An interplay of factors has rekindled political and public interest in mental health. These include the adoption of a new Mental Health Act in 2012, the establishment of a mental health commissioner, indictment from a National Audit Office report and coordinated public pressure from local media, non-governmental organisations and professionals. Government responded by publishing a mental health strategy for consultation in December 2018. This was intended to address both long-standing challenges and new challenges arising from rapid socio-demographic and economic changes which have put further strain on an already over-stretched system, demanding urgent action. An extensive consultation process took place in the first half of 2019. As a result the document was amended to place a larger focus on the role of families, the emergence of digital health and the need to clearly state that the mental health asylum would cease to function as a mental health hospital.
The concept of strengthening resilience is put forward as a central tenet in the strategy. The vision encompasses both policies and actions to create an environment that decreases risks and vulnerabilities while also developing and strengthening services to provide timely and comprehensive quality mental health care to people who need it.
The strategy is built around a series of actions grouped under four clusters:
• Promoting mental health and wellbeing by addressing the wider determinants of health
• Transforming the framework within which mental health services are delivered
• Supporting all persons with mental disorders and their families
• Building capacity and fostering innovation to improve the performance of our mental health services
Integration of physical and mental health services is a key objective. Community and hospital mental health services are set to become more tightly integrated. The mental health service framework will be transformed such that community services become the mainstay of care, treatment and rehabilitation of persons with mental health problems in Malta. Acute hospitalisation for mental illness will be provided from a purpose-built psychiatric facility which will be developed on the Mater Dei Hospital campus in the coming years. Consequent to the development of community based mental health services and the opening of the psychiatry facility on Mater Dei campus (acute hospital), Mount Carmel Hospital (the mental asylum) will be repurposed and will cease to function as a mental health facility. A review and update of the medicines available on the national formulary for mental health is also planned.
A mid-term review of the strategy is planned in 2025 and this will provide an opportunity for reviewing and revisiting the strategy in line with country contextual development and service innovations. The Mental Health Strategy Board which brings together representatives of various stakeholders in the mental health sector will continue to be consulted and provide feedback on the implementation of the strategy on a regular basis to ensure full ownership and engagement of all those involved.