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Liaison and Emergency Psychiatry: The Role of the Psychiatry Liaison Nurse

Dialogues in Psychiatry

Mr Gary Brincat

M.Sc. Mental Health Nursing (Melit.), B.Sc. Mental Health Nursing (Hons)(Melit.), Dip. Health Studies (Nursing)

This article emphasises the crucial role of Psychiatric Liaison Nurses (PLNs) within the Liaison Psychiatry team, shedding light on their significance in delivering comprehensive and patient-centred care and underlining their importance in bridging the gap between physical and mental health.

Liaison Psychiatry

Liaison psychiatry, also known as consult-liaison psychiatry, bridges the gap between physical and mental health. Its primary objective is to address acute psychiatric symptoms and disorders experienced by patients with medical and/or surgical conditions. This is achieved through a multidisciplinary approach involving various professionals’ input from the respective point of view.

This field of medicine is relatively new and has been gaining recognition in recent years as more attention is being given to the importance of mental health in overall health and well-being. In the UK, the NHS Long Term Plan has identified liaison psychiatry as a priority area for development, with plans to increase funding for liaison psychiatry services and expand the workforce (NHS England, 2019).

Liaison psychiatry in medical-surgical care

Liaison psychiatry is effective in a variety of medical and surgical settings and has been used to improve the management of chronic medical conditions such as diabetes, cardiovascular disease, and chronic pain. These conditions are typically accompanied by psychiatric co-morbidities such as depression and anxiety, which can negatively impact patients’ physical health outcomes. By addressing these psychiatric co-morbidities, liaison psychiatry can help to improve the patient’s quality of life (Katon & Unützer, 2013).

Liaison psychiatry in neurological care

Liaison psychiatry plays a critical role in providing mental health support and care within the context of neurological care. In addition, liaison psychiatry has also been effective in the management of medically unexplained symptoms (MUS), also known as ‘conversion’. MUS are a common problem in medical settings, and they can be difficult to manage as there is often no clear physical cause for the symptoms. Liaison psychiatry can help to identify or rule out any underlying psychiatric issues that may be contributing to the symptoms and provide appropriate treatment and management strategies (Kroenke, Sharpe, & Sykes, 2007).

Liaison psychiatry in psychogeriatric care

Liaison psychiatry consults are important in psychogeriatrics, especially in conducting capacity assessments, incapacitations, managing symptoms of neurodegenerative illnesses and administering cognitive screening tests. Liaison psychiatry delivers guidance and support in evaluating a patient’s decision-making capacity, assisting in determining incapacitations, and ensuring appropriate care and support for patients.

Liaison psychiatry in palliative care

Palliative care is focused on the management of patients with advanced or life-limiting illnesses. Liaison psychiatry in palliative care involves the assessment and management of psychiatric symptoms such as depression, anxiety, and delirium. The goal of this type of consult is to improve patients’ quality of life and ensure that their end-of-life care is as comfortable and supportive as possible.

Liaison psychiatry in alcohol dependence and substance use disorders

Consultation for alcohol and substance use disorders involves the assessment and management of patients with substance use disorders who are also receiving medical or surgical treatment. The goal of this type of consult is to provide comprehensive care that addresses both the physical and psychiatric aspects of substance use disorders.

Emergency psychiatry

Emergency psychiatry is a sub-speciality which is also covered by the liaison psychiatric team. These department consults involve patients who present to the emergency department in crisis, with acute psychiatric symptoms or who require emergency psychiatric assessment and treatment. Psychiatric consultation in the emergency department is focused on the assessment and management of acute psychiatric conditions, such as suicidal ideation, psychosis, and severe anxiety. The goal of this type of consult is to provide rapid assessment and intervention to stabilise the patient’s condition and determine the appropriate next steps.

What is a Psychiatric Liaison Nurse?

Psychiatric Liaison Nurses (PLNs) are specialised psychiatric nurses, also known as Registered Mental Health Nurse (RMN), who work within the liaison psychiatry team and work closely with medical/surgical teams to ensure that patients with psychiatric disorders receive appropriate and timely care. They play a vital role in the assessment, management, and treatment of patients with psychiatric conditions, particularly those with co-morbid medical and/or surgical co-morbidities.

PLNs facilitate communication and collaboration between the psychiatric and medical teams. They serve as a liaison between the psychiatric and medical teams, communicating the patient’s psychiatric status and treatment plan to the medical team and vice versa. This ensures that patients receive comprehensive care that addresses both their medical and psychiatric needs.

Psychiatry liaison nurses within the liaison psychiatry team

Central to the provision of an array of liaison psychiatry services are PLNs. They are integral members of the liaison psychiatry team, playing a crucial role in delivering a range of liaison psychiatry services.

These nurses have proven to be influential in reducing healthcare costs by shortening hospital stays, decreasing readmission rates, enhancing patient satisfaction, preventing deterioration and relapses, and reducing suicide rates (Vos et al., 2015). Their contributions are essential in achieving these positive outcomes and improving overall patient care within the field of liaison psychiatry.

In each of these types of consults, the PLN plays a crucial role in ensuring that patients receive timely and appropriate psychiatric care. PLNs are trained to assess and manage psychiatric disorders in medical and surgical settings, and they work closely with the team to provide coordinated care that addresses patients’ unique needs.

The Role of the Psychiatric Liaison Nurse

One of the key members of the liaison psychiatry team is the PLNs. The PLN plays an important role in supporting and working closely with the liaison psychiatrists in the assessment, diagnosis, and management of psychiatric co-morbidities in patients with medical and surgical conditions.

The primary role of the PLN is to conduct initial assessments of patients referred to the liaison psychiatry service, gathering relevant information about their medical and psychiatric history, presenting symptoms, and psychosocial context. They are also crucial in conducting comprehensive psychiatric assessments of patients.

The extensive and specialised role of the PLN can be summed up in the following:

● Mental state examinations,

● Risk assessments,

● Capacity assessments,

● Triaging

● Crisis and emergency,

● Mental welfare officers,

● Advocating, educating and training

● Liaising and referring

● Documentation

● Service development

Mental State Examinations

Mental state examinations are used to evaluate a patient’s current mental state, including their mood, thought process, verbal and non-verbal behaviour, and cognitive functioning.

Risk Assessments

Risk assessments are a critical component of psychiatric care, particularly in medical and surgical settings. PLNs work with the multidisciplinary team to assess a patient’s risk for self-harm, harm to others, and other possible psychosocial risks. This information is used to develop a risk management plan that aims to minimise the risk of harm to the patient and others and is essential in formulating a safety plan.

Capacity Assessments

PLNs also play a role in conducting capacity assessments. Capacity assessments are performed to determine a patient’s ability to make decisions about their medical treatment, (long-term) care, and other important life decisions. They also work closely with the team to assess a patient’s capacity, provide support and advocacy, and develop a management plan that respects the patient’s autonomy and best interests.

Triaging

Psychiatry liaison nurses play a pivotal role in triaging calls and consultations through the liaison pager. They serve as a primary point of contact, receiving incoming inquiries, urgent requests, and consults from healthcare professionals. By efficiently assessing the urgency and nature of each call, these nurses prioritise and direct the appropriate resources and interventions, ensuring that critical situations are addressed promptly and efficiently. Their expertise in psychiatric care and knowledge of available services enable them to make informed decisions, provide immediate support, and facilitate timely access to mental health resources. Through their role in triaging calls and consults, PLNs ensure that patients receive the necessary care, support, and interventions based on their unique needs and circumstances.

Crisis and Emergency Department

PLNs play a major role in the emergency department as they provide crisis intervention and support to patients who are experiencing acute mental health issues, provide psychological first aid, administer medications, gather collateral histories from relatives, and provide support and reassurance to patients and their families. Furthermore, PLNs are essential in utilising their expertise and experience to offer rapid advice and guidance on complex cases to the psychiatrist and emergency staff. Additionally, they are crucial in providing continuity of care and bridging the gap between clinic hours and duty hours. They ensure continuity of care and support for patients during times when direct access to mental health providers may be limited.

Mental Welfare Officers

PLNs are instrumental both in the presence or absence of a responsible carer, to determine whether patients require sectioning under the Mental Health Act. Acting as Mental Welfare Officers, they carefully evaluate a person’s mental state and risk status and work collaboratively with other healthcare professionals to determine whether an involuntary admission to the state’s psychiatric facility is necessary. Moreover, they ensure the well-being and rights of patients, adhering to the guidelines of the Act.

Advocating, Educating and Training

Apart from conducting assessments, the PLN is also involved in the implementation and coordination of treatment plans. This may involve recommending and administering psychotropic medication, training nursing staff in administering depot injections and recognising and responding to common mental health issues.

Furthermore, they also provide education and support to patients and their families, such as providing information about psychiatric diagnoses, treatment options, management of psychiatric symptoms and information about mental health services.

In addition, PLNs act as advocates for patients, ensuring that their needs are met and their rights are respected, receiving appropriate treatment and care, facilitating communication between patients and medical teams, and ensuring that patients are involved in decisions about their care.

Liaising and Referring

In addition to being advocates for patients, PLNs also collaborate with community mental health services to ensure that patients receive appropriate and timely follow-up care and support after discharge from the general hospital or emergency department. This includes liaising with the psychiatric hospital admission nurse to provide essential admission details, liaising with community mental health teams to arrange outpatient appointments, providing information on local support services, and ensuring that patients are connected with appropriate community resources. Furthermore, PLNs are crucial in receiving information from community mental health services about patients who are referred to the hospital and/or emergency department.

Documentation of reviews

Documentation of psychiatric reviews provides essential information when patients are admitted to the state psychiatric hospital or discharged to outpatient settings. By maintaining comprehensive notes, liaison nurses facilitate seamless transition of care, ensuring accurate communication among healthcare providers and enabling outpatient teams to understand the patient’s psychiatric background, ongoing treatment needs, and recommended follow-up services. This meticulous documentation enhances patient safety, quality of care, and effective communication throughout the psychiatric care continuum.

Service Development

PLNs are also responsible for conducting research and quality improvement initiatives to help improve the delivery of liaison psychiatry services. They collect and analyse data on patient outcomes, develop new interventions or approaches to care, develop care pathways or protocols, and share best and modern policies and practices with other healthcare professionals.

Conclusion

Overall, the role of the PLN is critical in providing comprehensive psychiatric care to patients with medical and surgical conditions. By working closely with the multidisciplinary team and using their expertise and skills, PLNs help to ensure that patients receive appropriate and timely care that addresses their mental health needs. Their unique combination of clinical expertise, advocacy skills, and as well as their ability to facilitate communication and collaboration between medical teams, makes them an essential and unique part of the liaison psychiatry team.

References

Katon, W., & Unützer, J. (2013). Health Reform and the Affordable Care Act: The Importance of Mental Health Treatment to Achieving the Triple Aim. Psychiatric Services, 64(6), 536-539. doi:10.1176/appi.ps.640601

NHS England. (2016). The Five Year Forward View for Mental Health. Retrieved from https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-fina l.pdf

Royal College of Nursing. (2016). Liaison psychiatry nursing: a career and competence framework. London: Royal College of Nursing.

Royal College of Psychiatrists. (2017). Liaison Psychiatry: the Way Ahead. Retrieved from https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-repor ts/college-report-cr215.pdf

Royal College of Psychiatrists. (2018). Liaison psychiatry: working with patients with long-term conditions. London: Royal College of Psychiatrists.

Thombs, B. D., & Groleau, D. (2015). The Role of Psychiatric Nurses in Liaison Psychiatry. Journal of Psychosocial Nursing and Mental Health Services, 53(9), 22-25. doi:10.3928/02793695-20150811-01

Vos, T., Barber, R. M., Bell, B., Bertozzi-Villa, A., Biryukov, S., Bolliger, I., … & Duan, L. (2015). Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 386(9995), 743-800.

Wang, Y., Wu, X., Li, Y., Xu, J., & Zhao, Y. (2019). The Effectiveness of Psychiatric Consultation-Liaison Nursing in the Management of Patients with Chronic Pain: A Meta-Analysis. Pain Research and Management, 2019, 1-10. doi:10.1155/2019/9187084.

Chronic/Complex Psychiatry: Available support for individuals suffering from chronic difficulties

Dialogues in Psychiatry

Dr. Adrian Richard M.D. (Melit.) illustrates an in-depth analysis of the services available focusing on complex and rehabilitation psychiatry while discussing their respective roles.

When there is an admission to Mount Carmel Hospital, there is a specific pathway that is followed. If the admission is a re-admission (less than 1 year from previous admission), then the patient is re-admitted under the care of the same consultant as before. 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 nursing, 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 

References

  1. Agius, M. (2022) Capuchin friars host residents at Suret Il-Bniedem homes for Easter Lunch, Newsbook. Available at: https://newsbook.com.mt/en/capuchin-friars-host-dar-suret-il-bniedem-for-easter-lunch/ (Accessed: April 23, 2023).
  1. Azzopardi, K. (2021) Casa Nuova to receive patients with Huntington’s disease and intellectual disability, MaltaToday.com.mt. Available at: https://www.maltatoday.com.mt/news/national/110170/casa_nuova_to_receive_huntingtons_disease_and_intellectual_disability_patients_#.ZETv4OxBzt0 (Accessed: April 23, 2023).
  1. Muscat, G. (2022) Ċans għal Pazjenti F’Monte Karmeli Biex Jgħixu ħajja indipendenti, Newsbook. Available at: https://newsbook.com.mt/cans-ghal-pazjenti-fmonte-karmeli-biex-jghixu-hajja-indipendenti/ (Accessed: April 23, 2023).
  1. Our services; Richmond Foundation. Available at: https://www.richmond.org.mt/our-services/ (Accessed: April 23, 2023).
  1. Sedqa; Sedqa Home. Available at: https://fsws.gov.mt/en/sedqa (Accessed: April 24, 2023). 
  1. Urry, S.C. (2022) Fondazzzjoni Suret Il-Bniedem donation., Information Systems Ltd. Available at: https://isl.com.mt/insights/fondazzzjoni-suret-il-bniedem-donation/ (Accessed: April 23, 2023).
  1. Webb, M. (2021) New premises for 50 of mount carmel’s residents, Newsbook. Available at: https://newsbook.com.mt/en/new-premises-for-50-of-mount-carmels-residents/ (Accessed: April 23, 2023). 
  1. Welcome to Caritas Malta; Caritas Malta. Available at: https://www.caritasmalta.org/ (Accessed: April 24, 2023). 

Accessing mental health care in Malta and Gozo

Dialogues in Psychiatry

Dr Martha Apap Bologna provides a detailed overview on how to access mental health services in Malta and Gozo

This post is intended to facilitate reaching out for help in Malta and Gozo. It is applicable to persons encountering difficulties and to their families. It is not a replacement for accessing in-person care, or a replacement for medical advice.

I / my loved one am / is having difficulty coping. Who can I reach out to?

Online services:

  • Kellimni.com – Website run in public social partnership between SOSMalta and the Ministry for the Family and Social Solidarity. Available through email, online chat, WhatsApp, Facebook Messenger and Instagram.
  • OLLI Chat – Online mental wellbeing support team run by Richmond Foundation (NGO)

Telephone lines:

  • 1579 – Mental Health Helpline run by Mental Health Services (NHS)
  • 1770 – Mental Health Helpline run by Richmond Foundation (NGO)
  • 21 228 333 – Victim Support Malta (NGO) providing clients with emotional and practical support in overcoming trauma following a crime

In-person services:

Speak to your Family Doctor / General Practitioner. Alternatively, attend a Health Centre in your locality. Health Centres open 24/7 are: Paola HC; Floriana HC and Mosta HC.

This is a crisis and I need to get help ASAP because of safety concerns.

Consider attending A and E – mental health professionals are available 24/7.

It would be best to be referred by your GP or family doctor to limit waiting time.

What services may my GP recommend?

After assessing you, your doctor may refer you to:

  • A Community Mental Health Centre. This is an out-patient service where you will meet your psychiatrist and possibly other members of the mental health team, including psychologists, social workers, occupational therapists, physiotherapists and nutritionists.
  • A and E. This is an emergency department visit where you will be able to speak to a member of the mental health team.

What if I / my loved one need /s inpatient care?

Your family doctor / GP, or the mental health team at A and E or at your Community Mental Health Centre may arrange admission to Mount Carmel Hospital (Malta) or to Short- or Long- Stay Unit (Gozo General Hospital). This may be on a voluntary basis (the individual agrees that admission to inpatient care is necessary) or under the Mental Health Act (if the individual is experiencing severe mental illness, poses a risk to themselves or to other persons, and community supports are not sufficient to ensure adequate care).

Persons admitted to inpatient Mental Health Care are able to receive visits from friends and family when they are well enough to do so. Smartphones and mobile phones cannot be kept on the individual’s person during inpatient care, to safeguard the safety and privacy of the individual and other inpatients. Persons admitted to Mount Carmel Hospital and to Short or Long-Stay Unit, GGH are able to receive phone calls from external lines.

I / my loved one has an addiction problem. How can I get help?

Persons who are experiencing addiction problems may find support with controlling or ceasing to use substances from SEDQA (helpline 179), CARITAS (telephone 22 199 000) and OASI (telephone 21 563 333). A number of different services are available, ranging from residential rehab to evening programmes and community outreach services.

If you are experiencing addiction problems as well mental health difficulties, a walk-in service is available at Substance Misuse Outpatient Unit (SMOPU), St Luke’s Hospital. This is a community-based medical service. The doctors who run this service may recommend meeting mental health professionals according to the individual’s specific requirements.

Persons seeking help with gambling problems, and their families, may benefit from making contact with Gluecksfall aka. EU Association for the Prevention of Addiction (EAPA): Telephone 79 333 374.

Community Mental Health – Before & After COVID-19

Dialogues in Psychiatry

Dr Roberto Galea

M.D. (Melit.), M.Sc. Mental Health Nursing (Melit.), B.Sc. Mental Health Nursing (Hons.)(Melit.), P.G.Dip. Clinical Psychaitry (USW)

This article discusses a local study investigating the impact COVID-19 had on the local community specifically looking into number of new referrals received during the period of interest at a local Mental Health Clinic.

 

While society is attempting to return to its previous conventional customs, we cannot but notice that despite our efforts, remnants of behavioural and psychological changes brought about by COVID-19 persist. COVID-19 required several containment measures which disrupted our daily activities and interactions with an attendant impact on mental health, as well as health services. The first wave of the pandemic hit Malta between 6 March and 24 April 2020 while public health measures were first announced on 12 March 2020. During the first wave, psychiatry outpatient clinics at Mater Dei Hospital were suspended with telepsychiatry taking over followed by significant restructuring of community mental healthcare services. A recent local study investigated the effect COVID-19 had on first contact community psychiatry referrals to a local Mental Health Clinic (MHC) before and after the onset of COVID-19 looking into; referrals, case presentation, demographics, as well as the respective adequacy of the service response.

Participants were identified through the MHC register from 11 March 2019 to 31 December 2020. Data was cross referenced with electronic medical records, while the imposition of public health measures on 12 March 2020 was used to separate the before and after the onset of COVID-19. A total of 236 new cases were identified (92 before & 144 after COVID-19).

The proportion of new case referrals for men aged 60-80 and women aged 60–70 years old have increased, reflecting health-related anxieties, the associated isolation of older persons due to both COVID-19 and public health restrictions together with the increased vulnerability and fragility of this population. However, the proportion of working age adults remained stable. This may be due to a lag and would thus benefit from further research.

Throughout the study most clients attending this MHC were Maltese nationals. Individuals from central and Eastern Europe significantly decreased following the onset of the pandemic, while the number of British citizens remained unchanged. Such numbers were in keeping with the authors’ expectations. Tendentially, central and Eastern Europeans are younger/middle aged workers who would return home if their job security were threatened while UK citizens tend to be longer-term residents.

Following the onset of COVID-19 there was a shift in the presenting complaints received. The commonest, anxiety dropped from 38% to 32% while depression increased from 33% to 40% – becoming the predominant presentation. Similar variations were also noted in psychosis (2 to 4%) and alcohol misuse which also dropped by half.

The study differentiated between three phases – before the onset of the pandemic, during the first wave and six months after. The closure of the Psychiatric Outpatients Department at Mater Dei Hospital meant that clients had to be redistributed to community mental health clinics. While this shift achieved better social distancing, limited potential COVID-19 transmission, and allowed service provision in the clients’ communities (bringing services into close-knit communities); the increased psychological impact COVID-19 had on our communities resulted in increased appointment rates, which put further strains on community mental health services, requiring service to adapt to these new requirements.

Service alteration secondary to disruptions due to pandemic-mandated isolation measures were significant confounding factors in the waiting time for appointments and thus this study. These changes resulted in a collective rise of a fivefold increase in demand in MHC services. To meet these challenges, clinic frequency was increased and staff re-deployed, increasing the monthly capacity of new case appointment reviews from 7 to 20 cases. A threefold increase in new case appointments has increased the burden of the clinic that was met through a fivefold increase in clinic frequency. Waiting time has decreased from a mean of 21.6 weeks before the onset of COVID-19 to 7.4 weeks. Constituting a 66% drop in waiting time despite a threefold increase in workload.

In conclusion, the COVID-19 pandemic resulted in significant challenging changes and difficulties for the community, health-service provision, and the staff who without faltering endured through such times. However, through major restructuring these challenges were tackled with psychiatric services being de-centralised into community MHCs and increased clinic frequency, successfully meeting a three-fold increase in new case appointments while decreasing the waiting time between referral and review by two thirds. This study investigated the associated impact early stages of the COVID-19 pandemic had on our community, further research investigating this pandemic had throughout its course is warranted.

L-anzjetà, il-kalmanti u l-fejqan

serrah il-menti

Aqra l-artiklu miktub minn Dr. Patrick Abela li gie ippublikat fuq in-Nazzjon.

Ladarba kulħadd jgħaddi minn żminijiet diffiċli fil-ħajja, kulħadd għandu l-mod tiegħu kif ikampa mas-sitwazzjoni li jinsab fiha. Iżda xi kultant, l-istrateġija li nużaw biex intaffu ftit mill-uġigħ tal-ħajja ma tkunx waħda għaqlija. Kemm-il darba fil-prattika naraw individwi li jkunu għaddew minn perjodu iebes fil-passat imbiegħed u li għadhom sal-lum, bosta snin wara, imkissrin bi ħsibijiet li ma jistgħux iwasslu għall-paċi interna. Sfortunatament, din hija sitwazzjoni verament komuni f’pajjiżna għax l-għodda meħtieġa biex wieħed isib sabar għat-toqol tal-ħajja ma jingħatawx fl-iskejjel bħal ma jingħataw is-suġġetti tal-matematika u l-lingwi. Is-sengħa tas-serenità hija waħda li tiġi mgħallma bl-eżempju fl-ewwel snin tal-ħajja, normalment mill-ġenituri li jkunu taħt l-istess saqaf. Dan il-proċess ta’ tagħlim jista’ ma jitwettaqx sew fis-snin kruċjali taż-żgħorija, u l-individwu jidħol fl-adoloxxenza armat b’apparat emozzjonali limitat u batut. B’hekk meta bniedem ma jsibx ruħu kapaċi jtaffi l-anzjetà, ma jsibx triq oħra ħlief li jmewwet id-djieqa flimkien ma’ kull emozzjoni oħra bl-għajnuna tal-kalmanti.  

Il-kalmanti huma klassi ta’ mediċini li jnaqqsu t-toqol fuq il-menti saħansitra anke fi ftit minuti mill-ħin li jiġu ngħatati. Minħabba l-effett immedjat tal-kalmanti fuq l-anzjetà, din il-klassi ta’ mediċini rebħet popolarità qawwija fi żmien qasir. Sal-1977, kienu l-iktar mediċini mibjugħa mad-dinja kollha u żammew it-titlu għal bosta snin. F’dan il-perjodu, ir-riċerka fuq il-mediċini kienet limitata ħafna u ma kienx hemm daqshekk informazzjoni fuq l-effetti ħżiena ta’ dawn is-sustanzi. Illum il-ġurnata però, wara ħafna studju fuq nies li kienu ilhom bosta snin jużaw il-kalmanti, saru iktar magħrufin l-effetti ħżiena ta’ dawn il-mediċini fuq il-moħħ u fuq il-fwied.  Biż-żmien beda jidher ukoll li min kien qed jipprova jtemm l-użu tal-kalmanti, kien iħoss dwejjaq u anzjetà kbira u b’hekk kien jerġa’ jaqa’ lura fil-vizzju, ħafna drabi fuq dożi ogħla biex ipatti għall-effett tan-nuqqas tagħhom.

Illum il-ġurnata, it-tobba huma ħafna iktar attenti li l-kalmanti ma jintużawx għal perjodi twal ta’ żmien. Dawn is-sustanzi xorta għandhom użu tajjeb kemm fil-qasam psikjatriku, kif ukoll oqsma oħra tal-mediċina u l-kirurġija, filfatt nużawhom ta’ spiss meta jkun hemm attakki tal-paniku, tal-epilessija u tal-aggressjoni.  Però hija r-responsabbiltà tat-tabib li jkun kiteb dawn il-mediċini għall-pazjent tiegħu, li jara li ma jibqgħux jiġu miktuba għal tul ta’ żmien. Fil-preżent, il-kura ta’ l-anzjetà saret ħafna inqas perikoluża bl-għajnuna tal-mediċina moderna. Sfortunatament, xorta naraw numru sew ta’ klijenti li jagħmlu użu regolari tal-kalmanti u li saħansitra jkunu ilhom jużawhom għal bosta snin. Dawn isibuha diffiċli ħafna li jneħħu l-vizzju u jispiċċaw jgħixu kuljum bil-kalmanti f’dożi għoljin u bl-effetti koroh tagħhom bħal sturdament, dimensja u l-ħsara tal-fwied.

Allura, kif jista’ bniedem li qed ibati mill-anzjetà joħroġ min-nassa? L-ewwelnett, irridu nifhmu li l- anzjetà dejjem ikollha raġuni għall-eżistenza tagħha. Meta nesploraw il-passat mal-klijenti tagħna, bosta drabi jkunu jistgħu jgħidulna sad-data u l-ħin li tkun bdietilhom din it-tensjoni. L-avvenimenti li jwasslu għall-anzjetà jistgħu ikunu bosta. L-iktar sitwazzjonijiet diffiċli ħafna drabi jkunu dawk ta’ mewt jew separazzjoni fil-familja, però anka sempliċiment li wieħed jiżżewweġ jew li jirtira tista’ tkun kaġun ta’ nervi kbar. Il-karattru tal-individwu ukoll jagħmel differenza kbira. Hawn min jingħata aħbar kerha u jirnexxilu jkampa bla problema ta’ xejn, u hawn min iġib id-dinja fit-tarf fuq inkwiet żgħir daqs nitfa. Minkejja l-individwu u l-istorja li wasslitu għat-tensjoni, l-aħjar għodda li għandna llum il-ġurnata kontra l-anzjetà hija l-psikoterapija.  

Il-psikoterapija tinvolvi li wieħed jiltaqa’ ma’ terapista sabiex jiftaħ qalbu fuq il-problemi li jkunu qed joħolqu d-dwejjaq. Il-fatt li bniedem jesprimi l-anzjetà bil-mod tiegħu u mingħajr ma jingħata ġudizzju ikrah jew jiġi mifhum ħażin, hija diġà biżżejjed biex wieħed jibda jifhem kif jista’ jtejjeb il-kwalità ta’ ħajtu. It-terapista jservi wkoll ta’ kritiku għall-ħsibijiet tal-klijent u jipprova jgħallem l-għodda neċessarja sabiex l-individwu jistrieħ mid-djieqa tiegħu u jerġa’ jsib kalma u sodisfazzjon personali minkejja l-isfortuna u t-traġedji tal-passat. 

Dan l-artiklu huwa parti minn sensiela ta’ publikazzjonijiet informattivi marbuta mas-saħħa mentali. Bħala parti mill-kampanja “Serraħ il-Menti”, it-tobba li qed jispeċjalizzaw fil-psikjatrija qegħdin jaħdmu biex iżidu l-għarfien pubbliku dwar is-saħħa mentali tagħna. Għal iktar informazzjoni, tistgħu tikkuntatjawna fuq publicrelations.mapt@gmail.com. Tistgħu iżżuru wkoll is-sit uffiċjali tagħna, http://www.mapt.org.mt.