There are those in this world who are mistaken. They may throw the first stone and call you the mistaken one causing you to believe it, yet they are false prophets. Patience time and again reveals truth. There are those who believe the national mental health system may shirk its duties to NGOs and still call itself a worthy national system.

Those who believe they promote mental health yet fail to actively promote true, practical progress. It has been exactly 45 days on penning this article since I published my urgent proposal for a national Suicide Crisis Prevention Hotline in my previous article ‘Cry for Help’.

None called out have, as of yet, stepped up to the plate. The ‘Cry’ is yet unanswered.

It is pertinent to mention that on August 19, 2018, Nigel Camilleri, psychiatrist and then head of the Malta Association of Psychiatry, advocated, in this newspaper, the need for an “adequately resourced crisis intervention... team”. The emergency team at Mater Dei’s A & E therefore does not cut it and it is not a long shot to believe that such a team would deal with suicide crisis phone calls.

Thus my previous proposal appears to be “factually correct”. Those who believe that our mental health system is perfect, and unquestionably so, are the most incorrect. The suicidal patient once again has become the victim of neglect, unsafe conditions and potential breaches of their human rights.

The Mental Health Act, the law protecting the mentally ill, and the correct training nursing students receive regarding constant watch, were referred to in the writing of this article. To clarify, constant watch is the 24/7 supervision of a patient for psychiatric, usually actively and effectively suicidal, or medical needs, for example, full paralysis.

The incongruency with reality between what nurses are trained in and the law is most shocking. This is not me being cynical, as interviews and consultations were held with a senior nurse with 25 years of experience working with the government and other equally capable sources.

To begin with, the MHA legislation was enacted in 2012 and the Constant Watch SOPs, on which nursing practice and training is based, were first drawn up in 2015. Therefore there is a gap of three years of unregulated, potentially outdated (and hence possibly inhumane), Constant Watch procedures.

One must keep in mind that the SOPs are subordinate to the MHA legislation, one being law and the other being a policy. The sheer disregard to the law says much. But it is the current misuse of Constant Watch in the present day that is most alarming.

The launch of the Constant Watch SOPs was a disaster, as told by my sources. They were sent quite unceremoniously by e-mail with no particular attention drawn towards the nurses, managers and other healthcare professionals who would be bound by them.

This brings up the question, “What of those who didn’t see the e-mail?” Does an unregulated free-for-all exist in certain instances? With delicate patients being treated in a manner with no regard at all to regulations.

The suicidal patient once again has become the victim of neglect, unsafe conditions and potential breaches of their human rights

This brings about the assumption that those who wrote the Constant Watch SOPs were experts in dealing with actively suicidal patients and the paralysed. This is not the case. I was informed that the writers were each professional and qualified in their own right but not at all capable of writing clinical regulations regarding and protecting the severely mentally ill.

In fact, after much protest from a handful of nurses and other healthcare professionals who weren’t consulted, including my source, a revision was penned and published. Interestingly enough, nurses are taught that constant watch, apart from being a safety measure, is considered to be a therapeutic action by law, in the psychiatric sense, with the nurse or carer being part of the suicidal patient’s multidisciplinary team providing holistic care.

To specify, the supervisor is to serve as company to the patient and build a helpful therapeutic relationship of trust and care with him. This is more crucial to the suicidal patient’s therapy than medication. Reality differs.

The most dangerous of patients are entrusted to mental health  nurses and a security officer, though the latter are rarely deployed. With the current shortage of nurses, the most dangerous of patients often fall onto carers’ duty. More alarmingly, when carers are in short supply, so-called ‘extras’ are brought in to take their place.

The keyword here is ‘training’. Those with most training are the nurses, specifically mental health nurses. However, this decreases from carers to extras.

Training must now be defined. It is established in our teaching that constant watch must be therapeutic, while the law states that carers must be appropriately trained. Therefore, by logic, training must involve therapeutic care methods. However, in truth, carers are only required to have the most basic of skills and knowledge. Notwithstanding the vague nature of these skills, extras have even less training than carers. More often than not, carers and extras are foreign with a very limited grasp of English and less so of Maltese, generally speaking.

They are quite often unable to fill in the official observation sheet, recording the patient’s condition regularly. They are less able to communicate with the patient at all, let alone therapeutically. The medical review of the patient, which is to be conducted every 24 hours by an appropriate medical practitioner, is done yet largely ignored.

With such scanty records, the aim set out by the law – that of using the least restrictive measures on a patient by reducing constant watch gradually – can never be reached. More worryingly is the inadequacy of the care plan, heavily emphasised by the law, of the suicidal patient. With no record of advance or regression, how can a patient ever be discharged or treated properly in the medical sense?

On another note, there have been consistent reports of suicidal patients being admitted into Mater Dei for stabilisation, following a failed attempt at their own life; what is most worrying here is that their transfer to Mount Carmel is very foggy with a slew of ifs and buts worthy of investigation.

This, along with the lack of records, makes the possibility of safe transfer prolonged and difficult. Severely suicidal patients are left in wards with access to needles, razors, glass and potentially even heights.

There is only so much, even the most capable of professionals can do if a patient is successful. What is certain is that it is unjust for them to risk their own health trying to save the patient.

While it can be agreed that Constant Watch is unpleasant yet necessary, there is no reason for it to be immoral and unjust.

Andrea Caruana is a student nurse.

This is a Times of Malta print opinion piece