Between promises and lived reality: What an email exchange on Mount Carmel Hospital really tells us

The recent email exchange I had with the National Mental Health Services CEO Roseanne Camilleri offers an insight into the ongoing debate about the state of Mount Carmel Hospital.

More importantly, it highlights the distance that still exists between public concern and official reassurance when it comes to mental health services in Malta.

In my correspondence at the end of January of this year, I asked for clarification on issues raised during the parliamentary Health Committee meeting: Building repairs, patient facilities, therapy provision, staff numbers, safety concerns and long-promised improvements. Camilleri in her reply described phased modernisation works, structured programmes and ongoing upgrades.

Yet reading through the conversation there is a deeper story—one about trust, transparency and the long road towards meaningful reform.

The questions I posed reflect public concern and as a broadcaster on Campus 103.7 and academic activist, listening to what people say is of essence. But that is not good enough, it is also about kicking up the system.

A checklist of concerns

My emails read like a checklist of concerns that have circulated for way too long: The physical condition of many wards, the adequacy of basic amenities for staff and patients, the state of outdoor spaces (or lack of). The availability of therapy and activities for patients are not abstract policy issues, they are daily realities for vulnerable people who depend on the system.

My questions were specific and grounded. How many wards have been repaired? Are all wards adequately equipped? Are therapy sessions available to every patient? Are enough professionals employed? Are patients meaningfully engaged or simply passing/killing time?

Perhaps most telling was the question about duvets, allegedly purchased ahead of a media visit. Whether trivial or not, such concerns reflect a deeper suspicion that improvements sometimes happen only when scrutiny is imminent.

That suspicion does not arise in a vacuum.

Mount Carmel Hospital has long been associated with ageing infrastructure and delayed reform. For many families, the hospital symbolises a mental health system that has struggled to modernise at the pace patients deserve. It is a pity since mental health hospitals are a crucial pillar of any mental health service.

Roseanne Camilleri’s reply attempted to address these concerns with a tone of reassurance and institutional clarity.

She outlined a multi-phase modernisation programme for the Young People’s Unit, including a therapeutic garden, accessibility improvements and ward refurbishment scheduled for the first quarter of 2026. She stated that wards are being upgraded and that maintenance programmes are ongoing.

She dismissed the duvet claim as unfounded and explained that replacements are part of routine improvements rather than preparation for media coverage.

She also stated that the hospital provides all essential amenities, including yard space, smoking areas, nurse stations, meeting rooms and adequate sanitary facilities while acknowledging that infrastructure quality is an ongoing concern.

I have to note that my information is very different from that supplied by Camilleri, so much so that a number of wards have been closed. At least three wards—Transition Ward, Ward 8b and Male Ward 2B—were shut in these last months. Once again, we don’t seem to be doing it right though. The closures caused aggravation in staff and patients as they felt they were not prepared for this transition.

Other points I raised were addressed in administrative terms. The Podiatry Unit has been relocated to a safe area, after I pointed it out. A landscaping tender is expected soon. A barrier has been installed at the back gate, with further works pending design completion.

Planning language vs lived experience

On patient care, Camilleri emphasised multidisciplinary teams, ongoing recruitment and therapy tailored to individual care plans. She rejected the suggestion that large numbers of patients are idle, stating that structured activities take place daily.

The information I have is very different.

What stands out most in this exchange is not disagreement over facts but a gap between planning language and lived experience.

Camilleri’s response was filled with phrases such as “modernisation programme”, “phased renewal”, “structured clinical…”, and “upgrades”. This is institutional management language.

My questions, by contrast, were rooted in practical realities: Toilets, gardens, nurse stations, activities and safety.

Both perspectives are legitimate. But when they collide, the result can feel unsatisfying to the public. Promises of future tenders and phased works do not always reassure families and patients worried about conditions today. References to programmes, strategies, road maps, policies and frameworks do not automatically answer whether a ward currently meets acceptable standards.

One positive aspect of the exchange is that it happened openly, with journalists copied into the correspondence. That decision reflects a recognition that mental health services must be accountable not only to administrators, politicians and clinicians but also to the people using the service and the public.

Mount Carmel Hospital remains one of Malta’s oldest healthcare institutions. Even with ongoing upgrades, it was not designed according to current mental health principles.

International best practice increasingly favours smaller community-based facilities rather than large institutional settings. Malta has taken steps in this direction, but Mount Carmel continues to carry a heavy share of the national workload.

This reality makes refurbishment both necessary and yet insufficient. Renovating wards can improve dignity and safety, but true reform requires improved and sustained investment in community services, professional staffing and preventive care. Add to this the fact of people being abandoned in the system because there is no adequate place to host them—an incredible thing to say with all the money that we put into social and health services.

Without that broader transformation, Mount Carmel Hospital risks remaining under pressure regardless of how many upgrades are completed.

It is understandable that administrators wish to defend the work being done.

Mental health reform in Malta will succeed only if policymakers, professionals, civil society, administrators and mental health survivors and their families work together rather than talk past one another. Ultimately, the true measure of progress at Mount Carmel will not be found in emails or committee meetings but in the lived experience of patients and staff.

The questions that matter most are these: Do wards feel safe and dignified? Do patients receive meaningful therapy? Are outdoor spaces welcoming and accessible? Do staff have the resources they need? Are persons with mental health and their families and friends involved in the care plan?

The recent exchange has helped clarify where things stand. The next step is ensuring that the promises described in official replies translate into visible improvements on the ground.

Mount Carmel Hospital has been waiting for renewal for decades. Patients and families will judge progress not by plans alone, but by results they can see and feel.

Roseanne Camilleri’s responsiveness and the health minister’s clear commitment to mental health are encouraging signs. I believe some posts need new people, but that is clearly not my call.

And on a final note, I encourage people to keep using these inpatient services where and when necessary. The majority of staff mean well; this at least gives me serenity.

If you are passing through a difficult period, you can request assistance from the following services: Support line 179 (FSWS), 1770 (Richmond Foundation), Olli chat or Mental Health Helpline 1579.