Drugs and alcohol account for one in four admissions to Mount Carmel

Alcohol and drug abuse is the main reason for the hospitalisation of nearly one in every four patients admitted to Mount Carmel, a study in the Malta Medical Journal has revealed.

The study, based on the records of 300 patients admitted to Mount Carmel Hospital between 15 October 2018 and 1 March 2019, shows that more than two patients are admitted to the hospital every day. And men are twice as likely to be admitted than women, while foreigners account for one in every four admissions.

Nearly a third are committed, against their will.

The study shows that 15.3% of admissions cases were linked to substance abuse, 15.3% of cases were linked to depression, and 13.3% were linked to acute psychosis, reflecting similar trends across Europe. Other reasons for admission were self-harm (7.7%), acute stress reaction (7.7%), schizophrenia (7%) and alcohol abuse (6%).

Cases involving alcohol and drug abuse or a mixture of both account for 23.3% of all cases. But the number of cases involving substance abuse could even be higher because psychotic episodes are also “mostly substance induced”.

The study shows that 205 inpatients, 68.3% of the cohort, were inpatients on a voluntary basis whereas 30.7% were admitted for assessment and observation under the provisions of the Mental Health Act.

Compulsory admission rates vary remarkably across the European Union, from 30% in Sweden to 3.2% in Portugal. This variation is linked to differences in legal frameworks or procedures.

Roughly two male patient were admitted for every female. In general, depressive disorders are more common in females whilst men were more likely to present with psychotic disorders, alcohol use, and substance use disorders. The fact that substance abuse accounts for most hospitalisations explains why males outnumber females.

75.3% of the cohort were of Maltese nationality, 14% hailed from the rest of Europe and Africans accounting for 8.3% of all admissions. Only 2% hailed from Asia or the American continents.

Nearly half of those admitted (46.7%) were between 20 and 39 years of age. 40 to 59-year-olds accounted for 32.3% of all admissions.

The reason for this is that the age of onset for the most common diagnosis, that is substance use disorders, is 20; while that for depression and mood disorders is 30. In fact out of 300 patients who were admitted, only 15 were aged under 20.

Most of those admitted (40%) were referred to the mental health hospital from the accident and emergency department in Mater Dei Hospital, while 26.7% were referred by general practitioners.

64.3% of all cases had been admitted for the first time while the rest had already been admitted on a previous occasion.

The study was conducted before March 2019 when crisis psychiatric services at casualty had extended their on-call hours from 8am till 5pm to a 24-hour service. According to the authors of the study, having a psychiatric specialist in the location where most referrals are made allows for better assessment of each case and should lead to a decrease in unnecessary admissions.

“This may also help prevent patients from future institutionalisation, cuts down on costs yet ensuring that inpatient hospitalisation is reserved for situations with high imminence of danger to the patient or others”.

Providing adequate and updated training to family doctors could also lead to better community management of mental health problems and possibly reduce admissions.

The study was authored by Bertha Grech and Beppe Micallef Trigona from the Department of Psychiatry in Mount Carmel Hospital.

In numbers 

• 15.3% linked to substance abuse
• 15.3% linked to depression
• 13.3% linked to acute psychosis
• 7.7% self harm
• 7.7% acute stress reaction
• 7% schizophrenia
• 6% alcohol abuse
• Cases involving alcohol and drug abuse or a mixture of both account for 23.3%