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Mt Carmel: a death too far

The tragic demise of an 18-year-old man found dead in a seaside hotel two days after he had broken out of Mount Carmel Hospital has sent a shiver down the collective spine of the community. The premature death of any person is bound to cause sorrow. In this case this sentiment turned to angry consternation when it became known that the man had voluntarily sought help at the psychiatric hospital, only to escape within a few hours of admission.

The authorities have reacted correctly to the event by appointing an administrative enquiry – besides the magisterial one envisaged by law – chaired by a respected physician to delve into the circumstances leading to the tragedy and, presumably, recommend changes to the procedures governing the treatment of particularly vulnerable patients at Mt Carmel Hospital.

Prudence, fairness and decency dictate that no firm conclusions be drawn on the manner of the man’s death before thorough official investigations are concluded, but the indications are clear enough. It has been reliably reported that the young man was suicidal on admission and had, in fact, been assigned to the ‘constant watch’’ regime which, however, was apparently not applied due to the dearth of staff.

No hospital can function properly if it cannot deploy the necessary number of qualified professionals to administer care to patients. The undoubted abilities and dedication of the current staff members – highlighted by the Mental Health Commissioner in his annual report – are simply insufficient to ensure adequate care for those who need it. There are many situations where quality alone does not suffice; the right ‘quantity of quality’ is essential.

While successive governments have failed to deliver all that is needed to ensure an adequate standard of care to mental health patients – suffice it to say that it took almost two decades of preparatory work before the current Mental Health Act was enacted in 2012 – it is now incumbent on the Labour administration to sort out the problems bedevilling the hospital.

The stark shortage of qualified nursing staff has to be viewed in the wider framework of a chronic dearth of nurses available to work in medical services. It’s not an easy nut to crack: the insufficient numbers may have as much, if not more, to do with reluctance among young people to opt for the caring professions as a career rather than being simply a result of low salaries and other material conditions on offer.

The structural problems at Mount Carmel Hospital and its physical deficiencies absolutely cannot be left out of the equation when one is considering the changes required to enhance psychiatric treatment. The state of the facility is not such as to attract those who require in-patient treatment to go there – nor to remain for long once they have actually sought admission. The necessary refurbishments should be carried out as a matter of priority and no expense should be spared in the effort to turn the hospital into a building that exudes the welcoming warmth and comfort conducive to healing.

The optimal management of the human and other resources is crucial. One has to wonder whether the appointment of four CEOs in almost as many years – not to mention the sidelining of the only one of them of proven ability and who possessed decades of experience in mental health – is a sign of a muddle-headedness on the government’s part. The latest appointee to the post, Stephen Sultana, has his work cut out to negotiate the minefield of political pressures to accommodate employees’ desires while ensuring that nursing and other staff are deployed in the most rational manner possible.

There are a very few bright spots in the dark firmament. A new psychiatric hospital is to be built close to Mater Dei to cater for acute admissions. This is a heartening prospect as it will help diminish the stigma associated with mental health treatment. Actually, it should have been finished by now according to plans announced in October 2013, but works have not even started. Mental health sufferers live in hope.

Meanwhile, work to modernise Mt Carmel Hospital must start in earnest. Emphasis on acute care in the new hospital and community services must not detract from the importance of providing a safe and therapeutic environment for those requiring acute care until the new facility is ready – and for those whose condition is more chronic and will have to remain at Mount Carmel for months, if not years. It is the Opposition’s duty to hound and badger the government until it lives up to its promises and commitments in this area, while contributing its own ideas to how services can be improved.

We look up to our government and parliamentary representatives to do their utmost to enhance mental health in-patient care. That tragedy in Qawra was one death too far.

This is a Times of Malta print editorial

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