The Maltese Association of Psychiatry (MAP) refers to the recent change of management of a care home for individuals with disabilities, as reported by the Times of Malta.
The country is presently and correctly in the process of deinstitutionalisation with closing down of mental health institutions, where a very considerable amount of persons with severe mental disorder have now left hospital and are being integrated into small community based homes. This process is ongoing and supported.
The reported required change of management of this particular home highlights the urgent requirement for strict adherence to internationally recognized care standards, to protect vulnerable individuals from neglect, abuse, and substandard living conditions.
Care homes for individuals with severe mental disorders or learning disabilities must uphold the highest standards of dignity, safety, and therapeutic care, in line with global best practices.
International Standards for Care Homes include:
1. Person-Centered and Dignified Care.
The World Health Organization (WHO) Quality Assurance Rights initiative (2021) emphasizes that care homes must prioritize individualized care planning, autonomy, and informed consent. Institutionalization should be minimized, with an emphasis on community integration and supported decision-making rather than restrictive, isolating environments.
2. Safe and Therapeutic Environment
The United Nations Principles for the Protection of Persons with Mental Illness (1991) and the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD, 2006) state that individuals must receive care in the least restrictive environment. Facilities must be designed to prevent abuse, neglect, and unnecessary seclusion or restraint, ensuring that residents live in conditions that respect their dignity and well-being. Work practices must include stimulation and compassionate care.
3. Access to Comprehensive Healthcare
The National Institute for Health and Care Excellence (NICE) Guidelines on Mental Health and Social Care (2022) emphasize that residents must have access to multidisciplinary healthcare teams, including psychiatric, psychological, and general medical services. Early intervention, rehabilitation, and ongoing medical support are essential in promoting well-being and preventing deterioration.
4. Staff Training and Ethical Practice
The WHO Mental Health Action Plan (2013–2030) highlights the importance of specialized training for caregivers, ensuring they are equipped with the necessary skills in trauma-informed care, de-escalation techniques, and ethical treatment practices. Staff must be well-trained to recognize and prevent human rights violations, ensuring the highest standards of care.
5. Monitoring and Accountability
The United Nations Special Rapporteur on the Rights of Persons with Disabilities (2019) stresses that independent oversight bodies must regularly inspect care homes to prevent maltreatment and enforce international care standards. Regular audits, transparent complaints mechanisms, and active service-user involvement in care planning are crucial to maintaining accountability.
Inter-Ministerial Collaboration and Mental Health Prioritization:
To prevent further failures in the care system, there must be stronger collaboration between all ministries. An interministerial, independent, commissioner for all persons in care is recommended.
A coordinated approach is required from policy makers to ensure:
a) Sustainable funding for mental health services, care home facilities, and staff training.
b) Strong regulatory oversight through joint inspections and compliance frameworks, operating to mandatory, clearly identified and internationally recognised standards.
c) Better community-based alternatives that reduce reliance on institutional care and promote independent living with appropriate support.
Governments must prioritize mental health services as an integral part of healthcare, ensuring that individuals with severe mental disorders or learning disabilities receive adequate resources, professional support, and dignified care.
As the country transitions to care of the more vulnerable in the community, this must take place within a setting of appropriate and timely oversight with ongoing clear messages that neglectful and abusive services will not be tolerated.