An audit carried out by the National Audit Office (NAO) has found that Mount Carmel Hospital (MCH) is in dire need of an overhaul as it pinpointed a number of problems including an “unacceptable structural condition”, a lack of resources and a strained relationship between staff and the management.
The NAO report said that mental health in Malta is “still considered as secondary priority when compared to the rest of the local public health sector.” The study calls on government to draw up a comprehensive national strategy for mental health, given what it described as “a vacuum in the vision and overall direction for this critical area within the local health sector.”
The mental healthcare hospital is in dire need of investment and in November 2017, the Commissioner for Mental Health said the dedication and respect shown by the staff cannot be expected to make up for the “lack of investment in the physical environment of care facilities”.
This was confirmed by the NAO which while acknowledging government’s pledge to invest some €30million to address the hospital’s “current unacceptable structural condition” it concluded that the hospital’s significant operational challenges are much more widespread.
The report added that “the hospital’s structural problems comprise but a portion of the challenges that MCH faces in its operations, and consequently a more holistic approach is required.”
The World Health Organisation predicts that mental health disorders are set to become the leading cause of the global burden of disease and NAO conducted a review to determine whether Mount Carmel Hospital, being the central national hub tasked with dealing with such conditions, is operating efficiently while effectively addressing society’s mental health needs.
NAO said that if capital investment is not accompanied by an upward revision in the hospital’s recurrent financial allocation, together with an overhaul of its operations, significant inefficiencies and ineffectiveness would still prevail.
“NAO strongly urges the relevant authorities and MCH management to invest the necessary resources as soon as possible towards making the hospital structurally secure so that mental health patients can receive their treatment safely,” the study said.
The national auditor also recommended that MCH management sets a minimum standard across all wards insofar as the hospital’s ambience and accessibility are concerned, thereby ascertaining that all mental health in-patients are afforded with a decent and dignified environment.
This, NAO said, “is to be done in a timely manner, which least effects mental health in-patients and which, in particular, avoids the phenomenon of overcrowding. Once this matter is tackled, NAO encourages MCH management to create, implement, and maintain a continuous maintenance programme so that the hospital would not revert to its current unacceptable state.”
MCH accommodates approximately 530 in-patients within its wards and provides services to approximately 11,750 outpatients within the community.
Apart from a pronounced shortage in human resources, particularly in the nursing grades, NAO observed that relations between the hospital’s management and its staff are generally strained.
Specifically, NAO noted how MCH personnel feel isolated and directionless while, on the other hand, MCH management feels that the former’s militant approach towards industrial relations impinges on the efficiency and effectiveness of the hospital’s operations.
NAO also concluded that MCH’s security arrangement is largely inadequate. The deployed security staff is not carrying out all security functions, particularly those involving the physical element, such as searches or restraint, as well as those relating to the monitoring of the hospital’s master keys, NAO said.
Some of these functions are instead carried out by nursing staff and NAO also noted that security at the hospital’s main gate is loosely implemented and that the CCTV system in place leaves much to be desired.
The study also showed that MCH is 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.
“This situation, NAO asserts, is putting further strain on the already stretched resources, and consequently, on the level of service offered to the mental health patients who do require hospitalisation.”
NAO also found that while the desired way forward is to push mental health services towards community care, MCH’s community clinics and day centres are generally understaffed and that the required attention from the hospital’s management towards this function is lacking.