Issue link: https://maltatoday.uberflip.com/i/1414163
9 maltatoday | SUNDAY • 26 SEPTEMBER 2021 INTERVIEW way we approach mental health issues in Malta? You've already mentioned the introduction of a loneliness helpline… but what else is FSWS doing to cope with the situation on the ground? Let's give a bit of background first. FWSW was originally set up in 1994… and as for services, it started with Sedqa – the national agency for addictions – and the introduction of child protection and domestic violence servic- es, under what was then called the Social Welfare Development Programme… which eventually became Agenzija Appogg. We have grown a lot since then… but that's how FSWS started. And what does this tell us? That 27 years ago, this coun- try's social welfare policy-makers identified two main 'problem are- as': and they responded by setting up three basic services. So until quite recently, we were - how can I put this? – a bit like a medical service, but with on- ly an emergency ward…. and no primary healthcare. At the time I was appointed CEO, we had four community service centres – one in Valletta, one in Qawra, one in Msida - which also caters for Birkirkara, because we couldn't find a place there (and still can't) – and one in Cottonera. Again, however: these have to considered as 'emergency ser- vices'. There was evidence, at the time, that those were the locali- ties we needed to be present in; but they are also the places that are traditionally associated with 'social problems': what we gen- erally described as 'depressed areas'. But this also means that we were not present in other areas. We had no presence at all in Gozo, for instance. Today, however, we have a presence in Marsalforn... Sorry to interrupt: but if Mar- salforn – a previously tranquil seaside village, if there ever was one – is now considered a 'depressed area', alongside Msida and Cottonera… then the social landscape must really be changing quite drastically… You could look at it that way, yes. But to be more precise: the actual Family Services Centre we set up in Gozo is in Rabat, not Marsalforn. But we felt the need to be present in Marsalforn too, because… yes, it is considered a problem area, today. There's a lot of internal migration, because of high rents – basically, people on low income find Gozo a cheaper place to live – and also a lot of foreigners, employed mostly in the catering sector. But it's not just Marsalforn. Just recently, the Bishop of Gozo asked us to set up a sim- ilar service in Xlendi, too. And meanwhile, we have opened up other centres in Malta: in places like Qormi; Hal-Kirkop; Zur- rieq… Because the instructions I was given – by my former minister, Michael Farrugia: who is a doc- tor by profession – were… well, the sort of advice you would ex- pect from a doctor, I suppose. All medical professions will tell you that you need a good Gen- eral Hospital, yes… but you can only have a robust health service, when you have strong primary healthcare. My present minister [Michael Falzon], on the other hand, comes from the banking sector; and all banks, traditionally, have a branch in every town and vil- lage. So the idea is to extend our reach, as FSWS, to all towns and villages, too. And we fully agree, because – while it may seem like a trite cliché – if we nip problems in the bud, we can solve them much faster, than if we allow them to fester, and grow… Your 'primary healthcare' anal- ogy is particularly relevant, because – as we so recently saw with Covid-19 – it is im- portant to prevent the emer- gency services from becoming overwhelmed. Nonetheless, a health service does still need to cater for emergencies, too. So how does this work out, in practical terms? Do you see your role as more 'prevention', than 'cure'? Let me it put this way: we're not the 'Light Brigade'. Our job is not to go 'charging in', wherever there is a problem. The way I see it… we are enablers. Our job is to assess what local resources there are, on the ground; and help them to grow. For this reason, we have – as I said - invested more in commu- nity services; but we have also teamed up those services with family therapy within the com- munity… what we call 'home- based therapy'. We are looking at – and working with – 'troubled families': to use the jargon prev- alent in the UK. Families which are at risk of poverty; which have problems which might end up in domestic violence, or even child protection orders… That, in a nutshell, is the direc- tion we are moving in. It is a mul- ti-disciplinary approach: involv- ing community workers; youth workers; social workers; family therapists; and community de- velopment agents... And yet, it wasn't all that long ago that the entire issue of mental health was virtually 'taboo' – to the extent, for in- stance, that individual cases were traditionally 'hushed up' by families. From your own ex- perience dealing with cases on the ground: have people really become more open and recep- tive to the idea – promulgated by FSWS – that 'mental health' is really just another medical is- sue, to be treated no differently from any other? Yes, I do believe that public per- ceptions have changed. But to be quite honest: it didn't begin now. One of our community-based services, which specifically deals with 'mental health in the com- munity', is based at the Qormi health centre. It was set up in 2004; and it has been an extraor- dinary success ever since. At that centre, there are three psychiatrists; three psychiatric nurses; and three social workers. And they cater for a population of around 500 to 600 patients: that is to say, people who suffer from mental health issues… but who continue to live independently in their own locality: and who have access to a locally-based support system. Much more importantly, how- ever… they are also accepted by the local community. And this means that those people are 'taken care of'… but not at the expense of their integration in- to society. And to me, that is a beautiful thing. Because it also proves that – while there will always be the need for an acute psychiatric hospital: in fact, a new one is be- ing built, and will hopefully be completed in as short a time as possible - the really important thing is to provide caring servic- es within the community itself. What would you say triggered this – let's face it – remarkable change in public perceptions of mental health? It is a combination of many fac- tors – too many to go into here – but if I had to single out only one aspect, I would say that… many people are now beginning to realise that ultimately, there is only a very fine line between be- ing mentally 'well', and mentally 'ill'. People are realizing that… 'it could be me'. We are, at the end of the day, all different from each other; some have higher resilience levels than others. But nobody is entirely immune; and there can always be the proverbial 'last straw that breaks the camel's back'. As for myself: I don't know when my own 'last straw' will come… but I do know that, like everyone else, I have my own breaking-point. So far, I thank God – or my lucky stars, or whatever - that I'm still one of the 'two', in that statistic of 'one in three' who may develop men- tal health problems. But for all I know… that could easily change tomorrow. Another thing I also know, however, is that – if my 'last straw' does come, in the end – there are also services, available within my own community, that can help me. And that, at the end of the day, remains the most im- portant thing: that we continue to look out for one another, as a society.