Chronic/Complex Psychiatry: Available support for individuals suffering from chronic difficulties
When a person is admitted to Mount Carmel Hospital, there is a specific pathway that is generally followed. If the admission is new, or it has been longer than 1 year since the previous admission, the patient is admitted under an acute consultant depending on the region (North/Central/South). If the patient is homeless, admission will be under an acute consultant through a specific admitting roster.
In case the admission takes longer than 6 weeks due to chronic difficulties, or if there is rehabilitation potential, a referral is made for takeover by specific chronic/rehabilitation consultants (similar process by locality/region) who have a very dedicated multidisciplinary team specialised in rehabilitating patients with chronic difficulties back into the community.
In Mount Carmel Hospital, the main multidisciplinary team consists of:
● Doctors (Including psychiatrists, psychiatric trainees and foundation year doctors)
● Nurses
● Social Workers (SW)
● Occupational Therapists (OT)
● Psychologists
● Physiotherapists
● Speech and language pathologists
● Dieticians/Nutritionists
Together, the multidisciplinary team works to tackle the many difficulties that different patients might encounter. The above mentioned specialties are available throughout the entire work week and organise frequent appointments with clients/patients to formulate a plan for the way forward and identify any aids that can help the patient’s wellbeing and facilitate their reintegration into the community. On site, there are social work, psychology and occupational therapy departments that are used to facilitate the process and provide hands-on practice to anyone who might need it.
The culmination of the above mentioned support is the Halfway House, now known as Dar Sebħ Ġdid (DSĠ), which is a building outside the main hospital grounds that can accommodate 14 persons, which has the main function of helping patients attain independent living. DSĠ is crucial in the rehabilitation process, as it gives patients a chance to hone their everyday skills, leading to a smoother transition to independent living in the community. There is a very well structured programme that allows patients to work as part of a team with other patients residing in DSĠ, as well as giving the opportunity to develop new skills through the help of OTs. At DSĠ, through OT and SW interventions, long term plans regarding job finding and residence finding are also explored. From DSĠ, once the rehabilitation programme is complete, patients will then be discharged back into the community. However, if further support is needed, further opportunities are available.
Richmond Foundation
Richmond foundation, a registered NGO and non profit organisation, was founded to aid people with mental health difficulties as well as their loved ones. Similar to DSĠ, the focus on independent living and skill finding, offering specific support systems to help the residents. Services offered include:
● Support Groups
These are groups that offer a secure environment wherein clients can share their experiences and difficulties. This environment ultimately helps with the recovery journey of the person and the other group members.
● Support at Work
With respect to the work environment, the Healthy Minds Work scheme helps organisations with safeguarding the overall well-being of their workforce by creating an inclusive and supportive work environment.
● Assisted Living
The hostel programme, which is a product of the mental health services and Richmond foundation, is a programme whereby long term, shared accommodation is provided to clients that were previously cared for at Mount Carmel Hospital. The programme offers 24 hour support, similar to services offered by DSĠ. This programme aims to help its residents achieve a good level of independence, which will ultimately decrease the likelihood of relapse into psychiatric ailments and thus admissions. Similar to DSĠ, there is a multidisciplinary approach which focuses on the residents’ abilities and social life. At present, there are 5 hostels:
● Attard Hostel: Space for 10 women
● Qormi Hostel: Space for 12 men
● Paola Hostel: Space for 11 men
● Mosta Hostel: Space for 10 men
● Kappara Hostel: Mixed gender, accommodating 12 clients
● K.I.D.s
This is a 3 year residential programme, designed for children between the ages of 7-10, who experienced significant behavioural and emotional difficulties. When a referral is made, a comprehensive assessment is carried out and a specific plan is made to help the child with their self-esteem and overall development whilst in a safe and healthy environment.
● Psychological support service
Includes psychological services which are offered to anyone who might need the service. Sessions are delivered by qualified therapists and specialists.
● Rehabilitation programme
Similar to DSĠ, Villa Chelsea (VC) seeks to empower and support people suffering from mental health conditions. Programmes offered both as a day user and as a resident helps clients attain independent living. Both programmes last 1 year and are open to adults between the ages of 18-65. The Villa is located in Birkirkara, and seeks to provide a supportive environment to its users, to ultimately bring out their potential.
● Support at home
This branch of Richmond foundation seeks to help people suffering with mental health problems by providing services that can help the individual and their families with everyday life. The support at home scheme also aims to educate individuals and their families about mental health and other issues relating to the condition.
● Mental Health First Aid Course
Richmond foundation also offers courses designed to provide knowledge and skills to its learners with respect to correct approaches to take to provide assistance to people suffering from mental health conditions. Courses offered include:
● Standard Mental Health First Aid
● Youth Mental Health First Aid
● Teen Mental Health First Aid
Fondazzjoni Suret Il-Bniedem
Set up in 1999 by the Maltese Franciscan Capuchin Province, Suret il-Bniedem (SiB) was originally opened by Fr Tabone, assisted by John Portelli, as a shelter which welcomed former prison detainees. In 1998, Fr Crispin Tabone from the Capuchin Province stepped in to help and SiB as it is known today was set up in 1999, with recruitment of full and part time staff.
Nowadays, SiB provides shelter to homeless persons in Malta. At present, there are 5 homes which cater for people with different backgrounds:
● Dar Patri Leopoldo
Situated in Gżira, Dar Patri Leopoldo, offers services to homeless males.
● Dar Tereża Spinelli
Situated in Valletta, this home has 15 bed spaces for women from different backgrounds; it accepts young women, single mothers, victims of domestic violence, former female convicts as well as their children.
● Dar Victoria & Dar Franġisk Marsa
Situated in Marsa, Dar Victoria and Dar Franġisk offer services to males who are in contact or were in contact with the Mental health sector
● Dar Imelda, Paul Debono Birkirkara
Situated in Birkirkara, this home opens its doors to females who are in contact or were in contact with the Mental health sector.
Casa Nuova
Opened in 2021, Casa Nuova, located in Paola, welcomes individuals with intellectual/learning disabilities and Huntington’s disease. The home holds 50 bed spaces, and was opened to house people with the above mentioned conditions who were previously cared for at Mount Carmel Hospital on a long term basis. Casa Nuova offers a patient centred approach in a community setting, in a more modern facility.
Casa Nuova is also equipped with staff from different professions, including nurses, specialists, therapists and other healthcare professionals.
CARITAS
Caritas was set up with the aim to battle poverty and promoting social justice, in accordance with the Christian faith. Set up on November 11, 1968, caritas strives to help people through social assistance and charitable activities. Its first director was Rev. Fortunato Mizzi (MAS).
Services offered by Caritas include:
● New Hope Project: This project is targeted for persons with substance use problems, and aims to help with rehabilitation through the help of professionals and carefully structured goals that assist with long term rehabilitation, education and prevention of relapses. This project consists of the following branches:
○ Outreach community services
○ Family services
○ Male Shelters
○ San Blas Therapeutic community including rehabilitation and residential phases for males
○ Et Iris therapeutic community including rehabilitation and residential phases for females
○ Semi-residential Dar Charles Miceli - Similar to DSĠ, support is offered for the person to integrate back into society, with specific plans being made for different individuals. National aftercare is also offered to help people maintain drug abstinence.
○ Evening programmes
● Fondazzjoni Dar il-Hena: This foundation is specifically intended for individuals experiencing homelessness. The foundation consists of three shelters: 1 long term shelter and 2 emergency shelters which are:
○ Dar Maria Dolores: Founded in 2017, this home offers shelter to women from different backgrounds. Thanks to social workers, appropriate support is given to these women to help them attain a stable lifestyle. The home also helps women with finding supported accommodation.
○ Dar Papa Franġisku: Opened in 2016, this home was the first of its’ kind, and was opened with the aim to house homeless males between the ages of 18 and 59. Like Dar Maria Dolores, the home meets the individuals’ basic needs and helps by providing social support to its residents, be it through attaining independent living or helping with finding further supported accommodation.
○ Reach Residential: This is a long term shelter for homeless people who have completed their emergency stays at either Dar Papa Franġisku or Dar Maria Dolores. The Reach residential has a programme aimed with teaching individuals important life skills to help with the eventual attainment of individual and independent living, which will ultimately lead to a better quality of life. Furthermore, here, the issue of homelessness and alternative accommodation is tackled as well.
● Tal-Ibwar Adolescent Therapeutic Centre: Through its day and residential programmes, this therapeutic centre offers programmes for people aged between 12-17 who have a problem with substance use. At the centre, psychological services are offered to the residents as well as their loved ones if needed.
Sedqa
This organisation aims to help individuals suffering from addiction problems, including substances, alcohol and gambling and seek to promote interventions that help with the prevention, treatment and rehabilitation of people suffering from such problems. The organisation works through specific branches:
● Prevention Service
Through its team of professionals, services are offered that aim to educate the public, to encourage a healthy lifestyle away from addictions. Correct, age appropriate information is given about different addictions which will ultimately help with prevention.
This service is also present in the educational sector, through T.F.A.L. 3 (Tfal Favur Ambjent Liberu), T.F.A.L. 5 (primary school level) and ‘Teen Outside the Box’ for secondary students. These three programmes aim to help with preventing the onset of addictions. In the workplace, S.A.F.E (substance abuse free employee) programmes also have similar aims, and also helps employees tackle addiction issues to ultimately remain in the workforce.
The prevention service branch also has a community outreach, which liaises with entities and organisations in the communities such as local councils. This service organises talks discussing addictions and how to prevent them.
● Substance Misuse Outpatients Unit SMOPU (Detox)
This service, located at St Luke’s hospital is offered on a national level. Detox aims to engage people with a substance problem through medical, psychological and social interventions. The unit is comprised of a multidisciplinary team, whose aim is to reduce harm caused by substances by as much as possible. At the centre, methadone is provided to people suffering from opioid addiction problems. Apart from this, other medical services and treatments used to tackle problems arising from substance addictions are also offered.
● Komunità Santa Marija – Residential Rehabilitation Services
This service is the integration of three separate services. The programme is divided into 3 phases and lasts for 14 months. The phases are split as follows:
Phase 1 - Assessment and Stabilisation phase
Phase 2 - Therapeutic phase
Phase 3 - Reintegration phase
Written by Dr Adrian Richard
