The following bio-psycho-social factors are at the heart of the challenges faced by Malta’s Mental Health Service and need addressing with a concrete action plan:
Life expectancy in Malta has increased steadily by about seven years over the last two decades, to reach 80.9 in 2010; 1.3 years higher than the EU average. Forecasts predict a further life expectancy increase of around three to four years over the next two decades. However, as indicated by Eurostat data, Healthy Life Years (HLY) currently stand at 71.7 years (the highest in the Eurozone) but will not rise as quickly as life expectancy, thus increasing significantly the burden on the Maltese Health Department. It is clear that the population continues to age, and with it, so will the levels of dependence on healthcare services. The total costs of chronic disease secondary to an aging population will undoubtedly rise significantly. The progressive aging of the population will lead to a greater need for service provision in the area of organic mental health disorders of the elderly. Both Mater Dei Hospital and Mount Carmel Hospital are in fact currently experiencing severe bed shortages, with a majority of beds “blocked” by elderly service users with chronic physical or mental health problems.
As indicated by unpublished data from psychiatric admissions to Mount Carmel Hospital, referrals to psychiatric outpatients department and psychiatry liaison consultations at Mater Dei Hospital, users of psychiatric services in Malta are on the increase. This mirrors the prediction made by the World Health Organization, i.e. that mental health problems would see a sharp increase in incidence to become the second leading cause of disability worldwide by 2020, second only to cardiac problems. The increased incidence and prevalence of psychiatric disorders has a number of direct and indirect costs associated. One must also consider the increase in the irregular migrant population reaching Malta’s shores which has undoubtedly increased demand on mental health services. Research has shown that migrant populations are at an increased risk of developing mental health problems when compared to the local population. Most irregular migrants arrive by boat from North African countries, many after travelling thousands of kilometres from as far as Ethiopia and Somalia. Many are economic migrants, however a sizeable proportion are fleeing torture and persecution. Research has shown that such populations are at even greater risk of developing mental health problems, when compared to the already increased risk of migrant populations. Added to this is the stress of involuntary detention in overcrowded detention centres on the Island.
Substance abuse increases the risk of developing psychopathology. The overall consumption of psychoactive substances, legal and illegal, is on the increase according to the latest European Monitoring Centre for Drugs and Drug Addiction data, and the increased rates of dual diagnosis service users (suffering from substance dependence and comorbid psychopathology) is a mirror of this phenomena.
Around 10% of children up to the age of 16 have a potentially diagnosable psychopathology. Early interventions thus take on intrinsic preventive value with respect to psychiatric morbidity in adulthood. The latest epidemiological studies in fact show that the vast majority of adult service users with psychiatric disorders already had symptoms, which were often untreated in childhood.
Over the last decades, the emphasis throughout developed countries has been the pursuit of community based psychiatric services. This model has shown to be superior to traditional institutional models in the treatment of persons with mental health problems. Malta, however, has yet to seriously attempt a similar shift. Therefore, the first objective of the MMHS will be the development of a community psychiatry service that operates with adequate resources and outlets of service provision, with the ability to integrate various public, private and non- profit health and social services.
Due to the specialised nature of work in the mental health field, a significant investment in the professionalism of the service providers is also required. Quality of care provided by mental healthcare practitioners depends on their motivation, involvement and satisfaction. It is universally recognised that spending more time with service users with mental health problems (who are known as a difficult client group) causes increased stress for healthcare practitioners. Staff support initiatives and continued professional development should therefore be given priority.