The Maltese Association of Psychiatric Nurses (MAPN) is a non-profit, apolitical, voluntary organization that represents mental health nurses in Malta. The association is committed to advance the practice of psychiatric mental health nurses by promoting and empowering the nursing profession in mental health, with focus on awareness, education and recognition.
Alliance for Mental Health - COVID 19 Statement
As Malta is experiencing a rise of COVID-19 infections, it is inevitable that fear, panic and anxiety increase as well. The COVID-19 pandemic is not only a threat to our physical health, but more important is the effect this is going to have on our mental health. People with pre-existing mental health conditions are likely to be more vulnerable to the anxieties this pandemic is generating and since mental health services had to undergo changes to the way they operate, these people might be more at risk of deteriorating in their mental health, without having the appropriate follow up and monitoring to prevent a mental health relapse. People with mental illness require ongoing support, monitoring, and medical-psycho-social interventions, which are essential to the management of their illness. Without this support and interventions they may become acutely unwell, needing hospital treatment and at worse, risking and succumbing to desperate ideation. Hence, any changes to service provision need to ensure that people already in care are not overlooked, that they continue to receive the treatment and support they require and that their psychological needs are being met.
At the same time, the COVID-19 pandemic is likely to unsettle the mental health of anyone. A document published by the United Nations in May 2020 states that: “Good mental health is critical to the functioning of society at the best of times. It must be front and centre of every country’s response to and recovery from the COVID-19 pandemic. The mental health and wellbeing of whole societies have been severely impacted by this crisis and are a priority to be addressed urgently.”
The impact is being felt locally as well. A mental health helpline which was set up at the beginning of the COVID-19 crisis received 2100calls between the months of March to August 2020. People are not only fearing getting infected but are also experiencing uncertainties never felt before. Jobs have been lost, financial income severely disrupted, drastic changes to the usual routine and the demands of home schooling, associated uncertainties about the re-opening of schools and the stress of managing work, social restrictions and isolation in quarantine, the anxieties the frontline workers are experiencing, whom might need to leave their homes and be away from their loved ones, and the list goes on.
Last year the government published a mental health strategy for 2020-2030, with a vision to improve mental health care in Malta, address the existing short comings, and to increase the profile of the Maltese mental health care system. The Maltese population deserves nothing less. The mantra has always been that anyone can experience mental illness and no one is immune, irrelevant of age, sex, level of education or social status. Now this is more significant. Mental health services are already experiencing a strain due to increased demand and limited supply. The closure of the psychiatric out-patients department along with the psychiatric unit at MDH means the complete removal of any mental health presence at the general hospital; which is the opposite direction of what was published in the mental health strategy. The development of community mental health services is important, however substantial investment is to be allocated to improve in-patient care, to train adequate staff to provide and expand mental health care in the community and the need for 24/7 service for urgent care remains imperative. If mental health care is not up to standard and ALL the necessary resources are not in place, than community care will become family care, resulting in excessive burden on the family and putting more strain on the population.
The Alliance for Mental Health (A4MH) is an organisation of the major stakeholders including patient representation, family caregiver and professional associations, has in the last 5 years called on the government to make changes and improve the delivery of mental health care in Malta. The A4MH warns that the probable course is that people are going to need the mental health services more and more. Grief, anxiety and depression will continue to affect people even when the virus is under control, and the people deserve mental health services which are of high quality, accessible and not stigmatized.
As the United Nations document declare, “mental health services should be an essential part of all government responses to the COVID-19. They must be expanded and fully funded”. It is in the nations’ best interest, that people are able to deal with the psychological impact of this pandemic. Otherwise, we risk a universal depression and its aftermath can be much more devastating than the physical effects of COVID-19.
Message from the President
Being a mental health nurse during the COVID-19 outbreak
Being a mental health nurse during the COVID-19 outbreak is an exceptional experience we were untrained for. No mental health text book, no university lectures, no seminars have prepared us to deal with this clinical reality, which was thrown upon us unexpectedly.
The nursing profession has never been so significant, most probably since the times of world wars, and at times and regions where similar outbreaks have happened. But what does this mean for the psychiatric mental health nursing profession? What impact this pandemic is going to have on nurses who work with people who are mentally unwell?
Although as mental health nurses, we are not on the frontline in caring for patients who are COVID-19 positive in the same way as general nurses are, some are still designated to work with COVID positive patients, and the risk of COVID query patients is always looming around for everyone, including nurses working in mental health settings. Besides, we still have to look after patients who due to their mental health difficulties, they experience increased distress during these difficult times. If there are pre-existing mental health issues, these could become worse. Patients will not suddenly stop relapsing in their mental health and stop being admitted to Mount Carmel Hospital because of this outbreak. It is imperative that the mental health services continue to function, as a breakdown in these services can be detrimental to the national health of the country.
As nurses who work with people who have mental health difficulties, our usual work have become all of a sudden more challenging. Our profession is based on the very activity we are being discouraged from performing...human contact. Now we are relying on distancing while at the same time have to show the same attributes.
Mental health nursing presents certain challenges which are unique to psychiatric practice. When a patient is not abiding by his or her careplan, when the patient’s paranoia is meddling with the reality of what’s happening around us, when the patient’s personal hygiene is a constant issue and the nurse need to visit the patient at home, when a patient in hospital is so agitated that cannot be contained while the nurses have to be vigilant about the mode of transmission. Containing the spread in a psychiatric setting is complex and tricky. Patients can be interactive, uncooperative and chaotic. We always based the treatment of mental illness on engagement, therapeutic activities and close supervision, which with the current situation might not be possible. Overcrowding of wards, which was always an issue, has become a significant health problem. On the other hand, promotion of social distancing may lead to social isolation, which puts people with mental illness at greater risks of relapse, which might instigate further admissions. Hence the need for community support, dialogue between in-patient and community services and looking at innovative ways of working is imperative.
We also need to safeguard ourselves and our mental health and we need to avoid becoming a source of infection. Anxiety is something even mental health nurses are experiencing and they need the necessary support and assistance to continue providing the care required to people with mental ill health.
As mental health nurses, we might not be on the frontline, but our work remains imperative during this outbreak. We have a key role in helping patients coming to terms with what is happening, explaining the changes which are taking place rapidly and helping them make sense of this new reality. We need to follow the Health Department’s directives and maintain social distance, as this will help Malta in fighting the virus. At the same time, it’s important to keep monitoring people with mental ill health, as these can be the most vulnerable during these times and hence, our role is more than ever necessary to the well-being of the country.
President - Maltese Association of Psychiatric