Patients lining up in a row waiting for their medicine; pills distributed in little transparent cups, with nurses watching over them; patients being asked to open their mouths to make sure they have swallowed their medicine. Scenes from the Florence Nightingale era, you would imagine. No, this is the day-to-day reality seen in Mount Carmel Hospital, a healthcare professional tells The Malta Independent on Sunday.
On condition of anonymity, the healthcare professional described these methods as “so degrading”. Even the way the patients are served food is demeaning, he said, explaining why it is so important that if the hospital is to be moved, then considerable investment needs to be made in re-training the staff.
This newsroom also spoke to another healthcare professional working in Mount Carmel Hospital who said that “there is a serious problem of homelessness”. He pointed out that there are a lot of people waiting for placements.
There are some people who are unwell for a few weeks, for example, and then they get better and have nowhere to go. “They remain in hospital because there is nowhere else for them to be homed. There are a lot of situations where these people end up without a home: for example, because either their family cannot accept their behaviour, or due to separation issues or financial problems,” he said.
There are also children who are waiting for placements, he told us. For example, because they suffer from autism and none the homes available would be suitable for their needs, they stay in Mount Carmel Hospital. “They cannot be placed in a standard care home but they should not be in the hospital if they do not need to be,” he said, pointing out that only those in the acute wards need to be hospitalised and the rest could easily be in a supported home.
‘Problems at Mount Carmel go beyond just the building’
While agreeing that Mount Carmel Hospital is not fit for purpose, the other professional noted: “The moment they just move people around they making the biggest mistake ever. We are going to have a lot of mental health problems.”
He pointed out that some of the staff at Mount Carmel Hospital have been working there for over 30 years, and said that this is the type of environment to which they are accustomed. It would be a very different situation if the carers were in a ‘normal’ situation, with seven people in a house, not a ward of 50 patients. He explained that, for example, the staff should help someone take their own medication, not the way it is done now.
The healthcare professional explained that the problems go beyond just the building. “They have been coming on for a long time” he said, pointing out that it is a 25 to 30-year-old problem.
A hospital that was built in the late 19th century is definitely not suitable for its purposes today, he noted. “The same will happen with the prisons, since they were built at the same time. We need to recognise that there are certain structures that have basically served their time.”
The structure in itself plays a major role when it comes to processes, he noted. “Even the process of how and where a patient is admitted, and how the nurses function, is affected when the structure is old.”
He explained that there is no emergency room at the entrance, so the patient has to be literally transported to a place far away from the admission area. In addition, the seclusion areas are a long way away from other areas which, in the event of an emergency, could cause problems. This is different to the way in which hospitals are designed, where everything is in one place.
This could also cause safety issues for the staff, the healthcare professional noted: “The other concern about the depilated structure is that you cannot expect the staff to be happy.” He said this also applies to patients, but there are also a lot of nurses who work overtime and who, basically, live there too.
Scaffolding holding up the walls
Both healthcare professionals confirmed that there are structurally dangerous areas in Mount Carmel Hospital. They pointed out that in some main corridors, where people are working, scaffolding, covered by wood, is holding up the walls.
Whilst there are areas of the hospital that are structurally safe, even in those there are other problems such as water seeping in through the windows. One of the staff members to whom we were talking said that rats had been seen in the corridors.
When asked if they were concerned about being in the hospital, one noted that “to some extent, even the staff has been institutionalised. We have become used to what we see and we do not talk about it. The situation has become so normal for us that we do not realise how bad it really is.”
Moving patients will results in behavioural problems
The problem, one of the professional notes, is that – worldwide – mental health has been side-tracked. “The first point you have to understand is that we can talk a lot about mental health, but if governments are not going to put their hands in their pockets then the problem is not going to be resolved. The issue revolves around the Ministry for Finance and not the Ministry for Health.”
When asked what the solution should be, he said that the solution is a very simple one. There are 100 patients who are in an acute condition and need to be in a hospital: a new hospital that has, however, been promised since the time of Lawrence Gonzi.
“It appears that the same plans from then are being put forward now. It was going to be situated near Mater Dei Hospital and to have an occupancy of 100 beds. This is the same plan now, which would still be enough.”
He noted, however, that there are a further 350 patients, most of whom have their address as ‘Mount Carmel Hospital’, so they actually live there. These patients could live in hostels or community homes, which do not need to be part of the new hospital.
In fact, he added, this is how it should be, and not how it is at the moment – with 50 patients in one area. A lot of them do not even need nurses.
“Having said that, these patients have been institutionalised, so moving them cannot be done quickly.” He explained that some of these patients have been living in Mount Carmel for 45 years and even though they would be moving to a nicer living area, moving them would result in problems.
“Despite this, such patients have been moved in the past so it should still happen, but adjustments need to be made.”
The patients would need time to adjust as they could have behavioural problems, so extra staff would be needed in the hostels, he explained. They will need nurses and doctors’ interventions for the first year. They will need the help of doctors and nurses for the first year.
Some of these patients are autistic, perhaps undiagnosed in the past, so a change in their routine could result in problems, one of the healthcare professionals noted. “There will be problems but it has to be done. You have to take the bull by the horns.”
Desperate need for a forensic unit
Another thing which needs to be provided is a forensic unit, he emphasised. Today, if you are sentenced by the courts as ‘insane’ and admitted to a mental hospital, you are placed in a standard ward. The so-called Forensic Unit at Mount Carmel Hospital is an extension of the prison. People housed in this unit are actually people sentenced to prison and not sentenced to a mental health institute.
The professional noted that the Mosta Cat Killer, as he was dubbed, who was certified insane by the courts, is not held in the Forensic Unit but in a ward. The same would happen if someone killed a person but was deemed insane by the courts. “Everywhere else in the world, you go to a forensic unit.”
The amount of money being spent to run the hospital will be the same to run around 50 houses, he notes. There would need to be a minimum injection of at least €20 million to build the extension and the community houses but it needs to be done.
Lack of staff motivation
The other healthcare professional noted that, over the past few years, the people in management do not have much of a background in mental health care. There is also the problem that the CEOs have changed frequently, actually four times since 2013. This he describes as “unhealthy” because every time any plan and/or momentum starts forming, they would have to start from scratch. “Even the current CEO has only been here for a year.”
This, amongst other things, has resulted in a lack of motivation for the staff. Career progression is also a problem, he notes because there is not enough money.
“Six people have to share a computer, and 13 have to share a printer,” he said. “There is no structure in place to make requests, such as getting a new computer: you have to pull some strings.” He explains that the lines of communication are there but nothing happens. “I try to follow the procedure but unless you go around it, your request is not heard.”
Both healthcare professionals noted that there are issues with employing healthcare professionals, with one adding that, on the other hand, there was a lot of administrative staff.
As employees, one noted that they are not told what is going to happen to them or the rest of the patients who will not be placed in the hospital next to Mater Dei, if or when it is built.
He also mentioned that people who are inappropriate for the job or should not be there because of things they have done, are still working in Mount Carmel Hospital. “Some people are placed there because they know someone,” he said, without going into detail.