The new Mental Health Bill, awaiting its second reading in Parliament, is proposing a radical overhaul of the mental health system in Malta.
Any law that manages to increase the dignity and protection of mental health patients is highly commendable...- Claire Axiak
To date, professionals, patients and their relatives have had to rely on the provisions of a somewhat archaic legislation dating back to 1976. This is all set to change if, as expected, the Bill makes it to the final reading and is finally adopted into Maltese law.
One innovative concept to be introduced is the community treatment order. Persons suffering from a mental disorder who do not require treatment in a licensed facility but who otherwise satisfy the criteria for compulsory treatment may be eligible to receive such treatment in the community under a specific care plan tailored to his/her individual needs.
First and foremost, the Commissioner for the Promotion of Rights of Persons with Mental Disorders has to be satisfied that the person has a severe mental disorder that is likely to benefit from treatment in the community, that notwithstanding treatment for his/her illness the person has refused or failed to consistently cooperate to an extent thereby resulting or likely to result in relapse of the mental disorder or to involuntary admission to a licensed facility, that the person should be given treatment for the illness in the interest of his/her own safety or for the protection of others and, finally, that the treatment can be safely provided in the community.
An application for a community treatment order is submitted by the responsible carer (or, in default, by a mental welfare officer) after a medical recommendation has been made by a specialist and a medical practitioner who must independently assess the person within a maximum period of 24 hours of each other.
What are the benefits of community treatment?
Evidence from abroad continues to show that a balance between proper community-based treatment and adequate hospital backup services tends to achieve a comprehensive level of mental health care. Community-based multidisciplinary teams create increased customer satisfaction; offer an increased continuity of care and patients benefit from receiving care from the same team members over a number of years in a comfortable setting. This flexibility and continuity of treatment also helps to identify, prevent or treat early relapses.
On the other hand, ethical concerns are bound to arise, especially within the confines of a small island. Abuse in patient confidentiality and overstepping of personal boundaries are two issues that are frequently mentioned by the detractors of community-based treatment. The safety of professionals carrying out their job must furthermore be ensured and pre-emptive measures need to be in place to safeguard their well-being.
Another interesting concept in the offing is the introduction of new measures to safeguard and protect those persons who are certified as lacking mental capacity or otherwise incapacitated or interdicted in terms of law.
Certification is no longer open-ended and a specialist is now required to give specific reasons on a prescribed form for his considerations, the type of decisions that the person is incapable of taking and the approximate duration for the lack of mental capacity. Such certificate needs to be confirmed by an independent specialist and approved by the commissioner within a short time frame and may also be revoked if it is found that the person concerned no longer lacks mental capacity.
Moreover, the commissioner is now required to notify the Registrar of the Court of Voluntary Jurisdiction of all certificates of lack of mental capacity, whether approved or revoked.
Interestingly, every court decree authorising the incapacitation or interdiction of a person on grounds of lack of mental capacity must be notified to the commissioner who may request a further assessment by three specialists to verify or contradict the mental capacity of the person concerned.
There are, of course, a myriad of other measures and provisions in the Mental Health Bill (ranging from new procedures with regard to involuntary admission to Mount Carmel Hospital to regulations dealing with clinical trials, medical and scientific research and administration of special treatments to patients) that are noteworthy and likely to be of great benefit to the Maltese population. This is not to say that the Bill will not pose any challenges.
Multidisciplinary teams need to be prepared for a revolution in their methods and way of thinking. At present, the consultant psychiatrist is ultimately responsible for the care of patients but the new Bill contemplates accountability across the board among all mental health professionals. Therefore, now more than ever, interdisciplinary cooperation and liaison between different fields in mental health care are of paramount importance.
Moreover, it is possible that the new procedures and tight time frames will add further pressure on current human resources that, at times, are stretched to their limit. Therefore, extra measures might need to be taken to soften the impact of the new law on the working conditions of mental health professionals while, at the same time, increasing the efficiency of the workforce.
Yet, it is abundantly clear that, once the inevitable teething problems of the new law are overcome, Maltese citizens will stand to benefit from a significant leap in the standard of local mental health care. Any law that manages to increase the dignity and protection of mental health patients is highly commendable and the Mental Health Bill seems to go a long way towards ensuring such a desirable outcome.
Dr Axiak is member of the Royal College of Psychiatrists.