Mental health beyond the medical model

Across every sector, practical experience is recognised as a form of expertise. Organisations value people who have navigated real-world complexity because they bring insight that theory alone cannot provide.

The same principle should guide mental health care. Yet, when services are evaluated and policies developed, the people who experience those services most directly are still too often absent from the decision-making table.

For decades, mental health care in Malta has been shaped largely by the traditional medical model. The expertise of psychiatrists, nurses, psychologists, social workers, occupational therapists and other professionals is indispensable. However, when decisions about treatment, rehabilitation and a person’s future are made primarily by professionals, the system risks overlooking the knowledge of persons with lived experience (PWLE) and those who support them.

The value of practical expertise

People living with mental health difficulties experience treatment side effects, stigma, fragmented pathways and the challenge of rebuilding life after a crisis or institutionalisation. Meanwhile, at home those close to them live through the shortcomings of the clinically drafted paper plans that do not meet the realities of daily life. This risks carer burnout. Their knowledge should complement clinical judgement. Care plans are stronger when service users and carers receive clear information and are treated as genuine partners.

Lived experience also highlights the different needs of diverse groups. Minors require age-appropriate information, meaningful participation and suitable parent or guardian involvement that respects their evolving capacity and best interests. Older people may face loneliness, sensory or cognitive difficulties, physical illness and dependence; their particular needs and preferences must not be dismissed because of age. Foreign nationals may encounter language and cultural barriers, limited awareness of available services and weak support networks. Interpretation, culturally responsive communication and accessible information are therefore essential to obtain genuine consent and participation.

The role of the ‘expert by experience’

Participation must go beyond occasional consultation. Malta should further develop trained and supported ‘expert by experience’ roles through which people with lived experience can support others, contribute to service improvement and influence policy. The collaboration between the Mental Health Services and the North Ayrshire Wellbeing and Recovery College, which trains staff alongside prospective patient experts, offers a valuable foundation.

The next step should be the meaningful integration of these experts into policy development and decision-making. This should not be a tokenistic or purely voluntary contribution. It should offer fair compensation, appropriate support and genuine influence. When these experts take part in decision-making, their contribution should carry equal respect alongside that of administrators and senior clinicians. We must therefore ask whether our services are ready not only to hear lived experience, but also to share power.

The legal right to an active voice

The Office of the Commissioner for Mental Health promotes these principles through visits to licensed mental facilities during which the rights under the Mental Health Act (Chapter 525) are explained. One important safeguard is the patient’s right to appoint a trusted responsible carer, who may receive information, seek clarification and contribute to the care plan.

However, a significant number of patients do not appoint a responsible carer. Some long-term patients have no trusted person available. They receive no visits or calls and may get caught between unnecessary hospitalisation and an unsafe discharge, where suitable community services may be lacking. This isolation can be particularly serious for minors, older persons and foreign nationals separated from family or community. A humane mental health system must build social connection as well as provide treatment.

The charter of rights and public feedback

Malta’s National Patients’ Charter of Rights and Responsibilities, launched in 2016, recognises the right of service users to comment on and complain about their care. To make this right meaningful, services should actively seek feedback in accessible formats and publish reports with anonymised information on complaints and the corrective action taken. Transparency strengthens accountability and public trust.

Mental health care in Malta is progressing, but progress cannot be measured only through buildings, beds or clinical activity. It must also be judged by the quality of care and by whether people are heard, respected and supported to shape decisions affecting their lives. Service users, carers and people with lived experience should have a permanent place at the decision-making table, with particular attention to those whose voices are most easily overlooked.

Moving beyond a purely medical model does not diminish professional expertise; it strengthens it with human evidence. This shared approach is essential to services that are effective, rights-based and worthy of public trust.