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Cinderella of health services

When Mount Carmel Hospital hits the headlines it is not good news. Something of a generalisation perhaps, but the truth is that when the nation turns its gaze to this hospital and the psychiatric services in general it is often in response to some negative event or development rather than to celebrate a welcome innovation or outcome. If it’s not the tragic suicide of a teenage abscondee, it’s the National Audit Office’s report, which has heavily denounced the way our psychiatric hospital is being forced to operate due to innumerable woeful deficiencies in the systems that sustain it.

In its report the National Audit Office does not mince words: for example, the problems regarding Mount Carmel’s infrastructure are described as “significantly pressing’’ and “brought about through years of neglect’’. These difficulties “reveal a lack of commitment and investment towards mental health by the relevant authorities so far”. 

The descriptions of the various parts of this hospital, the “central hub specifically tasked with promoting good mental health and providing treatment to persons suffering from mental health illnesses”, are bound to make all those who care for the plight of the vulnerable bristle with anger: in some wards there is serious overcrowding, grossly inconvenient location of bathrooms, inadequate sanitary facilities, lack of time-out or seclusion facilities and inaccessibility.

The NAO underlines the negative effects of the ambience on patients’ dignity. “Overall ambience in a good number of MCH wards is a non-starter for the wellbeing and dignity of mental health patients” thunders one of the sub-headings in the report. Moreover, while it is known and appreciated that clinical treatment within the hospital is top qua­lity and that staff are skilled and dedicated, a cold and impersonal physical environment almost certainly militates against efforts to improve the psychiatric condition of patients. Given the serious manpower and industrial relations issues bedevilling the hospital, the management will not allocate a great deal of importance to this aspect of care, but it has to be pointed out, besides the deleterious effect on patients’ health, that a negative ambience impinges on the hospital’s image and attendant stigma.

There are grave security concerns. The report depicts a worrying picture of lax attitudes at the gates where visitors can enter without being questioned, challenged or in any way checked – and the same goes for those leaving the hospital.

Manpower considerations are possibly the most serious problems Malta’s psychiatric hospital is facing. There is an acute shortage of nurses and of other professionals which is seriously hampering efficiency and undermining the sterling efforts aimed at providing care and treatment. Relations between management and staff are chronically strained with disenchanted employees seeking union help to resist changes management wishes to introduce.

It is quite clear that psychiatry is the Cinderella of the health services, relegated to the lower rungs in the hierarchy of sectors of health care seen to be deserving of the largesse distributed in the form of the Budget, and other resource allocation. The government would be quick to point out – with a degree of justification – that it has allocated no less than €30 million for the infrastructural upgrading of Mount Carmel and that some of the problems highlighted by the Audit Office’s report (overcrowding, for example) will be alleviated once the refurbishing works are completed. However, the project will take at least five years to be completed, and in any case the core problems go beyond the inadequate infrastructure.

The Commissioner of Mental Health and the Mental Health Alliance were quick to endorse the report’s findings. This is not in the least surprising because practically all the stakeholders within mental health service provision have been voicing the same concerns and re­commending more or less the same way forward for quite some time. That way forward points unequivocally to the promotion of Community Mental Health Care as the central pillar of a wide-ranging comprehensive Mental Health Ser­vice, with a new hospital replacing Mount Carmel as the facility providing care for acute cases. Mount Carmel could be utilised for longer-term care which will always be necessary for some patients.

That a National Mental Health Strategy outlining the main policy provisions to be implemented in both care and prevention is needed – as recommended in the NAO’s report – is clear. But the process of formulating this strategy could be as crucial as the content itself: the absolute necessity of ensuring that all voices be heard and all experiences digested and utilised in the generation and development of policies is incontestable.

Perhaps one way of kick-starting the process could be to call a National Conference on Mental Health, bringing together all interested parties, including organisations representing patients and their families. Theirs, after all, is the most vital interest. Their voice must be heard and accorded great attention.

This is a Times of Malta print editorial

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