Malta lacks the facilities to cater for adolescents with challenging behaviour so they are kept too long at Mount Carmel Hospital “because it is the only place where they can be contained”, according to mental health experts.
Mental Health Services chairman Anton Grech said he had recently encountered a case of a teenager who had behavioural problems.
Following an outburst in which he cut his hand, the teenager was sent to Mount Carmel Hospital.
The crisis subsided but once he was released, the community could not cope with his behaviour and he was sent back.
“By keeping adolescents with behavioural problems in Mount Carmel, we are medicalising the problem and reducing the space for people with psychiatric problems,” he said.
Mount Carmel also accommodated a number of young people with social problems who had “no one to take them”, such as drug addicts.
Dr Grech was joined yesterday by public health consultant Stephanie Xuereb and Mount Carmel’s chief operations officer Clifton Grima in presenting the Parliament’s health committee with a proposed plan on mental health services for children and adolescents.
The plan says there is an absence of mental health services geared specifically towards adolescents, with the consequence that juveniles are being managed in “inappropriate environments”.
The Young People’s Unit (YPU) at the hospital is a two-storey building catering for young children on the lower floor and adolescents on the upper floor.
Over the past three years, there has been a constant increase in admissions and in the utilisation of inpatient services.
Young patients sometimes had to be moved to the adult wards and genders were occasionally mixed.
Additionally, Dr Grech pointed out, there was not enough security in the YPU, especially in the case of patients with suicidal tendencies who resided on the top floor.
According to statistics presented by Dr Xuereb, last year a total of 54 young people received treatment as inpatients.
Thirty-six suffered functional disorders (such as depression), 15 had conduct disorders or personality issues while three had learning disabilities.
By keeping adolescents with behavioural problems in Mount Carmel Hospital, we are medicalising the problem and reducing the space for people with psychiatric problems
Nearly 50 per cent of the young people being cared for were migrants, who were mostly diagnosed with depression or post-traumatic stress disorder.
“This specific patient group will place increasing demands on existing services in terms of cultural knowledge, linguistic resources and a lack of infrastructure to support ethnic programmes,” the plan noted.
Dr Xuereb also pointed out that of the 54 admissions, only three were under 11, with the rest aged 12 to 17.
“This fact alone clearly illustrates the urgent need for adolescent services.”
The team put forward four options to be considered that could meet the present and future inpatient needs of children and adolescents with mental illness in Malta.
The first option was persevering with the current situation (with a total of 13 children and adolescent beds in a two-storey building) and attempt to improve and modernise the services within the present YPU.
However, Dr Xuereb continued, this option was flawed because the number of beds was insufficient and because the size and environment of the existing service does not permit children to be separated from adolescents or separation by clinical needs.
This will continue to require placing young people in adult wards in certain circumstances.
The second option was to construct a new unit outside of the immediate environment of Mount Carmel: “This is an attractive option as it would address the enduring and pervasive stigma attached to the existing hospital, which is counterproductive to an equitable, accessible service.”
However, Dr Xuereb also admitted there was the risk that stigma would, in time, be attached to the new premises, while studies abroad showed young people were reluctant to make use of the services because of anticipated discrimination.
The third option would be to provide all the services in the community, with the complete closure of the YPU.
“However, this option is not viable as it is commonly acknowledged that high quality inpatient provision is a core component of virtually all comprehensive child and adolescent mental health services.”
The fourth option was to identify and renovate another site within the Mount Carmel complex. This was attractive, Dr Xuereb added, because it addressed economies of scale and enabled the requirements to increase bed space and service options.
What she strongly stressed was the migration from the medical model of care to a social model of care.