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Mental health is a community matter

Demand is growing for mental health services in the community to improve

Demand is growing for mental health services in the community to improve

Mental health community services in Qormi offer continuous support to patients and their families, helping them integrate better. Gillian Bartolo, a trustee of the Richmond Foundation, says psychiatric services as part of community health services in Malta actually started in 1994.

No published statistics exist about the waiting time between one appointment and the next for people with mental health problems who use public services. However, reliable mental health sources, including users, have consistently told me that the average waiting time between appointments, for a person with serious mental health difficulties and on prescribed medication, is six months – unless they are prepared to pay for a €60 private consultation, in which case the waiting average is one month. And unless they live in the catchment areas of Qormi, Paola or Floriana, Mtarfa and Cospicua, where State-run multi-disciplinary community psychiatric services are in operation.

Over the years, sporadic attempts have been made to extend the services to other areas but various forces, including money, lack of staff, but also prejudice, fear and self-interest, have stood in the way. Thankfully, more recently, with a greater number of sufferers speaking out, better media coverage, more social awareness, mental health is being brought out of the shadows and pressure is growing for services in the community to be improved.

In its recently published performance audit, the National Audit Office found several serious shortcomings in mental health services, and again emphasised that better staffed community services should be at the centre of any mental health strategy.

Its community focus echoed a pledge made in an earlier interview with One News on May 30 by Health Minister Chris Fearne: that in line with a health plan being drafted with the World Health Organisation (WHO), more mental health services would be set up in the community, away from hospitals.

Psychiatric services as part of community health services in Malta actually started in 1994 when Qormi was selected as a pilot area and equipped with a skeleton staff. With time this was replicated in Paola, and to a lesser extent in Floriana and Cospicua. It took another 10 years for the three clinics to be assigned full-time nurses and specialised staff. And 14 years later the health centres in Żurrieq, Sliema, Gżira, Mosta, St Paul’s Bay, Rabat and Gozo still offer only minimal psychiatric support.

Mental health is being brought out of the shadows and pressure is growing for services in the community to be improved

I spoke to staff at the Qormi Health Centre. They said the mental health community services identify individuals at risk of mental illness and provide early intervention which leads to quicker healing, less hospitalisation and shorter stays there. Continuous support and help is given to patients and their families within the community. Patients and their families’ rights are protected, helping them integrate better in the community. On a national level such services can contribute towards lessening the stigma against mental illness. 

The waiting list in Qormi is negligible because there are three consultants who hold clinics there and a GP who also sees less severe cases and monitors patients who are stable. On the initiative of the administration, the Qormi clinic was recently assigned a higher specialist trainee psychiatrist who sees severely ill patients who would formerly have been referred to Mount Carmel Hospital.

Patients come mainly from the community as well as from Mount Carmel, and the clinic offers a walk-in service. They are assessed by a psychiatric nurse and a GP and then given an appointment and assigned a key worker. If the case is urgent – say a person is suicidal – they are referred to Mater Dei Hospital and seen by the crisis team.

The key worker has shared responsibility with the patient and the family and the latter have the last say unless the patient is seen to be a danger to themselves and others. “We teach our patients how to manage their illness, how to notice early signs of relapse, how their medication works, the side effects, how to cope better with life.” The centre also works with employers to help patients going through a rough patch at work because of mental health problems.

Most importantly, the psychiatric staff/key workers at Qormi confirmed  Mental Health Commissioner John Cachia’s observation that none of the patients who had undergone treatment at the Qormi centre after being discharged from Mount Carmel had needed to go back to hospital for a significant amount of time in the following five years. 

On the other hand, the Commissioner for Mental Health’s  2016 annual report notes that there was a readmission risk to Mount Carmel Hospital of 14 per cent within three months from the previous date of admission. Though there could be a number of reasons for this, the evidence suggests that community health services that offer psychiatric help on the lines of the Mental Health Clinic in Qormi reduce the risk of readmission to hospital.

Amy* (55 years)

If I had to identify the things that brought on my mental problems I would say the first was being bullied at school by two ‘cool’ modern girls, because I was a devout member of Tal-Mużew – a ‘chosen’ one – attending monthly meetings dressed in black, my hair in the regulation tight plaits till I was 14, long after the end of obligatory duttrina. 

The second happened when I was eight. I had a traumatic encounter with an acquaintance which filled me with a sense of guilt and shame, though I was not at fault. I told no-one, afraid any disclosure would have repercussions on my family.  Consequently, the gravity of the incident grew in my imagination, and I became seriously depressed for the first time.

From about this time I began experiencing bad mood swings. I would be full of energy, be the life and soul in company and then sink into a depression for about two months, usually around October. My mother took me to a psychiatrist when I was 20 and I talked about my fears. He gave me medication but never told me what was wrong with me.

Things changed in 1994 when I was referred to the Qormi clinic. The nurses would explain what was happening to me, they would visit me at home whenever I was bad and over tea and cakes they would explain things to my husband and children too and reassure them it would pass.

Because I have bi-polar disorder there are periods when I become manic. So every fortnight I phone my key worker who keeps tabs on me and say: “Am I speaking too fast?” (a sign of mania), and when I am, she alerts me and tells me to rest more. She and the rest of the staff are always there for me, they are like part of my family, supporting us with our problems: health-related or otherwise.

And now those of us who suffer from mood disorders have got together to form a support group; this year I was chosen to co-lead the group, and we meet to talk every fortnight. Sometimes we invite a guest speaker to talk about things like money management, menopause and depression. We support each other through depressive episodes; when without support and encouragement people tend to despair. Members of the multi-disciplinary team are always at hand to help when we get stuck. 

Since I have been making use of services from the Qormi Mental Health Clinic, I have only needed to go to the psychiatric unit in hospital once. I went through a terrible time when I turned 50 and my symptoms were really physiological: I spoke little and slowly, had visions of the Madonna and had a bout of psychosis. I was admitted to hospital and they changed my medication. Along with my family, my key worker visited me regularly while I was there.

I had a depressive episode about three weeks ago and the other members really supported me, phoning me regularly to give me encouragement and hope. I take mostly mood stabilisers but when I am occasionally prescribed anti-depressants, the clinic monitors me to make sure I don’t become manic. Now I know how to handle my pills and my bad spells last less. I feel in control now.

*Not her real name

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