I am a medical doctor who is specialising in psychiatry here in Malta. I would like to share my thoughts on mental health in Malta; with reference to the recent incident in Valletta, where a man was goaded to jump by a minority of onlookers, and the ensuing discussion about the stigma that this incident triggered.
Unsympathetic reactions to people suffering mental health crises are not surprising. Unacceptable, upsetting and unfortunate, but not surprising. I was actually surprised by how surprised social media was… I recall reading comments like “this country has lost its soul” and “I cannot believe how hypocritical our society is”.
I’ve been involved in mental health in Malta in some way since 2017, when I first graduated as a doctor. I have heard huge amounts of positive talk about mental health. A very positive Mental Health Strategy for Malta 2020-2030 was published in 2019. The opening quote from Minister of Health Chris Fearne reads:
“This strategy will guide the implementation of investment and reforms which will truly place mental health and treatment of mental illness at the heart of the health policy agenda of our country in the years to come.”
The strategy promises a brand new hospital providing acute mental health services, as well as the re-purposing of Mount Carmel Hospital into a “dignified care complex” (implicitly recognising the lack of dignity available in the hospital’s current form).
The strategy, although not perfect, is really very well written and cannot be faulted in any major way. I urge anybody with an interest in the field to go and read it.
Nonetheless, “culture eats strategy for breakfast” (P. Drucker), and plans for our brand new psychiatry hospital seem to have been served alongside eggs and toast.
Now credit where credit is due: there is a section of Mount Carmel which has been refurbished and it is genuinely very pleasant, and we have actually started to slowly increase our community services. But achievements such as these do not reek of mental health being a priority. Not when we fund bypasses so enthusiastically.
I know that we are in a pandemic and that healthcare strategies have suffered as a result of this. I know that money does not grow on trees and that funding cannot magically be allocated to mental health services: the finance minister has a limited budget and spending in one place means saving in another.
What does bother me is that we are able to find the financial and human resources to rebuild kilometres of roads, bypasses and overpasses (which we had only partial need for) but are unable to do so for our psychiatric hospital. This makes me think that claims that “mental health is a priority” are disingenuous.
The solution to our mental health service problem is not a far fetched fantasy but lies in funding and prompt action. Community services have been developed for people with mental health issues manageable in the community.
But if someone presents to medical services in a crisis and community services are not appropriate, they must be sent to Mount Carmel, and that is problematic, not least of all because of its physical state. This may discourage people from seeking help when they need it, and this is dangerous.
A refurbished, pleasant Mount Carmel will not solve all problems but it will be a good start. It will reduce stigma because if the government is seen to give value to something, then the population will value it as well.
If there’s one thing Malta does not lack, it is developers. Perhaps they could be engaged for the good of the nation’s mental health services.
Regretfully, I feel that keeping Mount Carmel in its current state is society’s way of devaluing mental health and exacerbating stigma. Would it be so wrong to suggest that the neglect of
Mount Carmel is society’s collective way of telling people who are suffering to go and jump, just like the Valletta onlookers did. It doesn’t have to be this way.
Dr Alexander Clayman graduated as an MD from the University of Malta in 2017 and is passionate about mental and reproductive health.
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Do you agree?