Safety measures and the overall environment at most wards in Mount Carmel Hospital are not up to scratch and require urgent attention, the mental health commissioner has warned.
Moreover, only one per cent of patient records at the hospital meet all the criteria set by law, which are meant to ensure the highest quality of care.
Mental Health Commissioner John Cachia made these comments in the 2015 annual report that included a detailed review of the existing facilities of all mental health hospitals and community residences in Malta and Gozo.
The findings are based on a number of onsite visits carried out between August and October last year.
On a positive note, it transpired that the vast majority of patients (89 per cent) felt they were treated with respect and dignity and 93 per cent made the same comment with regard to the staff.
The report points out that such positive values “cannot be expected to make up for lack of investment in the physical environment of care facilities”.
Only one particular file contained all the requirements of the Mental Health Act
It flags the lack of standardisation of care across wards and facilities saying this was fuelling “discrimination” between patients who happened to receive adequate treatment and those who had not been so lucky and who ended up in sub-standard wards.
In this respect, Dr Cachia noted that the Mater Dei Hospital psychiatric unit represented the “gold standard”.
He noted that safety in many parts of Mount Carmel left much to be desired and called for investment in a number of wards such as the male dual diagnosis unit, the female forensic unit and the male ward.
As for the physical environment, the report said that improvements were urgently needed, especially in the male forensic unit, admission wards and the female medical ward.
Concern was expressed on the facilities at the two mental health wards at Gozo General Hospital.
Dr Cachia remarked that staff at Mater Dei and at residential facilities seemed to be more professional and had better patient interaction. The same applied for hygiene and patients’ upkeep.
The review also focused on the implementation of the strict Mental Health Act obligations on patient records and flagged various shortcomings.
“The fact that the diagnosis of a patient is not easily retrievable on the file is unacceptable as it is a basic requirement to ensure safe care, especially if this is needed outside office hours when the caring team of the patient is not present,” Dr Cachia noted.
While noting that most files lacked a multidisciplinary care plan, the “most shocking finding” was that only one particular file contained all the requirements of the Mental Health Act, namely the completed forms of consent giving and for the appointment of a responsible carer and a multidisciplinary care plan.
In spite of these shortcomings, the report said that improvements were registered when compared to 2014, with patients seemingly better looked after and an improved overall physical environment.
Nevertheless, Dr Cachia noted that even certain requirements that could be easily implemented, such as consent taking and the appointment of a responsible carer, were still not being met.
Main findings of the report
• Saint Vincent De Paul scored highest for safety, with 72 per cent, followed by hospital facilities (Mount Carmel Hospital, Gozo General Hospital and Mater Dei Hospital) with 55 per cent and residential facilities with 48 per cent.
• The male dual diagnostics unit at Mount Carmel was ranked the worst overall in terms of safety, with a score of 25 per cent. Only eight of the 18 wards scored above 50 per cent in this respect.
• Environment was the worst in hospital facilities (mostly Mount Carmel and Gozo hospital) with 62 per cent, even though recently-refurbished wards obtained a high score.
• The male forensic unit ward was ranked the worst with a score of 22 per cent while the psychiatric unit at Mater Dei was the best with 88 per cent.
• Thirteen out of 34 respondents claimed they had been threatened by patients or staff but only two reported the incident as they feared retribution.
• The level of activities at Mount Carmel wards, especially during the weekends, is extremely low. As for the rest of the week, the most popular forms of activities were occupational therapy sessions, reading, watching TV and, according to some respondents, smoking.
• Thirteen out of 21 smoking rooms at Mount Carmel and Gozo hospital; were deemed inadequate as they were poorly ventilated or in a TV room.
• Most wards do not allow use of mobile phones but the available facilities lack any privacy as the phones are in corridors.
• Nearly a third of respondents said they could not meet relatives and friends in privacy.
• Nearly all those receiving treatment (96 per cent) at hospital facilities had their patient status in their medical records but this was not the case for Saint Vincent De Paul patients. In the case of residential facilities, such data was either not clear or absent in 40 per cent of the cases.
• Only one per cent of the medical records had the completed set of documents as required by the Mental Health Act.