Malta’s mental health system, with its hallmark being Mount Carmel Hospital, is a throwback to “Victorian-style” services and needs to move away from hospitalisation and stress community services, according to experts.

Speaking yesterday at the first conference organised by the Maltese Association of Psychiatry, experts in the field stressed that hospitalisation should be the absolute last resort.

They referred to foreign models of care that saw people with severe mental health conditions being treated within their homes.

Walter Busuttil, a UK-based consultant psychiatrist who is medical director of Combat Stress (a leading UK charity that provides mental health care to army veterans) insisted that services should be tiered across primary, secondary and tertiary care, with heavy emphasis being placed on community services.

“Hospitalisation is literally the last resort,” he said, adding that, along the years, the UK shut down a number of hospitals and instead developed many community services.

The first tier was primary care, which required the involvement of GPs to detect people at risk of developing mental health problems and who would then go on to refer them to specialist services. Dr Busuttil strongly advocated the setting up of a crisis resolution and home treatment team.

In the UK, such teams worked with patients with severe mental health conditions who would otherwise require hospitalisation, such as those suffering from psychotic episodes, severe self-harm and suicide attempts.

Hospitalisation is literally the last resort

Such teams, working on a 24-hour basis, would visit patients two to three times a day, thereby avoiding hospital admission. It cost the government a lot of money to have patients living in hospitals for long periods of time, he pointed out.

The teams also worked from other community settings, such as dedicated crisis houses or day centres.

Other community services included an assertive outreach team who looked after adults with severe mental health conditions and personality disorders. These people may find it difficult to work with services and may have other problems such as violence, self-harm, homelessness or substance abuse.

Rehabilitation and recovery teams focused on the needs of patients with long-term severe mental illness. They provided ongoing care and support, particularly focused on preventing relapses, developing social networks and establishing meaningful activities in people’s lives.

Other community services included an early intervention for a psychosis team (who worked with patients between the ages of 18 and 35 who were experiencing their first episode of psychosis), a community forensic team, a community alcohol team and an eating disorders team.

Asked about the problem of patients relapsing and having to be re-admitted, Dr Busuttil said that, if there were no services to parachute patients into the community, they would not function well, leading to relapse.

“You must work collaboratively. You cannot discharge patients unless there is a proper care plan.

“Why don’t you start with a pilot project? Close down 10 beds from Mount Carmel, discharge those patients and get the staff to work from the community. Change is difficult but it is not impossible.”

Members of the audience bemoaned the lack of collaboration with GPs and the lack of a patient advocacy group, with one consultant psychiatrist decrying “the Victorian-style services” and the way Malta tended to introduce new services without rethinking what was being done wrong.

Mental Health Services chairman Anton Grech said change was extremely difficult as everyone tended to have their comfort zones.

“In our department, the problem is that we are still in the civil service,” he said, highlighting the excessive red tape which muzzled the system.

Finances was a struggle, he said, adding that Mount Carmel Hospital faced debts amounting to €7 million. Moreover, chronic and acute cases were being treated together in the same wards.

“Two years ago, I had proposed the setting up of better acute mental health facilities. Now, I can say I’m seeing a little light at the end of the tunnel,” Dr Grech said.

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