In a Talking Point on World Mental Health Day last Wednesday, the Commissioner for the Promotion of Rights for People with Mental Disorders, John Cachia, highlighted the urgent need for a national mental health reform programme.
There is consensus among stakeholders in this country that a national mental health reform is urgently needed. Dr Cachia’s office has gathered first-hand evidence of the prevailing state of mental health services in Malta and has drawn up “recommendations that can be meaningfully utilised to provide a robust way forward”. He highlighted the five pillars on which reform could be built.
First, “mainstreaming mental health services”, whereby mental health issues become an integral part of government policy and action. Second, shifting the focus of care from institutions to the community. Third, moving acute psychiatric care to the acute general hospital setting. Fourth, supporting rehabilitation through specialised units, preferably in the community. Fifth, having long-term care in “dignified facilities”.
The challenge, as ever, is to translate these recommendations into a coherent strategy and, most importantly, into implementation plans properly funded and backed up by sound human resource planning and support. Adequate human resources are critical. Robust leadership is fundamental for the desired change.
Dr Cachia also focuses on the vast number of “cross-cutting” issues involving several ministries and departments together with other public and private entities and agencies.
In Maltese planning terms, this coordination and cooperation is often a major stumbling block to progress. It must be addressed energetically if progress in this field is to be achieved.
About two thirds of admissions to involuntary mental health care last year consisted of individuals below the age of 45, confirming the tragic incidence of mental disorders among the younger generations of society. Investing in their well-being is a policy priority that requires holistic action between health, education, employment, youth services, social welfare, workplace and employer, an immense challenge.
The approach must address the core determinants of poor mental health and the need for early intervention. Future planning must also consider the relative risk differences within the Maltese population and the increasing influx of foreigners, a quarter of whom accounted for acute involuntary admissions in 2017.
The soaring levels of younger people and foreigners among acute psychiatric cases underline the need for effective workplace mental health support as part of the country’s economic development. Tackling substance abuse, which last year accounted for a third of acute involuntary admissions, is crucial. Moreover, addressing the stigma that hangs over any consideration of mental illnessess is crucially important to reducing discrimination towards people with such a condition and to normalise the difference between physical and mental health.
Failure to recognise mental disorder, or to understand it as something more deep-rooted than moodiness, is leading to avoidable misery, with young people bearing the brunt.
The challenge Dr Cachia has laid down is massive . It is long overdue and vitally important. His main message has been to highlight that mental health is not merely a matter of being strong, stoical and resilient but that disorder involves real illnesses that have immense psychological, physical and economic costs.
This is a Times of Malta print editorial