All the lonely people… | Alfred Grixti

The Foundation for Social Welfare Services has just come out with its annual report for the year 2021 – a year that was dominated by the Covid-19 pandemic. On the basis of this report: what can you tell us about how the crisis actually affected our society, in terms of mental health?

Let’s start with this: even before the pandemic, all the research was showing that mental health issues were on the increase. About four years ago, it was estimated that around ‘one in four’ of the population was liable to suffer from some form of mental health problem or other. At the end of 2019, there was some research published suggesting that it was even going to increase to ‘one in three’. And that was before Covid-19…

Nonetheless, the pandemic obviously didn’t help. It did drive people ‘up the wall’, so to speak. Even here, at our offices, our employees had to juggle their work responsibilities, with working from home. And I can confirm – as FSWS CEO: and therefore, the guy who had send out all the memos to our (mostly young) staff… to remind them that ‘work from home’ is still ‘work’ – it wasn’t easy.

And if it wasn’t easy for us, as a national agency catering for social welfare… one can only imagine how much harder it must have been for everyone else. For instance: many teachers – I would say practically all of them, in fact – did a fantastic job of giving their lessons online. But it still meant that there was a greater expectation on parents, to – at minimum – make sure that their kids were not playing on the internet, rather than following the lesson…

And of course, those parents also had their own jobs, and household duties, to attend to: on top of all this new pressure. So the pandemic did, undeniably have an effect. It caused a shift in the way people live and work… which, after a few months, started becoming difficult to accept.  It took time for people to adjust to this new reality; and it also meant that people had to learn a whole new skill-set: in a very short time, and under very difficult circumstances.

Don’t get me wrong: I’m not arguing against the concept of ‘remote working’ as a whole. There is, at the end of the day, a lot to be said for the possible benefits of working from home… or even the need to change our life-work routines in general. But it all takes its toll, ultimately…

As mental health frontliners, however, the FSWS is in a position to quantify the effects of all this pressure. Was there, for instance, any noticeable increase in the number of people using FSWS services, over the course of the pandemic?

Let me put it this way: towards the end of March 2020 – at the beginning of the pandemic - we introduced what we call the ‘loneliness helpline’. In the first six months, we received around 6,000 calls… from people – mostly elderly – who just wanted to chat.  In recent months, that rate has gone down considerably: presumably, because people are now going out more, as a result of restrictions being lifted.

But still: during the first six months of the pandemic, we were receiving around 1,000 calls a month… from people who are basically lonely. People who are in solitude. And if you ask me: that says a lot.

Because in a small country like ours – where, let’s face it, we so often complain that people are too ‘intrusive’… where everybody lives on top of each other, and where it is so difficult to live in privacy… it turns out that there are 6,000 people, who called a helpline just to be able to talk to someone. To have a chat, with anyone, about nothing in particular…

This shows us that, in spite of whatever we say, and whatever we think about ourselves as a society: this little island of ours is changing…

How much of this change is directly attributable to Covid-19, though? Reason I ask is that the perception you alluded to there – of Malta as a small country, where everyone knows each other; and where there is a strong tradition of close family networks, etc. – all that has been changing for a long time now…

Yes, it has. To give you an example: I myself live in Haz-Zebbug. Not that I am originally from Haz-Zebbug, mind you. My wife is… but as for me, I’m a ‘Belti, minn Tas-Sliema’. All the same, I live in Haz-Zebbug – and I was even its mayor, in what feels like another lifetime – and as such, I can confirm that there is still a strong sense of community, in that village.

But it is undeniably changing. The main road leading into Zebbug, for instance – ‘Gate Avenue’, ‘Vjal il-Helsien’… call it what you will – is all being pulled down. The ‘Zebbugin’ are selling their family homes, and building apartment blocks instead.  Now: I don’t want to digress into other issues… but one of the consequences of all this new development – apart, of course, from the effects of construction itself: noise, dust, disruptions, etc. - is that… people no longer ‘know everybody’ in their towns or villages, like they used to. People now have complete strangers, living in the same apartment block, or down the same street…

I’m only giving this as an example of how the social landscape is changing: because if it’s happening even in the core of Malta’s more traditional villages… just imagine, how much it is happening in places like Sliema, St Julian’s, Gzira…

But what effect are these changes having on – for instance – the way we approach mental health issues in Malta? You’ve already mentioned the introduction of a loneliness helpline… but what else is FSWS doing to cope with the situation on the ground?

Let’s give a bit of background first. FWSW was originally set up in 1994… and as for services, it started with Sedqa – the national agency for addictions – and the introduction of child protection and domestic violence services, under what was then called the Social Welfare Development Programme… which eventually became Agenzija Appogg.

We have grown a lot since then… but that’s how FSWS started. And what does this tell us? That 27 years ago, this country’s social welfare policy-makers identified two main ‘problem areas’: and they responded by setting up three basic services.

So until quite recently, we were - how can I put this? – a bit like a medical service, but with only an emergency ward…. and no primary healthcare. At the time I was appointed CEO, we had four community service centres – one in Valletta, one in Qawra, one in Msida  - which also caters for Birkirkara, because we couldn’t find a place there (and still can’t) – and one in Cottonera.

Again, however: these have to considered as ‘emergency services’. There was evidence, at the time, that those were the localities we needed to be present in; but they are also the places that are traditionally associated with ‘social problems’: what we generally described as ‘depressed areas’.

But this also means that we were not present in other areas. We had no presence at all in Gozo, for instance. Today, however, we have a presence in Marsalforn...

Sorry to interrupt: but if Marsalforn – a previously tranquil seaside village, if there ever was one – is now considered a ‘depressed area’, alongside Msida and Cottonera… then the social landscape must really be changing quite drastically…

You could look at it that way, yes. But to be more precise: the actual Family Services Centre we set up in Gozo is in Rabat, not Marsalforn. But we felt the need to be present in Marsalforn too, because… yes, it is considered a problem area, today. There’s a lot of internal migration, because of high rents – basically, people on low income find Gozo a cheaper place to live – and also a lot of foreigners, employed mostly in the catering sector.

But it’s not just Marsalforn. Just recently, the Bishop of Gozo asked us to set up a similar service in Xlendi, too. And meanwhile, we have opened up other centres in Malta: in places like Qormi; Hal-Kirkop; Zurrieq…

Because the instructions I was given – by my former minister, Michael Farrugia: who is a doctor by profession – were… well, the sort of advice you would expect from a doctor, I suppose. All medical professions will tell you that you need a good General Hospital, yes… but you can only have a robust health service, when you have strong primary healthcare.

My present minister [Michael Falzon], on the other hand, comes from the banking sector; and all banks, traditionally, have a branch in every town and village. So the idea is to extend our reach, as FSWS, to all towns and villages, too. And we fully agree, because – while it may seem like a trite cliché – if we nip problems in the bud, we can solve them much faster, than if we allow them to fester, and grow…

Your ‘primary healthcare’ analogy is particularly relevant, because – as we so recently saw with Covid-19 – it is important to prevent the emergency services from becoming overwhelmed. Nonetheless, a health service does still need to cater for emergencies, too. So how does this work out, in practical terms? Do you see your role as more ‘prevention’, than ‘cure’?

Let me it put this way: we’re not the ‘Light Brigade’. Our job is not to go ‘charging in’, wherever there is a problem. The way I see it… we are enablers. Our job is to assess what local resources there are, on the ground; and help them to grow.

For this reason, we have – as I said - invested more in community services; but we have also teamed up those services with family therapy within the community… what we call ‘home-based therapy’. We are looking at – and working with – ‘troubled families’: to use the jargon prevalent in the UK. Families which are at risk of poverty; which have problems which might end up in domestic violence, or even child protection orders…

That, in a nutshell, is the direction we are moving in. It is a multi-disciplinary approach: involving community workers; youth workers; social workers; family therapists; and community development agents...

And yet, it wasn’t all that long ago that the entire issue of mental health was virtually ‘taboo’ – to the extent, for instance, that individual cases were traditionally ‘hushed up’ by families. From your own experience dealing with cases on the ground: have people really become more open and receptive to the idea – promulgated by FSWS – that ‘mental health’ is really just another medical issue, to be treated no differently from any other?

Yes, I do believe that public perceptions have changed. But to be quite honest: it didn’t begin now. One of our community-based services, which specifically deals with ‘mental health in the community’, is based at the Qormi health centre. It was set up in 2004; and it has been an extraordinary success ever since.

At that centre, there are three psychiatrists; three psychiatric nurses; and three social workers. And they cater for a population of around 500 to 600 patients: that is to say, people who suffer from mental health issues… but who continue to live independently in their own locality: and who have access to a locally-based support system.

Much more importantly, however… they are also accepted by the local community. And this means that those people are ‘taken care of’… but not at the expense of their integration into society. And to me, that is a beautiful thing.

Because it also proves that – while there will always be the need for an acute psychiatric hospital: in fact, a new one is being built, and will hopefully be completed in as short a time as possible - the really important thing is to provide caring services within the community itself.

What would you say triggered this – let’s face it – remarkable change in public perceptions of mental health?

It is a combination of many factors – too many to go into here – but if I had to single out only one aspect, I would say that… many people are now beginning to realise that ultimately, there is only a very fine line between being mentally ‘well’, and mentally ‘ill’. People are realizing that… ‘it could be me’.

We are, at the end of the day, all different from each other; some have higher resilience levels than others. But nobody is entirely immune; and there can always be the proverbial ‘last straw that breaks the camel’s back’.

As for myself: I don’t know when my own ‘last straw’ will come… but I do know that, like everyone else, I have my own breaking-point. So far, I thank God – or my lucky stars, or whatever - that I’m still one of the ‘two’, in that statistic of ‘one in three’ who may develop mental health problems. But for all I know… that could easily change tomorrow.   

Another thing I also know, however, is that – if my ‘last straw’ does come, in the end – there are also services, available within my own community, that can help me. And that, at the end of the day, remains the most important thing: that we continue to look out for one another, as a society.