Safeguarding the vulnerable and elderly

Dr John M CachiaCommissioner for Mental Health & Older

Persons

Malta Health Network Seminar Sliema11 September 2012

One year on....

Commissioner

The Office of the Commissioner for Mental Health and Older Persons established in 2011

• Promotes awareness of matters relating to the rights and interests of older persons and persons with mental health problems

• Protects, upholds,safeguards those

rights and interests• Hence our logo....

The Mental Health Act, 2012

Aim

A New Mental Health Act:

• To regulate the provision of mental health services, care & rehabilitation

• To promote & uphold the rights of persons suffering from mental disorders

Patient Focus

• Patient rights enshrined & safeguarded• Responsible carer – involvement in care• Holistic & multidisciplinary team care

approach• Care plan with timeframes & outcomes• Establishment of the Commissioner • Approval, monitoring & review of

compulsory care by Commissioner

New Models of Care

• Treatment in the least restrictive manner• Voluntary vs involuntary• Community vs hospital• Regulates restrictive care, special

treatment & medical research• Great reductions in lengths of compulsory

hospital stays (table next slide)

Hospital Stay

6 months renewable

2 years renewable

Subsequent extensions

5 weeks1 yearFirst Extension

10 weeks1 yearTreatment Order

15 days28 daysObservation Order

New ActCurrent Act

Maximum Length of Stay

Mental Capacity• Person able & competent to make decisions

unless otherwise certified by a psychiatrist• Introduces 3 levels of lack of mental capacity:

Note in clinical file

< 15 daysTransient

Approval by Commissioner

< 26 weeksTransient

Through Court of Law> 26 weeks

Long term(requiring incapacitation or interdiction)

Minors

• Specifically addresses the needs of minors admitted to hospital for treatment

• Protects the parent-child bond:– Flexible visiting hours

– Possibilities of rooming-in

• Involves minors in consent for treatment when they have sufficient maturity & understanding

Social Inclusion• Addresses social inclusion • Provides for elimination of discrimination• Promotes equal opportunities• Requires the State to provide:

– Appropriate work training programmes– Health care– Education, training & employment

– Social Services including Housing

CriminalProceedings

• Retains the provisions of the current Act

• Institutional psychiatric treatment to be provided in a duly licensed facility for forensic psychiatric patients

Way Forward

The Bill has been published in the Government Gazette on 28th June 2012 and is currently third on the priority list in

the Parliamentary agenda for 1st October 2012.

Active Ageing: An Agenda for Malta

Challenges faced by Older Persons

• Polypharmacy

• Risk of Undernourishment

• Falls Risk

• Chronic Disease Management

• Age - Unfriendly Environment

Challenges faced by Older Persons

• Polypharmacy

• Risk of Undernourishment

• Falls Risk

• Chronic Disease Management

• Age - Unfriendly Environment

How are we going to overcome

these challenges ?

Polypharmacy (1)

• Monitor the medicines prescribed

• Ensure that the doses administered are those recommended for elderly persons

• Prevent possible serious side effects

• Look out for possible interactions

Polypharmacy (2)

• Focus on admissions to acute care, rehabilitation or long term care

• Audit prescribing habits in free medicines system

• Professional awareness: pharmacists, doctors, nurses

• Awareness among older persons and their carers at home

Risk of Malnutrition

• Dependent elderly cannot always feed themselves

• Persons at risk of undernourishment in wards, nursing homes and in the community.

• Action:– Risk assessment culture including a BMI

test to be promoted.

Falls Risk

• Falls Prevention Policies are very common

• Staff is often trained in the prevention of falls

• Incident Reports are drawn up but....

– Are they being analysed

– Is there a formal monitoring system

– Are causes identified

– Are underlying factors addressed

– Are reporting systems blame free

Chronic DiseaseManagement

• Clinical treatment protocols are often in place and available to professionals in hospital and outpatient settings

• But do we involve...– primary care staff

– the older person– relatives and carers

Age Friendly Living

Physical and social environments are key determinants of whether people

can remainhealthy

independentautonomous

long into their old age

Dimensions

• Cities and communities become moresupportive of older people by addressing:– the built environment

– transport– housing

– communication– social participation

– respect and social inclusion – civic participation and employment

– community support and health services

Our Vision for Malta

• Inclusion and active contribution in all

areas of community life

• Flexible responses to needs and

preferences

• A more friendly physical & social

environment

THANK YOU