Mental healthcare needs investment and resources

By Nick Calamaro

Last week saw the publication of the Mental Health Board’s 2023 Inspection Report.

This report is provided to parliament annually, to highlight areas requiring attention and to flag ways of improving the services on which many of us rely.

While the report did highlight some areas of improvement, it also raised many issues which are leaving people without necessary care or being treated inappropriately.

As someone who has relied on these services, and had family members in care, it’s painful to see that many issues remain unresolved after five years of such reports.

Every week, my team and I hear stories of people unable to get a diagnosis, parents unable to find local therapists for their children, and of people whose work and family life are being severely impacted by their lack of support.

We’re incredibly grateful to the charities filling in these gaps, but they shouldn't be the main provider of critical services.

It is a fundamental responsibility of the Government to take care of its people, and up to the opposition to challenge them for their failings.

For these reasons, it’s also deeply upsetting to see that our care workers and civil servants are well aware of these problems, and have many potential solutions, but have been left powerless to resolve them.

KENT HOUSE

To give a tangible example, Kent House is one of several government managed flats used as supported accommodation for individuals moving out of Oceans Views.

The Inspection Board were unequivocal that Kent House is not fit for purpose, and has not been since at least 2019.

Residents have been living with persistent dampness and a lack of basic furnishings.

It is unacceptable that we are treating members of our community in this way and that in five years we have not found a way to fix these known issues.

LACK OF ACCOUNTABILITY

By far the most consistent and most pertinent issue raised by the report is the part which is not said explicitly, but which is apparent on every page.

Despite the best of intentions, the inspection team, along with the vast majority of our public sector workers, do not have the tools, the resources, the training or the authority to make a difference.

From page 65 of the report we hear this explicitly: “This disconnect [in budgeting] means that the dedicated individuals who are most familiar with the intricacies of the service do not have the authority to allocate financial and human resources effectively. As a result, any attempt to advance or refine the service becomes a protracted and laborious process.”

Over and over throughout this 68 page report, we hear recommendations, opinions, suggestions…but not a hint of how any of this feedback will be used, delivered, or checked up on.

This is simply not good enough, especially when government ministers go on to use this report as a vindication or say that “mental health services are better than they have ever been”.

Put bluntly, that is incredibly cold comfort to anyone who has spent months waiting for an appointment only to have it cancelled at the last minute.

LACK OF RESOURCING

Another persistent issue throughout the report is the lack of adequately trained staff.

It’s clear that the Inspection Board has a very good idea of where the gaps are.

An overreliance on contractors, lack of local recruitment, and an inefficient use of trained staff.

They also have practical suggestions for how this could be resolved: hiring and training more local care workers, reducing the dependence on untrained contractors, providing more development opportunities and ensuring staff have clear job descriptions.

The board also acknowledged the problem of recruiting specialists.

Currently we have to import them to provide services, and when faced with the reality of working in Gibraltar, many of these specialists don’t want to stay.

This creates a vicious cycle where no one has institutional experience of local cultural factors, and service users are passed from professional to professional each with a totally different view of their condition and its treatment.

The Inspection Board acknowledged that even preparing a welcome pack for these specialists and helping them work through government bureaucracy could help alleviate the issue.

If we need ministerial intervention for even these basic tasks, then the whole system, not just the mental health services, is simply not fit for purpose.

INVESTING IN PEOPLE

Throughout the report, it is incredibly clear that Gibraltar has the passion and the talent to fix these kinds of issues.

Unfortunately, the Board who has done all the work do not have any tools to implement the solutions, nor do we as the public have any means by which we can make sure the government ministers act to change this.

As I help Together Gibraltar work on their policies for the government, this lack of enablement in our public sector will be my number one priority.

As a proud Gibraltarian who knows lots of talented public servants and who believes in the power of government to make people’s lives better, I simply can’t just sit back and watch another year go by where we know what the problems are, but refuse to invest in the people who can fix them.

Quoting again from the Inspection Report: “In an ideal world, those at the helm of Mental Health Services would be given the autonomy to determine how their budget is spent, enabling them to make informed and responsive decisions.”

This ideal world is not only possible, it’s necessary for all of our wellbeing. Endless reviews, audits and investigations will not solve these problems.

A change in government will not solve these problems.

The only solution to these perennial and persistent problems is to finally, properly, invest in our public sector workers.

Nick Calamaro is the Leader of Together Gibraltar.