Issue link: https://maltatoday.uberflip.com/i/1313317
6 maltatoday | SUNDAY • 29 NOVEMBER 2020 NEWS JAMES DEBONO ALCOHOL and drug abuse is the main reason for the hospitalisation of nearly one in every four patients admitted to Mount Carmel, a study in the Malta Med- ical Journal has revealed. The study, based on the records of 300 patients admitted to Mount Carmel Hos- pital between 15 October 2018 and 1 March 2019, shows that more than two patients are admitted to the hospital every day. And men are twice as likely to be admitted than women, while foreign- ers account for one in every four admis- sions. Nearly a third are committed, against their will. The study shows that 15.3% of admis- sions cases were linked to substance abuse, 15.3% of cases were linked to de- pression, and 13.3% were linked to acute psychosis, reflecting similar trends across Europe. Other reasons for admission were self-harm (7.7%), acute stress reac- tion (7.7%), schizophrenia (7%) and alco- hol abuse (6%). Cases involving alcohol and drug abuse or a mixture of both account for 23.3% of all cases. But the number of cases involv- ing substance abuse could even be high- er because psychotic episodes are also "mostly substance induced". The study shows that 205 inpatients, 68.3% of the cohort, were inpatients on a voluntary basis whereas 30.7% were admitted for assessment and observa- tion under the provisions of the Mental Health Act. Compulsory admission rates vary re- markably across the European Union, from 30% in Sweden to 3.2% in Portugal. This variation is linked to differences in legal frameworks or procedures. Roughly two male patient were admit- ted for every female. In general, depres- sive disorders are more common in fe- males whilst men were more likely to present with psychotic disorders, alcohol use, and substance use disorders. The fact that substance abuse accounts for most hospitalisations explains why males out- number females. 75.3% of the cohort were of Maltese na- tionality, 14% hailed from the rest of Eu- rope and Africans accounting for 8.3% of all admissions. Only 2% hailed from Asia or the American continents. Nearly half of those admitted (46.7%) were between 20 and 39 years of age. 40 to 59-year-olds accounted for 32.3% of all admissions. The reason for this is that the age of on- set for the most common diagnosis, that is substance use disorders, is 20; while that for depression and mood disorders is 30. In fact out of 300 patients who were admitted, only 15 were aged under 20. Most of those admitted (40%) were re- ferred to the mental health hospital from the accident and emergency department in Mater Dei Hospital, while 26.7% were referred by general practitioners. 64.3% of all cases had been admitted for the first time while the rest had already been admitted on a previous occasion. The study was conducted before March 2019 when crisis psychiatric services at casualty had extended their on-call hours from 8am till 5pm to a 24-hour service. According to the authors of the study, having a psychiatric specialist in the loca- tion where most referrals are made allows for better assessment of each case and should lead to a decrease in unnecessary admissions. "This may also help prevent patients from future institutionalisation, cuts down on costs yet ensuring that inpatient hospitalisation is reserved for situations with high imminence of danger to the pa- tient or others". Providing adequate and updated train- ing to family doctors could also lead to better community management of men- tal health problems and possibly reduce admissions. The study was authored by Bertha Grech and Beppe Micallef Trigona from the Department of Psychiatry in Mount Carmel Hospital. jdebono@mediatoday.com.mt Drugs and alcohol account for one in four admissions to Mount Carmel One-fourth of patients admitted to hospital are foreigners, 31% are forcefully admitted and two thirds are men IN NUMBERS 15.3% linked to substance abuse 15.3% linked to depression 13.3% linked to acute psychosis 7.7% self harm 7.7% acute stress reaction 7% schizophrenia 6% alcohol abuse Cases involving alcohol and drug abuse or a mixture of both account for 23.3% "Having a psychiatric specialist in the location where most referrals are made allows for better assessment and should lead to a decrease in unnecessary admissions, preventing future institutionalisation."