Funding required for ADHD services

Following Dr Nigel Camilleri’s article on the state of mental health services in Malta in the Times of Malta of 19 September 2018, I would like to bring to his valid argument the voice of the service users, the voice of frustrated parents, youngsters and adults who are recipients of these services and the lack thereof but intimidated to speak out for fear of negative repercussions due to stigma.

People with ADHD are recipients of services such as the ones offered at CDAU, CYPS, YPU, POP, CAPES, Detox, DDU, ASU, CORRS, CCF, SEDQA, Appoġġ, Caritas, etc. for various reasons, from a young age. ADHD Malta is the local NGO, support organisation and advocacy group for anyone with ADHD and is aware of the hardships that the Maltese ADHD community faces every day.

ADHD Malta has always steered away from complaining about service provision for fear of upsetting the professionals that whom we need to rely on for these services and treatment plans. However, on reading such an honest declaration coming from the professionals themselves speaks volumes and warrants a push from our end to highlight this grave lack in our Maltese psychosocial services and beyond with regard to the state of Mental Health Services in Malta.

The national service for children and youths (CYPS) is operating with only one psychologist causing a waiting list of up to two years for an evaluation and services for around two thousand children. Early intervention for ADHD diagnosis and management is internationally proved to be the most crucial way to assist a child and his/her family.

CYPS needs to be able to offer interventions to these children, be it diagnosis, anger management, CBT or DBT, and support parents with regular and ongoing parental skills courses in a timely manner. The premises being used leave much to be desired both operationally as well as from a patient- centred approach perspective.

There is no internet access, even when this is a basic resource that would greatly facilitate compliance and attendance of youths to this service. Parking is a real problem and older youths find the place decorated in an outdated and far too childish manner for their liking.

If parents are supported within their communities and shown how to manage their difficult situations as part of the services provided, everyone will benefit, including the educational system: teachers and LSEs. There will be fewer marital break- ups, less school truancy, fewer youths committing petty crimes, fewer reports to the police, and less exclusion.

If youngsters are supported better, given the necessary therapeutic support alongside the best pharmacotherapy possible (as advised by psychiatrists), there will be an improvement in not only their educational outcomes but also their quality of life in the long term, and to society at large.

As a key part of the multi-modal treatment plan for ADHD, patients need to have access to the full range of ADHD medicines which that are available in most European countries but not in Malta. To explain further, ADHD patients have been made to shift onto generic medication through POYC and this is causing difficulties to some individuals due to the way the generic medication is different (not as effective) to the original branded one.

This is resulting in a decrease in their quality of life due to less control of symptoms. Alternatively, it leads to an increase in the generic medication use for symptom control. It is about time that the money being saved from this exercise is used to provide ADHD-ers the other medications we desperately need to reach the various needs of the ADHD community. People moving here from European countries where there is access to a variety of medication are also finding themselves at a loss when faced with this serious lack of availability of medication, even on the private market.

It is hoped that the authorities will recognise the rights of ADHD patients at long last and invest heavily in the mental health sector as a whole, including POP adult services, where there are one-year waiting lists, rehabilitation services for addictions as well as Correctional Facilities that would benefit from a paediatric forensic psychiatrist.

All areas leave much to be desired to be up to the standard that patients deserve in a European country in 2018. It is about time that the plight of persons with ADHD is truly addressed in the best possible manner.