Issue link: https://maltatoday.uberflip.com/i/1547021
ACROSS every sector, prac- tical experience is recognised as a form of expertise. Organ- isations value people who have navigated real-world complex- ity because they bring insight that theory alone cannot pro- vide. The same principle should guide mental health care. Yet, when services are evaluated and policies developed, the people who experience those services most directly are still too often absent from the deci- sion-making table. For decades, mental health care in Malta has been shaped largely by the traditional med- ical model. The expertise of psychiatrists, nurses, psy- chologists, social workers, occupational therapists and other professionals is indispen- sable. However, when decisions about treatment, rehabilitation and a person's future are made primarily by professionals, the system risks overlooking the knowledge of persons with lived experience (PWLE) and those who support them. The value of practical exper- tise People living with mental health difficulties experience treatment side effects, stigma, fragmented pathways and the challenge of rebuilding life af- ter a crisis or institutionalisa- tion. Meanwhile, at home those close to them live through the shortcomings of the clinically drafted paper plans that do not meet the realities of daily life. This risks carer burnout. Their knowledge should complement clinical judgement. Care plans are stronger when service users and carers receive clear infor- mation and are treated as gen- uine partners. Lived experience also high- lights the different needs of diverse groups. Minors require age-appropriate information, meaningful participation and suitable parent or guardian in- volvement that respects their evolving capacity and best in- terests. Older people may face loneliness, sensory or cognitive difficulties, physical illness and dependence; their particular needs and preferences must not be dismissed because of age. Foreign nationals may en- counter language and cultur- al barriers, limited awareness of available services and weak support networks. Interpre- tation, culturally responsive communication and accessible information are therefore es- sential to obtain genuine con- sent and participation. The role of the 'expert by experience' Participation must go beyond occasional consultation. Malta should further develop trained and supported 'expert by ex- perience' roles through which people with lived experience can support others, contribute to service improvement and influence policy. The collab- oration between the Mental Health Services and the North Ayrshire Wellbeing and Recov- ery College, which trains staff alongside prospective patient experts, offers a valuable foun- dation. The next step should be the meaningful integration of these experts into policy devel- opment and decision-making. This should not be a tokenistic or purely voluntary contribu- tion. It should offer fair com- pensation, appropriate support and genuine influence. When these experts take part in de- cision-making, their contribu- tion should carry equal respect alongside that of administra- tors and senior clinicians. We must therefore ask whether our services are ready not only to hear lived experience, but also to share power. The legal right to an active voice The Office of the Commis- sioner for Mental Health pro- motes these principles through visits to licensed mental facil- ities during which the rights under the Mental Health Act (Chapter 525) are explained. One important safeguard is the patient's right to appoint a trusted responsible carer, who may receive information, seek clarification and contribute to the care plan. However, a significant num- ber of patients do not appoint a responsible carer. Some long- term patients have no trusted person available. They receive no visits or calls and may get caught between unnecessary hospitalisation and an unsafe discharge, where suitable com- munity services may be lacking. This isolation can be particu- larly serious for minors, older persons and foreign nation- als separated from family or community. A humane mental health system must build social connection as well as provide treatment. The charter of rights and public feedback Malta's National Patients' Charter of Rights and Respon- sibilities, launched in 2016, recognises the right of service users to comment on and com- plain about their care. To make this right meaningful, services should actively seek feedback in accessible formats and pub- lish reports with anonymised information on complaints and the corrective action tak- en. Transparency strengthens accountability and public trust. Mental health care in Malta is progressing, but progress can- not be measured only through buildings, beds or clinical ac- tivity. It must also be judged by the quality of care and by whether people are heard, respected and supported to shape decisions affecting their lives. Service users, carers and people with lived experience should have a permanent place at the decision-making table, with particular attention to those whose voices are most easily overlooked. Moving beyond a purely med- ical model does not dimin- ish professional expertise; it strengthens it with human evi- dence. This shared approach is essential to services that are ef- fective, rights-based and wor- thy of public trust. 10 maltatoday | WEDNESDAY • 7 OCTOBER 2026 OPINION Mental health beyond the medical model Denis Vella Baldacchino Commissioner for the promotion of Rights of Persons with Mental Disorders Moving beyond a purely medical model does not diminish professional expertise; it strengthens it with human evidence. This shared approach is essential to services that are effective, rights- based and worthy of public trust