Mental health infrastructure

The Minister for Health and Active Aging, Jo Etienne Abela, has announced a much-needed reform in mental health care in Malta.  

As the minister said when announcing the reform, the 19th century Mount Carmel Hospital is not fit for purpose and every government in history has some blame for not investing in our mental health infrastructure, which led to the current ‘reality’. The minister plans to close it down within four years. 

The hospital is currently home to around 230 patients. Some 100 patients will be relocated from Mount Carmel to other psychiatric homes and services in the community. By the end of this year, the psychiatric unit Mater Dei Hospital - closed during the COVID pandemic - will host a further 30 patients from Mount Carmel.  

The third and final phase - the biggest project in modern mental healthcare - will consist of the construction of a new, acute psychiatric unit within Mater Dei, which the minister plans to open within four years.  

Plans are already in hand for the unit that would eventually cater for another 128 clients and will be built with the funds previously earmarked for a new, acute psychiatric hospital close to Mater Dei, a project that was scrapped weeks after Abela took over the health portfolio earlier this year. 

In less than six months since he took over the health ministry, Abela completely turned the country's mental health strategy around. In March, he scrapped plans for the long-promised new mental health hospital, and then announced he would close down the stigmatised Mount Carmel hospital. This way, the minister believes mental health would come to be treated in hospital just like any other illness or condition. 

Mount Carmel Hospital started receiving patients in 1861. The name Mount Carmel was given to the place by PN Minister Alex Cachia Zammit in the 1960s in an effort to remove the stigma associated with the hospital that was then known as a lunatic asylum. 

In fact, Mount Carmel was founded as a ‘Lunatic Asylum’ in 1861. Back then, the main aim of the hospital was to keep psychiatric patients away from society rather than support them towards reintegration in the community. 

It is obviously not fit for purpose in this century. 

A woman - Belle de Yong - who was sent to Mount Carmel for a few days in 2020 narrated her experience in what many must consider to be a horror story: ‘From the outside, the psychiatric hospital looks alright. Tranquil and pleasant, even. On entrance, you’ll find a roundabout with a fountain, well-kept flowers and bushes, and a decent building. But what’s behind this façade tells a whole different story.’ 

She ends recalling her experience: ‘It was the caring staff and the right medication that effectively helped me out of the psychosis. The qualified psychiatrists and lovely nurses make up, as far as they can, for the dilapidated state the hospital is in. 

‘Mount Carmel is anything but a place to heal. If you aren’t mentally ill to begin with, the conditions the place is in will certainly drive you mad. Psychiatric care is in dire need of funding and transformation. It is crucial for Malta to leave the 1800s lunatic asylum in the past and provide psychiatric patients with the care they need and deserve.’ 

In other words, Mount Carmel Hospital is Malta’s best hidden scandal. The building is not fit for purpose, let alone its dilapidated state and dangerous structures.  

Now that the decision has been taken for the country’s health authorities to give up Mount Carmel for good, the government must start thinking of a new use for the buildings. Otherwise it will be abandoned and left to go to ruin even more. 

This is what happened to St Luke’s Hospital which Vitals/Stewards were supposed to rehabilitate for medical tourism. Now it will cost more to rehabilitate and/or give a new use to it. 

‘Adaptive Reuse’ is a way to save a neglected building that might otherwise be left to fall to pieces. The practice can also benefit the environment by conserving natural resources and minimizing the need for new materials.  

We need to think of new ideas in the process of repurposing buildings that have outlived their original rationale, for different uses or functions - while at the same time, retaining their historic features. An increasing number of examples can be found around the world. A closed school may be converted into condominiums. An old factory may become a museum. Sometimes called property rehabilitation, turnaround, or historic redevelopment, the common element is that the building is put to good use. 

Finding an intelligent new use for the Mount Carmel Hospital buildings and site should be immediately put on the government’s agenda. 

International Criminal Court 

As the war in Gaza nears eight months, the International Criminal Court (ICC) is considering arrest warrants against leaders of Israel and Hamas for alleged crimes committed ‘in the situation in the State of Palestine.’ These charges are remarkable but are unlikely to change the policies of either side - or of the United States. 

The ICC's prosecutor-general is seeking warrants for five officials, his office announced recently. Hamas leader Yahya Sinawar is accused of ‘war crimes and crimes against humanity’ starting with the attacks of October 7, including murder, hostage-taking and torture. Israeli Prime Minister Benjamin Netanyahu is charged directly for using ‘starvation of civilians as a method of warfare’ and ‘intentionally directing attacks against a civilian population.’  

The ICC has no official authority over Israel or the United States, so its actions serve more to influence the global community and draw rhetorical lines in the sand than they do for meting out justice.  

US President Joe Biden reacted saying the ICC prosecutor’s application for arrest warrants against Israeli leaders is outrageous because the ICC is implying that Hamas and Israel are equally guilty. It does not do anything of the sort.  

Incidentally, the US did help write the Rome Statute, the code that created the ICC in 2002, establishing an international body to bring some of the world’s worst criminals to justice.  

But when it came to formally submitting to the ICC’s jurisdiction over war crimes and genocide, the US was one of the countries that refused to sign, along with China, Russia and Israel.