The National Commission for Mental Health Reform has warned Health Minister Louis Deguara it will be resigning en masse if its proposals to widen the mental illnesses covered by free medication remain ignored by the government.
Chairperson Connie Magro confirmed that a letter sent to the minister earlier this month was still unanswered, as was the commission’s previous correspondence demanding the government’s attention to what it believes is a pressing problem.
“I can’t speak before the minister answers our letter,” Magro said. “We’re still awaiting his reactions.”
In fact, the letter speaks of the commission’s disappointment at the minister’s lacking feedback to proposals made last month that would entitle long-term mental health patients to free medicinals while stopping the blatant abuse of patients and the system.
Warning it was determined to resign if the situation persists, the commission – which includes Director of Psychiatry Joe Saliba, mental health NGOs and users of the mental health services – has slammed the minister for ignoring its proposals despite it being a constituted body.
Psychiatrists told MaltaToday that as the present health regulations stand, most of the medication given for free is being prescribed under a false diagnosis – that of schizophrenia – simply to fall under Schedule V, the list of chronic illnesses meriting free medicine. That means that those suffering from illnesses such as bipolar affective disorder or chronic depression, amongst others, are not eligible for free medicine because the illnesses are not listed under Schedule V.
As a result, most of the medication being given for free is prescribed under the misdiagnosis of schizophrenia or schizo-affective disorder, which are the only two illnesses eligible for free medication under Schedule V.
“The system is wrong because everyone is virtually classified as a schizophrenic even if they have ‘mere’ chronic depression, challenging behaviour and learning disabilities,” a psychiatrist said. “It is wrong because it’s unfair on the patients to be misdiagnosed, it’s unfair on the system itself because of the chaos it creates in treatment, and it’s unfair on all those who resist being mislabelled as schizophrenics but still require free drugs.”
This means that the health records are largely inaccurate and are also causing chaos in treatment, the commission maintains.
And yet, many patients with mental health problems are already being given free medication under the schizo-affective disorder label, so changes to the regulations would not add much to the financial burden, the commission has argued.
On the contrary, making medications more accessible would probably decrease admissions to hospital, which are very expensive, and hence decrease costs.
The commission has proposed given free medication to all pink card holders and hospitalised patients immediately. It also proposed cutting abuses through having patients followed up by psychiatrists for six months to ensure that chronic illness is genuine, while the registration of patients would be centralised at the psychiatric outpatients.
According to the commission, Schedule V should include bipolar affective disorder, chronic depression, chronic obsessive compulsive disorder, challenging behaviour in learning disabilities and attention deficit/hyperactive disorder (ADHD).
The commission pleaded with the minister to take on its suggestions as this would lead to better patient care at no extra costs to the services.
But in contrast with his previous statements declaring his commitment to improve mental health services, Deguara refused to commit himself yesterday night when asked if he would take the commission’s proposals on board.
“The request being submitted by the Mental Health Commission for free drugs for mental patients is similar to other requests for free drugs,” a spokesman for Deguara said. “The whole issue is being pursued in its entirety.”
And yet, last month Deguara said the people “deserve this commitment from us politicians” when speaking about new medicinals that should be handed for free to mental health patients.
In December last year, he said mental health “must be a priority” at a conference organised by the same commission now threatening to resign.
“There was a time when mental health was considered to be one of the ‘Cinderella’ areas in the field of medicine and health care. … The challenge we are facing is the prevention of mental illness that can be prevented and the speedy and effective treatment and rehabilitation for those who suffer from some type of mental illness. The spectrum of mental illness and the disability associated is extremely wide and one has to be wary in being too general when discussing mental health as a diversity of approaches need to be taken to ensure that we are catering for all the needs. … We need to make mental health a priority for all other sectors.”
And in October 2002, Deguara said: “Mental Health in Malta, as in other countries, has been for a long time the subject of frustrations and hopelessness. …The sad fact is that society generally does not have a clear understanding of the nature of mental illness. … I feel the popular press could do more to alter this perception. … Although mental illness may affect as many as one in six people within western societies, health budget allocations seldom reflect this statistic. Mental health care across countries is often a poor relation of that for physical health.”

kschembri@mediatoday.com.mt