Mount Carmel Hospital’s state of neglect laid bare in hard-hitting Auditor’s report

Mental health in Malta and the island’s Mount Carmel mental hospital “are still considered as secondary priority when compared to the rest of the local public health sector,” the Auditor Genera; has remarked in the NAO’s latest investigation.

While the NAO said that government had committed to invest €30 million in long overdue repairs to Mount Carmel’s (MCH) premises – currently said to be in an unacceptable structural condition – the office said this was only a portion of the challenges it faces in operations.

“Being a mental health institution, MCH has to absorb a stigma which, unfortunately but generally, surrounds the type of health conditions it deals with. Decades of neglect and manifest lack of commitment by central government towards this area have however accentuated this concern, transforming an already challenging situation for the mental health patient to one even more difficult,” the NAO said.

The study found that MCH was severely under-resourced, both financially and in terms of human resources, while facing considerable internal challenges.

The NAO said it was particularly concerned on the generally strained relations between MCH’s management and its staff; the hospital’s inadequate security arrangements; the fact that MCH is partially serving as a place of last resort to individuals who, though possibly in need of assistance and other targeted services, do not require hospitalisation in a mental health institution and; the lack of drive towards community based services.

Apart from a pronounced shortage in human resources, particularly in the nursing grades, the NAO said relations between the hospital’s management and its staff were generally strained, and that security arrangements were largely inadequate, with the deployed security complement not carrying out security functions involving the physical element – such as searches or restraint – as well as those relating to the monitoring of the hospital’s master keys. “Some of these functions are instead carried out by nursing staff. The audit team further noted that security at the hospital’s main gate is lax, while the CCTV system in place leaves much to be desired,” the NAO said.

“These considerations are exerting further unnecessary pressures on already stretched resources to the detriment of mental health patients, and strengthening the misplaced and lowly perception by which MCH is generally regarded,” the NAO said.

The office called for an all-encompassing national strategy on mental health to be implemented at the earliest to ensure the effective overhaul of MCH and address the prevalent negative stigma on mental health.

It also said any future mental health strategy should have community services as its flagship, which are instrumental to reduce the burden from the central hospital by reaching out to potential new cases, detecting early symptoms of mental health problems, providing early interventions, and following up on patients’ progress within the community.

The NAO also found that MCH was partially serving as a place of last resort to a significant number of individuals who, though possibly in need of assistance and other targeted services, do not require hospitalisation in a mental health institution. “While the way forward is to decentralise mental health treatment towards community-based services, MCH’s community clinics and day centres are generally understaffed and the required attention from management towards this function is on the whole lacking.”

“With a strong community based system, hospitalisation in a mental health institution would become only a requirement for the most clinically acute cases. By implication, such a system would significantly reduce the impact on the national health bill, while ascertaining that, when possible, mental health patients remain integrated within the community and valuable contributors to society,” the NAO said.