What is the difference between mental health and mental illness?
Mental Illness
Mental Illness is a clinically recognizable set of symptoms or behaviours associated in most cases with distress and with interference with personal functions.
ICD-10
Mental Health
Mental Health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.
World Health Organization, 2018.
Mental Health is determined by a range of socioeconomic, biological and environmental factors.
Protective Factors
PROTECTIVE FACTORS are positive attributes that can help provide support and maintenance of positive mental health. Ideally, protective factors should be introduced earlier on in childhood so positive mental health is acquired and maintained throughout life.
Protective factors include:
- Individual Factors – resilience, physical activity, internet use, diet.
- Family Factors – positive parenting, family relationships, kinship care.
- Social Factors – social relationships, social support.
- Work/School Factors – employment status, positive work/school relationships, positive belonging perceptions, positive connections.
- Living Environment – location, housing.
Risk Factors
RISK FACTORS increase the impact that life challenges create, making the person susceptible to a decline in mental health whenever things do not go according to plan.
Risk factors include:
- Individual Factors – smoking, alcohol use, substance misuse, screen time, sedentary lifestyle, obesity.
- Family Factors – lack of support, partner loss, no home care, perinatal period.
- Social Factors – lack of social support, loneliness, bullying.
- Work/School Environment – bullying, poor relationships, job overload, high demands.
- Economic Factors – job insecurity, low income, economic crisis.
- Adverse Life Events – migration, refugee status, violence exposure, chronic illness, homelessness.
In-Patient Mental Health Services
In Malta, Mount Carmel Hospital is the only place in which in-patient mental health services are offered. Services include: acute, PICU (psychiatric intensive care unit), rehabilitation, psychogeriatric, learning disability, and children and adolescents.
Outpatient Mental Health Services
Outpatient mental health services available include:
- Community Clinics
- Crisis Intervention Services at Mater Dei Hospital
- Outreach
- Child and Adolescent Out-Patient Clinic (community services and crisis intervention)
- Centro Tomaso Chetcuti – individual is on leave; review is also scheduled at the centre; no paperwork is required if re-admission is required
- TMS & ECT Services – ideal in the case of resistant depression
The Mental Health Act
Mental Health Act Terminology
MENTAL DISORDER – “significant mental or behavioural dysfunction, exhibited by signs and, or symptoms indicating a disruption of mental functioning, including disturbance in one or more of the areas of thought, mood, volition, perception, cognition, orientation or memory which are present to such a degree as to be considered pathological in accordance with internationally accepted medical and diagnostic standards” (ICD 10., 2013); mental disorder = the illness
MENTAL CAPACITY – “the ability & competence to make different categories & types of decisions & to be considered responsible for his actions (MHA., 2012). Any person over the age of 16 is assumed to have full legal capacity, unless it is proven that they lack capacity at the time the decision needs to be made; mental capacity = ability to make a decision.
COMMISSIONER – the role of the commissioner is to safeguard the rights of the person detained in a mental health facility, such as making sure the person is not detained for a longer period than needed, and that the person is retained ONLY if needed.
RESPONSIBLE CARER – the person can choose a responsible carer, such as a family member, friend or carer); the Mental Health Commissioner can also appoint a responsible carer for a person, such as a social worker.
MENTAL HEALTH LICENSED FACILITY – the only mental health licensed facility that we have in Malta is Mount Carmel Hospital; a licensed facility can detain a person as per the Mental Health Act.
Mental Health Facility Admission
Voluntary Admission
- Voluntary admission to a mental health facility requires consent in writing and consent to significant change in care plan. The person is not secluded unless consent in writing is given.
- A person may be admitted to a mental health facility as a voluntary patient, but may still be later on detained under the Mental Health Act involuntarily.
- Following voluntary admission, a person may choose to be discharged. However, medical personnel may prevent his discharge in case of falling within the involuntary admission criteria. Discharge prevention may take up to no more than 4 hours, during which a review by a medical practitioner takes place.
- When a person lacks the mental capacity to consent, this can be obtained through the responsible carer. When the responsible carer is unavailable, emergency treatment may be administered with the aim of preventing physical harm to self and to others, or to prevent mental deterioration.
Involuntary Admission
- Involuntary admission into a mental health facility requires a psychiatrist’s certification that the person meets 3 criteria: the person has a severe mental disorder AND there is a serious risk of physical harm to self or to others AND not admitting the person is most likely to lead to serious deterioration in his condition or prevent administration of appropriate treatment which cannot be administered in the community.
- In an emergency situation, reasonable suspicion of a severe mental disorder is enough for involuntary admission.
- Involuntary Admission for Observation = 10 Days
- Involuntary Admission for Treatment Order = 10 Weeks
- Extended Treatment Order = 5 Weeks
- Continuing Detention Order = 6 Months (Renewable)
Community Treatment Order = 6 Months
Involuntary Admission into Mental Health Facility for Observation
- 2 doctors, one of which is specialised in mental health, perform an initial assessment in order to detain a person under the IOA. An independent assessor may be sought in case of discrepancies.
- The likelihood of physical harm or similar emergency situations, a single assessment is enough, provided that a second assessment by a mental health specialist is performed within 24 hours.
- The first part of the IOA is signed by a medical doctor, which is later on reviewed by a mental health specialist. A 3rd signature by the person’s responsible carer or the Mental Welfare Officer is also required.
Involuntary Admission into Mental Health Facility for Treatment Order
- The application, which is a continuation of the IAO and includes a MDT plan, has to be completed by a Responsible Specialist.
- Approval for treatment order also requires a review by an independent responsible specialist who may also ask to interview the person’s responsible carer.
- The IATO Involuntary Admission for Treatment Order is endorsed by the Commissioner following completion of application for a maximum of 15 weeks.
- An extension IATO may be used to extend a person’s treatment for a further 5 weeks, leading to a conversion to a Continuing Detention Order for a maximum of 6 months if longer hospitalisation is required; this is done with the approval of the commissioner and a multidisciplinary care plan. On the other hand, a person may be released earlier from an IATO.
Community Treatment Order
- Application for Community Treatment Order is done when a person requires treatment but is in no need of hospitalisation.
- Application requires a care plan and a Healthcare Professional.
- Compulsory treatment is received once in the community.
- Treatment order is supplied for a maximum period of 6 months, which is also renewable if needed.
- If the person doesn’t comply with the care plan, a Conveyance Order is set up; the person can be detained involuntarily for a maximum period of 10 days.
Mental Health Care for Minors
Timelines for minors are shorter than the ones for adults:
- IATO (Involuntary Admission for Treatment Order) is for a maximum of 4 weeks.
- EIATO (extension for Involuntary Admission for Treatment Order) can be extended to a total involuntary stay of maximum 12 weeks.
- CDO (Continuing Detention Order) is for a maximum of 3 months with the possibility of renewal.
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