of these disorders is highlighted when the amount of years lived with disability are considered, as they account for over 40 per cent of chronic disease and are the greatest cause of long term disability.
In many countries in Europe, 35 to 45 per cent of absenteeism from work is due to mental health problems. Four of the 10 leading causes of disability in developed countries are mental disorders, including major depression, bipolar disorder and schizophrenia. In fact, by the year 2020 depression is expected to be the second most common disability in the developed world while suicide will become the 10th most common cause of death.
"We do not know what the prevalence of mental illness is in Malta because hardly any research has been carried out. However, it would appear that Malta is no different from the rest of Europe," Ms Gauci said.
One must not underestimate the close relationship between mental and physical health. It is well documented, for example, that back pain is often the consequence of mental health problems and that depression is a risk factor for cancer and heart problems.
Reversely, those affected by long term and chronic disease, such as diabetes or physical disability, consistently suffer from major depression more than the general population would.
"It is therefore crucial that the relevance of mental health is acknowledged in a society which expects a good quality of life for its citizens and gains in economic and social welfare. There is no doubt that mental health needs to become streamlined throughout our public policy," Ms Gauci emphasised.
She went on to explain that we have seen other important aspects being very successfully streamlined in our social policy, gender equality and disability issues being two such examples. So it should not be so unrealistic for mental health issues to be streamlined successfully too.
At a Health Ministers' conference in Helsinki in January, Malta, like its counterparts in Europe, acknowledged that "mental health is central to the human, social and economic capital of nations and should therefore be considered as an integral and essential part of other public policy areas such as human rights, social care, education and employment".
The Health Ministers signed the European Mental Health Declaration for Europe. The EU has now published a Green Paper on Mental Health which will form the basis for an EU strategy on mental health by 2006, a strategy which Malta will be expected to adhere to.
"These are all very interesting developments which will lead to Maltese society being healthy both on the human level but also in social and economic terms," Ms Gauci said.
She believes it is not just up to the government to make changes. There is a need for non-governmental organisations and patient groups in the health sector to come together and work towards common issues on the national, European and international level.
As vice president of the Global Alliance for Mental Illness Advocacy Network - Europe, Ms Gauci was recently invited to attend a conference with the theme Driving Better Health in Europe - the Value of Health Education and Compliance.
The conference, in Brussels, was organised by the European Patient's Forum.
Ms Gauci explained that the creation of the European Patient Forum was the result of a strong need for capacity building, networking, exchange of information and cooperation between patient groups throughout Europe.
It was felt that by getting together, pan-European and national patient groups can work towards an exchange of knowledge and can lobby for the improvement of health services where required in order to begin to reach a state of equality for all European patients coupled with equity of access of treatment.
In Malta, she said, we do not have a very strong tradition of networking.
"If people experiencing different types of illness, together with the organisations that represent them, get together they will have a much stronger voice. Patient organisations have a lot of experience and knowledge which needs to be acknowledged.
"You will find there are common themes and issues among patient organisations, such as stigma, barriers to compliance with treatment, health literacy and doctor-patient relationship," Ms Gauci explained.
Patient groups can learn from each other and can lobby to form part of the decision-making process when it comes to current and future health policy development and the sustainability and rational use of healthcare systems.
If these issues were looked at globally and holistically, they would be given more weight. The European Commission, for example, would acknowledge far more the voice of a national network of patient organisations.
Ms Gauci said the individual patient would benefit from a concerted effort to tackle the issues. There would be strength in numbers, the result would be better and would be achieved faster. A unified voice could also enhance the protection of patients' rights.
Ms Gauci acknowledged that the challenges ahead for Malta in the health sector, be it in mental health or any other aspect, are many.
"The same challenges create a pressing need for action if our health services are to improve, coupled with equity of access to treatment and sustainable health care."