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Mental health service challenges - Nigel Camilleri

The Malta Association of Psychiatry (MAP) recognises that this administration is showing interest in mental health and is demonstrating a desire to develop appropriate mental health ser­vices while improving the quality of service provision.

Both the structural building (Mount Carmel Hospital) in which the services are delivered and the standards of care provided are decades behind what would be expected for mental health treatment from a standardised service in a deve­loped country today. Eurostat and the World Health Organisation report that the number of psychiatrists in Malta is the lowest in all Europe, while the number of patients reviewed per psychiatrist per year is one of the highest in Europe.

These worrying figures denote that while the number of medical staff available in mental health services is ex­tremely low, these same psychiatrists are stretched beyond what is expected by EU standards, and they are also facing huge risks of burn out. Furthermore, MAP’s recent work on data collection revealed that most patient reviews are almost entirely carried out by medics. This goes to show that the grossly outdated medical model is still standard practice in Malta. This form of practice affects the overall quality of care provided, and is lower than that which would be reached if a holistic model of care was employed in our mental health services.

The MAP completely supports the plans to develop a new acute psychiatric hospital; one that will phase out treatment from a stigmatised, unsafe, dilapidated hospital to one that is constructed architecturally appropriate to meet the needs of the mental health services and which is also physically connected to Mater Dei Hospital.

The MAP wishes to emphasise that while the meticulous planning of the new hospital is much welcomed, there must be an ongoing parallel shift in ser­vice delivery for moving most of the mental health service provision into the community with a drive to strengthen human resources there. The MAP believes that there must be a shift in the allocation of the mental health budget whereby the majority of the budget for mental health services is focused on the setting up and running of community mental health services while maintaining an adequate standard of care within the in-patient hospital.

The number of patients reviewed per psychiatrist per year is one of the highest in Europe

Therefore, MAP advocates that a national mental health strategy plan is written up in which the simultaneous service development of the acute in­patient hospital takes place together with the community mental health ser­vices; these will include the children and adolescents, adults, addictions, forensic and old age psychiatry.

Furthermore, this service development plan needs to include a third sector, which is an adequately resourced crises intervention and home-based treatment team, and another team that includes the assertive outreach team for the more complex and chroni­cally unwell patients.

Lastly but possibly most importantly, these suggested changes need to be in parallel with a cultural shift in the current way of working. This means that all staff need to be actively encouraged and supported to seek continued professional development in their field of expertise, so as to provide an evidence-based mental health service.

Management should consider addressing the huge deficits in human resources, not just in terms of number of medics but also other mental health professionals such as in the speciality of psychology. Perhaps it could look at ways of attracting more professionals to work in the government sector through the facilitation of further speciali­sation in training provision and providing a platform of work that respects the work done by such professionals.

These would be a step in the direction of making the public sector competitive against the private sector and also help retain staff, rather than the public service simply serving as a stepping stone to private work. Failure to introduce the mentioned cultural changes, and simply building a new acute hospital will only serve to shift the status quo to another place, without treating the amotivation currently present in mental health servi­ces and further perpetuate the ongoing brain drain from these services.

Nigel Camilleri is a child and adolescent psychiatrist and the current president of the Maltese Association of Psychiatry.

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