MALTA’S HIDDEN CRISIS
At the risk of being labelled an alarmist, Malta is fast heading into a mental health crisis. And the structures supposed to handling it are close to crumbling. Yet there’s still time and hope for things to change, if society at large can be engaged and encouraged to improve its attitude and motivated enough to know that they too can save a life.
WARNING —This articles will discuss mental health issues, with special attention to suicide. If you, or anyone you know, is struggling with suicidal thoughts, seek help now. You can get in touch with Crisis Resolution Malta on 99339966 or call your national suicide helpline.
NO MORE HIDING
It’s time to stop hiding, and start showing up. I fully understand my family’s concern about airing my personal stuff in public — the idea of a vulnerable, flawed man is still a relatively new concept in Malta, and people can be so cruel. But this is not my family’s weight to burden. This is totally mine, and its time to start owning back the narrative. It can’t be that Maltese families of suicide victims continue to live in shame and suffering. It cannot be that Maltese struggling with mental health issues continue to fight in silence for fear of unwarranted prejudice. There’s nothing to lose. Only some lives to be saved, hopefully.
My family might not agree with this decision but it was not theirs to take to begin with. I can only ask them one thing — please be proud of me, be proud of what I’m about to do and don’t feel ashamed any longer. Because there are others out there who are survivors, just like me, other families like you out there. And if anyone still makes some snide remark or engage in shitty behavior about this thing, it’s absolutely their problem, not mine, not my family’s, not ours. A problem that they will eventually have to address some time or another, and learn a most valuable lesson.
I struggle with depression and have had suicidal thoughts. I was close to ending my life at least 3 times. Even though I still struggle sometimes, I look back with confidence and say that I have made great strides in handling my own struggles. You can rest assured it wasn’t easy, it isn’t easy, and it won’t be any easier. Yet I persist and my resilience becomes stronger. I am also lucky enough to have an increasingly supporting family, and a good network of friends. We just don’t realize it sometimes when we find ourselves fighting off the darkness.
MY OWN PERSONAL EXPERIENCE
There’s no two ways about it — one major reason I left Malta because it has become a noxious environment of denial, delusion and toxic positivity. Even its political leaders are actively encouraging it. The disconnect and cracks in this idea that Malta is some happy, sunshine country became even more apparent when the pandemic came around. And no matter how much people say that the pandemic made things worse, this issue didn’t come about just because of the coronavirus only. The issue became more exacerbated because Malta’s structures intended to handle mental health crises are in shambles. And this comes from the horse’s mouth.
DEHUMANIZATION THAT CUTS BOTH WAYS
I have been institutionalized twice at Mount Carmel, and vouched never to return again, even if the situation required me to. And let’s be absolutely clear, this is no fault of the staff working there, neither of the people receiving some form of cure at the hospital.
The first time I went in was already a distressing enough situation — what if friends found out? What will they think of me? What will people say and think of my family? These are all thoughts stemming from the stigma related to the place. And you can already deduce that these thoughts are definitely not helpful in the path of recovery. My family insisted to keep this hush hush. Looking back I understand the feeling, but I can’t no longer condone it now, since the situation in there has apparently gotten worse.
I was already feeling uncomfortable. The perception I had was that for a patient to be able to receive occupational therapy, it squarely rests in the hands of the mental health professional. If the patient didn’t go, even after the expert’s recommendation, then it was no longer anyone’s responsibility and everyone was left to their own devices. I am more than happy to be called out on this, because I fully acknowledge this is just an impression I got.
Otherwise, the routine was as follows — wake up, shower, breakfast, first course of pills, TV/free time, lunch, second course of pills, siesta, visiting hours, dinner, third course of pills, TV/free time, lights out. I do understand you cannot force anyone to do anything, but honestly, this was counterproductive. It’s like we were some kind of drones. So much so, I kept this in mind when I went in the second time.
Even within the staff you could sense a certain sense of discontent. As dedicated and committed as they were, they were definitely understaffed, underpaid and overworked. Before I would say having familiar faces helps, now I see it more as a sign that the institution is understaffed.
FURTHER TRAUMA
In the ward where I stayed, Psychiatric Out Patients, there used to be an absolutely loveable dog both patients and staffers loved dearly. It had one eye missing, yet he was good-natured and full of patience. He brought joy and solace to everyone in the ward.
One time, sitting alone in the ward, the dog naturally came up to me resting its head on my knee. I was petting him when suddenly, as I reached to scratch his ears and neck area, the dog snapped and bit me. I remember clearly there was no over-reaction from my side — my first thought was that I had maybe found an area where he disliked being touched or was hurting him and needed to be looked at. In addition, the bite mark wasn’t as deep and serious — no blood was let, and it was more like a bruise which appears when someone twist your skin hard enough. Some ointment could have done the trick.
In a very calm manner, I went to the head nurse’s office, explained what happened. The head nurse did his job and called in the shift doctor, or whoever it was, to make a quick assessment. I remember he had enough authority to take executive decisions. I am still filled with a sense of anxiety and panic as I write this, but classifying the doctor’s decision as an overreaction is a huge understatement. “The dog has to be removed from the premises,” he said, “he is a danger to the patients.” Words failed me — this guy clearly saw my wound wasn’t serious, he listened to me taking responsibility and explaining the dog reacted according to his nature, yet his decision, taken in a very dismissive manner might I add, was a punitive measure, for everyone in the ward, patient and staff members.
I don’t remember how long the dog was there before I came in. All I know he was there long enough for having a devastating effect on both staffers and patients upon learning the dog was no longer allowed in the ward. And I had to bear responsibility for it. This was an injustice, against me, against the patients, against the staff. I had to bear the brunt of both staff and patients who were not privy of what happened, who were understandably angry and hurt because this new patient “forced” their one source of joy and comfort out.
Obviously, other patients didn’t handle it well — I remember one of them, a lively young male, hitting his head against the Perspex door, because that was his coping mechanism. The nurses saw to it he stopped, only for him to later punch hard enough through one of the windows he broke into pieces. In addition, a number of staff members constantly shot me dirty looks. I was fearful then. Now I am quite angry, not at the staff or the patients who held it against me. But at that so-called expert who had this wonderful idea to begin with.
All I remember is me insisting with my family and other doctors to get me the fuck out of there, and a couple days later, I was back home.
THE SECOND TIME
I had to be admitted a second time to Mount Carmel Hospital for suicide ideation. With the knowledge of what happened the first time round, I went in prepared. After a few days of rest, I insisted I do something to keep my mind occupied — I starting helping out with the cleaning up after lunch and dinner. Any time my ideation got stronger, I fought against myself and let the nurses know immediately.
From the get-go, I insisted I am let go for Occupational Therapy. I had to wait a while for that recommendation. In the meantime, I had to power through the frustration of doing nothing, making further observations in the meantime.
The situation since the first time did not get any better. There is no sense of dignity whatsoever, be it in the work to provide the best possible treatment and care to patients, or be it the patients themselves who just while their time around in the ward.
Back then, I made a promise to myself — whatever how bad I feel, even if the situation requires it, I am never going to set foot again in those premises ever again. Definitely not until the issues about both worker and patient conditions are addressed directly, not with just lip service or “drafting policies”. In Malta we’ve became experts at drafting policy after policy, but we are still amateurs at seeing these policies followed through.
THE “HAPPY COUNTRY” DELUSION
Not mincing my words anymore, but Malta and the Maltese should really stop buying into the idea that we as a country are doing fine. We haven’t been doing fine since before the pandemic. But if we take all this into account now, it will be the most crucial step moving on forward.
Let me first make it extremely loud and clear — Malta is in deep shit, politically, environmentally and socially. Newer generations should be applauded that they’re slowly realizing that something is rotten in the state of Malta — a certain sense of discontent and disconnect — not admonished and/or demonized. Malta has fostered a noxious environment of denial and toxic positivity, which is further exacerbated by its political leadership, no matter where you stand on the political divide.
I couldn’t stick living in a country which I’ve lived for most of my life, whose response to very urgent matters is further alienation and deflection. We can attract as many tourists as we want, organize parties as much as we want, and while having some well-deserved fun in the weekend can relieve us of some weekly stress, it still does not address mental health issues head on. From where I stand, it has further pushed us into denial.
There’s only so many parties one can go, so many times one can say everything will be okay, before one breaks apart. It takes a lot of courage to say you’re not okay, that you’re vulnerable and that you have a problem that needs urgent addressing. However, rest assured, that despite everything, despite even what I just said before, Maltese people are ready to get their hands dirty and be of any help necessary.
The intentions are there. It’s just that we still have long outdated tools to address serious issues. And the first step is to step up and take collective responsibility and admit we’ve all screwed up in our lives, one time or another. The important thing to ask is what are we going to do about it? What can we do about it? And, in my opinion, my strong recommendation is to stop buying into the bullshit that Malta is a land of sunshine charm and smiles.
An increasing number of people are not speaking up about their struggles, because prejudice is still prevalent. An increasing number of people are not opening up about their regrets or their dreams or ambitions for fear of being ridiculed. In public they keep up this air of everything being ok, but it is now taking a heavy toll on the mental health of even the average Maltese person, pandemic notwithstanding.
It affected me so much I felt I had to be physically removed from that environment, in order to be able to take better care of myself. It still affects me today with this irrational fear that going back will take some huge mental toll on me. However, I am confident in saying I’m not alone in this feeling, and, at least for me, removing myself from the country has done me a great deal of good in taking better mental and emotional care of myself.
GO DEEPER
This past week, the national broadcaster in Malta aired this TV program. It will be available for the next 20 days and is only available in the Maltese language. I strongly recommend dedicating an hour to watch it as it has some valuable information. In my opinion, I felt it didn’t go deep enough into the issue Malta is facing. Psychiatrist Dr Xuereb and psychotherapist Ms Baldwin made many valid contributions nonetheless, even though it felt they made it a point to hold back.
Some crucial highlights were Dr Xuereb mentioning that there’s only 1 psychologist for every 4,000 Maltese citizens, and Ms Baldwin clear instruction of giving less unsolicited advice and passing judgement and starting to listening more to people going through a dark time. What I found a bit outdated is a sort of over reliance on the usual suspects as causes of depression — drugs, alcohol and prostitution. Admittedly they did mention the adverse effects of social media, and the importance of education. However, even this idea that Malta being a Catholic country automatically means our rate of suicides are low, which I will disagree wholeheartedly. I actually feel the figures in Malta are very conservative, as there’s still a hesitation from families to report any deaths by suicide.
In my experience, having been raised Catholic, specifically Maltese Catholic, put me in a great deal of conflict against myself and the rest of people. Even in one of the comments underneath a Facebook post promoting this same program, someone proclaimed that suicide is what happens to people who abandon God. Tell that in the face of parents who raised their child in strong Catholic values, yet still succumb to mental health struggles.
The issue is more complex and nuanced. The general patronizing attitude in Malta should be put totally in the forefront. The general public is accustomed to see people in need, whether they struggle with mental health issues, disabilities or other physical ailments under a lens of pitifulness and constant sorrow. It is a warped view drummed into the Maltese psyche through initiatives like L-Istrina solely for the purpose of raising money, giving a false sense of having fulfilled some sort of altruistic duty. But it all it managed to do is remove any source of dignity or humanity, and create more confusion between pitying and compassion. Pitying sees only victims, compassion gives courage to survivors.
URGENT ACTION MUST BE TAKEN
I can’t exactly commend enough the drafting of policies as a good first step in the right direction. That it had to be a pandemic to spring authorities into action into just drafting a policy, I’m sorry but that is absolutely incompetent of authorities, not of the individuals and health experts who have been campaigning tirelessly for ages about the need of a mental health policy.
Does that mean we should still continue depending on authorities? Not at all. The power for better change is within the Maltese general public, and it’s best to start ignoring the authorities as much as they ignored us in times of desperate need. The tools are out there and within grasp of our hands.
Here’s a list of what I feel you should and shouldn’t do if one of your friends and family are struggling mentally and emotionally:
- Stop saying stuff like “Stop thinking that way!” “Think of positive stuff!” “Everyone goes through difficult things in life!” “Suicide victims are selfish,” “You’re exaggerating!”
We understand this comes from a good place, but when we’re in darkness, this sounds patronizing and unhelpful for us. However,
- Make it a point to listen rather than give in to the urge of giving advice.
- Don’t just expect someone to reach out to you when they’re in difficulty.
You know how the adage goes — if the mountain doesn’t come to Mohammed, Mohammed goes to the mountain.
- Re-evaluate yourself about any prejudice or misconception you have about mental health and suicide.
Prejudices and misconceptions are only programmed into us and can be unlearned. And you can manage this by
- INFORMING YOURSELF
Samaritans.org is a good place to start, and Malta has apps called Kellimni.com and Krizi. I have to point out, however, that the latter needs thorough optimization. The chat function is misleading and not at all user-friendly, and needs to be addressed immediately, and I encourage any app developer to get in touch with the persons responsible.
That being said, however, there is a call function which quickly calls a 24/7 free hotline, and the app also provides valuable information in providing a toolkit, not just for victims, but to anyone who is looking out for their friends and family.
I hope sharing my experience was insightful enough, and encourage other people to come forward. There is absolutely no shame in what we’re going through, and if you feel like you can’t speak up for yourself, speak up for others and for those who want to help you.
And to end all this with a good dollop of cheese, do keep this in mind — you are valued and you are loved.
Stay safe out there!
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