A Hospital For Our Times
In a country as crowded as ours, building a new mental hospital from scratch is a challenging prospect. People who are hospitalised need more than beds, wards and showers to recover. They need air, quiet and space, assets which are very hard to come by here.
Eye-witness accounts of conditions at Mount Carmel make for harrowing reading. They describe an infrastructure and a quality of care that fit the description of the architecture of the building: Victorian. There are, no doubt, many good intentions. Health care professionals do the best they can with the resources they have. But they cannot make up for the fact that the care we provide has not kept up with the passage of centuries.
The quality of a civilisation is measured by the way it treats the weakest who live within it. In the conduct of the State, that measure should account for the way we treat people we entrust in institutional care. Migrants in detention, prisoners in custody and patients in a mental hospital are vulnerable to abuse which can take the form of the infliction of harm (fortunately a rare occurrence) or neglect in the duty to prevent it.
The “hell” Belle de Jong described in her now famous account of her stay at Mount Carmel is unacceptable by any civilised standards. She spoke of filth, exposure, lack of privacy, darkness, noise, unnecessary restraints, chaos in the dispensation of medicine, and shabby, perhaps dangerous infrastructure: in a word a “nightmare”.
The promise of a new hospital near Mater Dei gives us a prospect to look forward to. It is easy for me to say but it is not a matter of pride for us as a community that we have only started to think about building a new mental hospital when the one we’ve had for 150 years has gone way past its expiry date. The reality we’re in is a blemish on our sense of solidarity as a community.
Consider that compounded with the suffering of mental health patients denied with the level of treatment and accommodation they are entitled to, is the fact that hospitalisation itself is an indicator of inequalities. The number of hospitalised patients at Mount Carmel that were not born in Malta is disproportionate to the national ratio. Similarly, patients tend to be poorer and hailing from parts of the community suffering several depravations.
Our national health service is a crucial leveller. The mission to provide health care to all people living in Malta no matter their economic, social or ethnic background is one of the greatest ambitions and, to the extent that it succeeds, one of the greatest achievements of our country. Governments of different hues have prioritised the health of our community and in that respect we have much to be proud.
That is perhaps why our collective failures in the mental health area are so painful. Because they contrast so dramatically with the rest of our health service.
The government’s own mental health strategy from 2018 recognises explicitly that in-patient care for mental health patients is “not fit for purpose”. We have no reason to believe the government is sugar-coating the situation. The ‘government’ in this case is the doctors who have no mission apart from the best possible care for their patients. But even without sugar-coating the prospect of having nothing better than a place unfit for the purpose of treating mental health patients is too short of the standard of decency we should be holding ourselves up to.
Yes, we need a hospital for our times, but in the meantime, this is not something that can wait. All too often Mental Health is side-lined when now more than ever it is very much at the forefront and we are late. We can already be able to utilize different existing facilities locally and re-purposing them, shifting the in-patient budget towards building well-staffed community-based centres to deliver local mental health services and provide interventions within each locality, rapidly increasing our capacity to handle mental health and provide quality services at volume whilst fazing Mount Carmel out.
One of our countries and governments ultimate definers of success is how it treats its people and those who are the most in need, the elderly, the sick, living with disabilities and those in the shadows suffering. This is being tested and we can’t afford to fail.