Experts in mental healthcare and the father of a girl with schizophrenia discuss the recent loss of a young patient and how to guide families to treatment.

John* would drag a mattress outside his 16-year-old daughter’s room at night and sleep by the door, so that when she suddenly woke up and ran into the road, he’d be able to run after her.

His daughter, who was diagnosed with schizophrenia, would act on impulse and dash out into the street or do other things to endanger her life, without realising it.

“It was the middle of the night. I had no one to call. So I slept on the floor, to make sure I was there whenever this happened,” said John. Had there been a phone number specialised in mental health, he would have made the call, he added. 

Indeed, the Alliance for Mental Health (A4MH) has long called for a 24-hour Mental Health Crisis Response Service willing to turn up on site, like an ambulance would in case of a medical emergency.

A 24-hour service for adult and child/adolescent psychiatric emergencies is available at Mater Dei Hospital, but it does not offer an ambulance service.

The alliance – made up of the Richmond Foundation, the Mental Health Association, the Maltese Association of Psychiatry and the Maltese Association of Psychiatric Nurses – has spoken up loudly following the death of a teenager, who was found dead after escaping from Mount Carmel Hospital earlier this month.

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The tragedy put the spotlight on the lack of adequate services for young people with mental health problems, as well as on staff shortages at Mount Carmel and the lack of specialised psychiatric nurses. The victim was supposed to be under constant watch when he escaped.

Better services for young people

Currently, young people with mental health issues can only be treated at Mount Carmel’s Young People Unit, explained Richmond Foundation CEO Stephania Dimech Sant.

The foundation offers a programme for children under 13, apart from its services for adults. This leaves a gap for the 14-to-17s. The foundation is working on addressing the gap by introducing mental health first aid for youth in collaboration with the Education Ministry.

It is also in discussions with the Foundation for Social Welfare Services to open a residential service for young people.

“The demand is so big. We’ve offered our services to children, but when they turn 13, they get lost in the system only to resurface when they become adults. Addressing young people is crucial,” she said.

Behind every patient there’s a parent struggling. I suffered from depression and yet I need to gather the strength to care for my daughter

Consultant psychiatrist David Mamo agreed that early intervention, associated with better mental health outcomes, was important but it had to be part of a more holistic reform.

“The tragic loss of a young man to mental illness and his family’s grief should serve to highlight the current state across mental health services that includes, but is not restricted to, child and adolescent services,” he said, adding that the alliance was insisting on a holistic, long-term plan.

The Health Ministry told this newspaper it was working on a holistic approach as well as increasing services for young people. A spokesperson said a new service for young people with complex needs had recently been introduced, and three specialised consultants were now focusing on child and adolescent psychiatry.

The alliance has also questioned what happened to the electoral pledge to build a new psychiatric hospital near Mater Dei. 

Asked about this specific promise, the ministry said the Health Department was working on the refurbishment and reorganisation of services at Mount Carmel Hospital. “Concomitantly, work on a medical brief to build a new acute mental healthcare facility on the campus of Mater Dei is ongoing. As the brief matures in the coming weeks, relevant stakeholders – including NGOs – will be asked to give their input,” the spokesperson said.

The department was also embarking on a programme of training and changing work practices – in consultation with unions – to improve and modernise the service.

Support for families

The teenager’s death had also shed light on the lack of support services for families of young people with mental health issues, Ms Dimech Sant said.

“On a national level, the first thing needed is an information service for young people and their parents – a place where they can go to understand what is happening without having to face the stigma.

“This service must be easily accessible and in the community,” she said.

Godfrey Borg, head of the Mental Health Association (an NGO that works to help the families of people with mental health issues), agreed, saying many carers, himself included, felt this lack of government-level support. His daughter was first admitted into Mount Carmel when she was 21, way back in 1999.

“Back then parents of these young people were not offered any support at the hospital. And the situation is still the same,” he said, as he called on the government to provide educational and support services. 

John couldn’t agree more. “Behind every patient there’s a parent struggling. I suffered from depression and yet I need to gather the strength to care for my daughter,” he said, adding that the situation had caused great strain on him and his family. He had to take a lot of leave to be there for his daughter, and this affected his career progression.

More time and resources

As a psychiatrist, Prof. Mamo witnesses the suffering of families through his profession. “Carers and families are key to a successful therapeutic outcome. Ask any parent or carer of a person suffering from a mental health illness and you will soon learn the anguish they experience in private. It is not only the practical issues of care and finances. It is also the grief, the stigma, the fear and other such emotions that plague them. 

“Yes, of course they need support, but support means time and resources. It’s not simply an issue of creating ad hoc family support systems,” said Prof. Mamo.

The lack of time and resources, John said, is evident to anyone who experienced Mount Carmel, as did his daughter.

The busy workload at Mount Carmel meant consultants’ time was limited. “I had no choice but to go privately. Not everyone can afford this,” he said. 

“Don’t get me wrong. I’m grateful towards the staff and the psychiatrists. The doctors managed to diagnose my daughter, and today she’s doing well with the medication. The nurses are doing their best in a hard situation.

“But there is a lot to improve. It shows that the nurses are not trained to deal with mental health patients,” he said, adding that this had been highlighted by the teenager’s tragedy.

“When I heard about that teenager’s death, I felt rage. This could have been my daughter,” he said as he called for more investment in the field. 

This investment, he stressed, needed to improve services and address stigma. “My daughter is making progress. The sad thing is all the people around her disappeared. Relatives don’t want to have anything to do with her because they’re scared of the responsibility, and friends have abandoned her. But she is my daughter.

I want my daughter back and I’ll do all I can,” he said.

Plans to increase support

The government is in the process of launching support groups for carers and patients at the Centru Tommasso Chetcuti based in Mount Carmel, the Social Solidarity Ministry said.

Mental Health Services already offers support to patients and their families, a ministry spokesperson said. A specially appointed practice nurse coordinates family support at Mount Carmel, where a multidisciplinary team, including psychologists and social workers, also plays a role in offering support.

The Health Ministry said doctors at health centres were in continuous contact with specialist doctors based at Mount Carmel to discuss patients with psychiatric needs.

“This service is being expanded to cater for the increasing demand, both for patients making contact with health institutions as well as for patients in the community,” the spokesperson said.

*Name has been changed for privacy.