7.5 Mental health
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A National Strategy for Mental Health targeting for the whole population, with a specific focus placed on promotion and preventive efforts in children and adolescents, was published in 2019 and covers the period between 2020 and 2030. This strategy will guide the implementation of investment and reforms which will truly place mental health and treatment of mental illness at the heart of the health policy agenda in the years to come.
The strategy upholds the values of dignity, autonomy and rights of all people with mental disorders. It recognises that everyone has an equal opportunity to attain mental well-being throughout their lifespan and all individuals are entitled to appropriate health care, including mental health care. It embraces a modal shift in the locus of care away from institutions towards community-based mental health care.
It is based on a vision that a society that promotes mental health and well-being for everyone, prevents mental disorders among individuals at high-risk and provides quality treatment, care and support to individuals with mental health problems This vision will be implemented through 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
The strategy falls under the direct responsibility of the Ministry for Health.
Improving the mental health of young people
The Child and Young People's Services (CYPS) at St. Luke’s Hospital offers assessments and management for mental disorders in young people. This is done in a collaborative multidisciplinary way with young people and their carers, rather than guide them and tell them what is best to do.
With regards to assessments, there are two functioning multimodal pathways: one for Attention Deficit-Hyperactivity Disorder (ADHD); and one for autism. These follow NICE guidelines.
Interventions include individual therapy for young people with depression, anxiety, bipolar, and early onset psychosis and group dialectical behaviour therapy (DBT) such as emotional dysregulation, distress tolerance, interpersonal skills for young people suffering from emerging personality disorders and low moods and self-harm behaviour.
CYPS also offers psychoeducation to parents with children with ADHD and Oppositional Defiant Disorder (ODD), and to parents with children who have autism.
The Innovations Team 13-25 years, is for young people with multiple complex mental disorders. This team offers multidisciplinary intense intervention, including home visits and weekly reviews and therapy.
The Young People’s Unit at Mount Carmel Hospital within Mental Health services uses a pre-admission system to screen patients and only admits young people between the ages of 12 and 18 with mental issues such as bipolar disorder, depression, and autism with aggression issues.
The Children Development Assessment Unit (CDAU) at St. Luke’s Hospital assesses and treats young people up to 16 years referred by consultants/doctors. Young people seen at CDAU are referred for various limitations and difficulties including Autism, Global Developmental Difficulties, Learning Difficulties, ADHD, Cerebral Palsy, Head Injuries, Down syndrome and other syndromes. Children may be treated individually or in groups. Group therapy includes the Sensory Motor, Handwriting, Prewriting, Perceptual Motor and the Alert Group. The CDAU aims to provide assessment, therapy and support to patients with cognitive impairment and their families from a very early age. Children can be referred to the unit as early as, immediately after birth.
The assessment and treatment services at the CDAU, are provided by a multidisciplinary team of professionals consisting of pediatricians, nurses, psychologists, physiotherapists, occupational therapists and speech and language pathologists.
Children and Adolescents Psychiatric Emergency Service (CAPES) offer mental health emergency service at Mater Dei Hospital.
Kellimni.com is a joint effort between SOS Malta, the Salesians of Don Bosco, Aġenzija Zghazagh and Aġenzija Appoġġ. This initiative is an online support service run by trained staff and volunteers reachable through e-mail, chat and smart messaging for support.
Through Kellimni.com, young people can, in an anonymous way, express their concerns and talk about the issues directly affecting them. Kellimni.com is aimed at young people who are suffering from any form of social exclusion, abuse, neglect, and/or psychological difficulties and are in need of immediate emotional, moral and social support.
In October 2020 to celebrate ‘World Mental Health Day`, Aġenzija Żgħażagħ launched the campaign ‘Trust yourself to talk. Anxiety is this you?’ The aim of this initiative is to encourage young people to speak up, reach out and obtain reliable information whilst making use of services to improve their mental health. This campaign lasted till the beginning of 2021 and it is envisaged to start again in April till May 2021. The Aġenzija Żgħażagħ will also be launching the service of a youth worker online to engage with young people who might have issues with anxiety on a one-to-one basis.
Youth in Focus provides social work intervention to adolescents and young persons, aged between 13 and 18, with the scope of assisting them throughout their adolescence, by addressing their needs and empowering them to reach their full potential. There is a wide range of presenting difficulties and issues that the team encounters and deals with. These may include, anger management, mental health difficulties, turbulent relationships, alcohol/drug abuse & other addictions, promiscuity, time management, prostitution, criminal behavior, employment, petty crime, past traumas, poverty & homelessness, etc.
In 2017 the service offered support to a total of 211 young people and received 68 new cases.
Embark for Life (E4L) targets young people aged 15-24 years and supports them in finding employment. This service was already in existence as it was a service funded by the EU under the European Social Fund and, following its success, local funds were provided and the service started operating in July 2013. E4L contributes towards the community strategic guidelines by matching project participants to avail of the already existing schemes and educational/vocational training in the country, whilst supporting them in finding suitable employment. Disadvantaged young people are often likely to fall into the social benefit trap. Thus, by supporting them to lead a sustainable healthy lifestyle and have job security, their dependence on social assistance and the revolving syndrome of attaining support from various public services is minimized.
In 2017, the service worked with a total of 188 young people and received a total of 52 new cases. During the said year 42 young people were successfully engaged in employment and continued to receive the support of the workers within the Embark for Life team.
The Adolescent Day Programme is a 16-week programme spread onto 3 phases namely Bronze, Silver and Gold. Activities/sessions range from intrapersonal and interpersonal skills learning to more active outdoor sessions. The programme includes also a 2- week experience with the Armed Forces of Malta. The programme is aimed at young people with challenging behavior and addictions and helps in trying to provide them with a secure and stable lifestyle. Young people meet 4 times a week for a 3-4-hour session. In 2018, the programme received accreditation from the Education Department, to implement the Prince Trust Achieve Programme