60% of drug users hospitalised for social reasons

More than half of psychiatric admissions at Malta’s mental health hospital were related to substance use disorder (SUD) and were primarily due to social issues, rather than medical or psychiatric deterioration, according to a recent study published in the Malta Medical Journal.

The study, conducted by Emma Camilleri, Caroline Vassallo, and Kristian Sant, analysed 95 patient records over a 13-week period between October 2021 and January 2022.

It found that social factors, including financial instability, unemployment, housing issues, and lack of social support, prompted 58.8% of psychiatric admissions among substance users. In contrast, 34.3% of patients were admitted with a comorbid mental health illness, while only 6.9% were admitted for stabilisation before entering a rehabilitation programme.

The authors noted that substance users often forwent existing community aid infrastructure and instead presented themselves to the emergency department or an emergency general practitioner.

“This often-prompted hospitalisation for social rather than acute medical or psychiatric complaints. However, acute medical facilities often could not provide immediate solutions for long-standing social issues,” the study said.

Despite initial referrals often citing mental health deterioration or suicidal ideation, the study found that social hardships were the predominant factor leading to hospitalisation. This suggested that many individuals with SUD used hospital admission as a gateway to access social services, which remained difficult to navigate or were not tailored to the needs of substance users.

Homelessness and psychiatric admissions

A striking 17.65% of patients admitted to the hospital were homeless at the time of admission, confirming a link between housing instability and psychiatric crises. The lack of accessible shelter and support services left many individuals with substance use disorder with no alternative but to seek hospitalisation. The study suggested that without targeted housing solutions and community-based care, this trend would persist, placing further strain on Malta’s mental health services.

A Profile of Admitted Patients

The study found that substance users requiring psychiatric admission were predominantly male (79%) and under 50 (88%).

While 31% were aged between 18 and 29, a significant proportion (30%) were aged between 30 and 39, while a further 27% fell within the 40-49 age group. 11% were aged between 50 and 59.

The Southern Harbour region, which includes Cottonera, Valletta, and other neighbouring towns, reported the highest concentration of admitted patients, accounting for nearly 30% of all cases. This was followed by the larger North Harbour region (29%), which includes major urban centres like Sliema, Birkirkara, and Qormi.

The findings also indicated that polysubstance use was common, with 55.75% of admitted patients using multiple substances. Cocaine was the most frequently used drug (67.3%), followed by opiates (34.5%), cannabis (33.6%), and synthetic substances (18.5%).

Need for stronger community support

The study called for better community-based services to reduce the burden on Mount Carmel Hospital, which it said was already overstretched. It suggested that timely, accessible social service interventions, along with specialised addiction mental health services, could help mitigate the high rate of hospital admissions.

Among the proposed solutions was the development of community residences specifically for individuals with SUD, as they were often excluded from general support facilities due to their substance use. Additionally, strengthening links between hospitals and rehabilitation centres could shorten waiting times and facilitate smoother transitions for patients needing long-term care.

Burden on the health system

Hospitalisation periods ranged from one to 64 days, with an average stay of 17.5 days. However, many patients discharged themselves against medical advice, leading to frequent readmissions. This cycle further strained hospital resources and highlighted these individuals’ lack of viable community alternatives.

The study concluded that urgent reforms were needed to improve community-based care, enhance social service accessibility, and provide targeted support for individuals with SUD. Without these changes, hospitalisation would continue to serve as the default option for those who fall through the cracks of Malta’s social support system.