When he first took office as Mental Health Commissioner, John Cachia was a solitary voice fighting the stigma linked to the disorder but, five years on, he believes there has been a positive shift in mentality. Still, policymakers have to walk the talk.

As political parties gear up for their electoral campaign, mental well-being should be one of the topmost priorities, according to Dr Cachia.

“Mental health is a national policy priority and, as parties start drafting their electoral manifestos in the coming months, they need to do a soul-searching exercise and look at the mental health and well-being of this country,” he said, adding that data showed something had to be done.

Nearly half of the population is unaware of how to access information about common mental health problems such as stress and depression. For Dr Cachia, this is a severe awareness problem.

Mental health issues have a bearing on several sectors within society – from employment to the social welfare system – and Dr Cachia would like to see politicians prioritise it more.

Malta’s major resource – human brain capital – needed to be protected in all ways possible. Politicians were heard talking and now they had to be in action, he added.

Dr Cachia said he believed there had been a positive shift in mentality and more people were speaking out about mental health problems.

He referred in particular to the launch of an alliance of four mental health NGOs in October, promoting mental well-being.

Echoing Dr Cachia’s comments over the past years, the Alliance for Mental Health is insisting that acute treatment for mental health issues should be provided at Mater Dei Hospital to eliminate the stigma associated with Mount Carmel.

While, in the past, his voice sometimes felt like a solitary one, this does not hold true any longer.

Dr Cachia reiterated the need to move from a hospital-based to a community-based outpatient service provision. This would require setting up mental health teams, led by specialists, which would support families and GPs within, or close to, the patients’ locality.

Such an approach should ease pressure on acute psychiatric admissions and encourage more people to seek help.

People often shied away from asking for mental health support because services were offered through an institutional approach, which, in people’s views, could be counterproductive, he noted.

It is estimated that in European countries, 50 per cent of those who need help with their mental health issues did not in fact seek any assistance.

Outpatients’ services could be provided within existing polyclinics or ad hoc centres. Strengthening community services would allow people to seek help earlier. The earlier they looked for support, the less the medication required and the easier it would be to get treated.

Dr Cachia also believes that crisis intervention services must become an integral part of the emergency response services at Mater Dei. A specialised team should be able to accompany ambulance personnel to reach out to people in crises situations, including suicide attempts.

His relentless appeal is to move acute (inpatient) mental health services from Mount Carmel to Mater Dei.

This would see between 200 and 250 people who are victims of past care systems remaining at Mount Carmel. These people had been institutionalised far too long to be able to settle down within community residential homes, he noted.

Some of them had been there for 20 and even 40 years.

Still, the environment within the psychiatric institution should be improved because the state of disrepair was not conducive to good acute or residential care.

Every year, there are about 2,000 new inpatient admissions at Mount Carmel, Mater Dei and through the psychiatric services in Gozo.

The lifetime risk of developing a mental health disorder is not low, standing between 20 and 30 per cent, and Dr Cachia insisted people should realise there was nothing wrong with them if they had a mental health issue.

Controlling or treating a mental health disorder was just like controlling any other chronic disease. The problem, as always, was early detection, he said.

His office hopes to raise awareness in the coming months about early intervention among youths and prevention at the workplace. About 80 per cent of all mental health disorders start before the age of 25.

“We need to empower young people, understand those exhibiting symptoms of mental health issues and intervene early within educational institutions, at home and at work,” he said.

Data shows that mental health issues do impact the labour market. According to a joint OECD and EU Commission report on health in Europe, issued last year, people aged between 50 and 59 with severe depression are twice as likely as those with two chronic illnesses to quit their job because of burnout.

Dr Cachia noted that there were workplaces that actually induced stress and anger in employees and were not conducive to mental health well-being.

Apart from advocating for the employment of people with mental health disorders, one of the commissioner’s priorities is to start a discussion about work and mental health issues.

This would require looking at the population and see where and why people were leaving their job.

“Why should we be losing such an important brain capital? We need to look at workplace stressors and functions within work that are conducive to people changing jobs. Why is there volatility within particular sectors? We need to understand whether it is a question of money or stress,” Dr Cachia pointed out.

Tenfold risk for migrants

Asylum seekers in Malta have a tenfold risk of being admitted to Mount Carmel when compared to the Maltese community, as can be seen in the 2015 annual report of the Commissioner for Mental Health.

The commissioner is looking into ways of empowering migrant communities and set up a network of support. This could require training professionals to become aware of migrant issues. Better known as transcultural psychiatry, this is a branch of psychiatry that focuses on the cultural context of mental disorders and the challenges of addressing ethnic diversity.

People trained in transcultural psychiatry are better able to understand the baggage that migrants come with and the connotations of mental health issues within the patient’s own community or country.

Move acute mental health services to Mater Dei Hospital and improve the environment at Mount Carmel Hospital (above), the Mental Health Commissioner says. Photos: Chris Sant Fournier