Mental health reforms correct historic error of ‘misdiagnosed’ schizophrenics

The mental health advocacy NGO Richmond Foundation has welcomed news that more free medicines have been included in the Schedule V list for chronic mental health sufferers.

Up till now only persons with schizophrenia were eligible to receive the appropriate treatment for free.

The widening of the list of mental health conditions that qualify for free medication was an urgent problem highlighted by the mental health commission over five years ago, when it threatened a mass resignation over the slow pace of progress.

Under the amended Schedule, the number of medical conditions which entitles patients to free medicines has been doubled, benefitting thousands who suffered from illnesses such as dementia, depression and hyperactivity disorder - but were deliberately misdiagnosed as schizophrenics because this was one of the only conditions benefiting from Schedule V drugs.

"With the announced amendment, social justice is served," Richmond's operations manager Holger Saliba said. "Psychiatric medication is expensive and it could be unaffordable even for persons who are not eligible for the pink card (Schedule II). The Foundation is fully aware that such change has been the result of months-long ongoing discussions between the helath ministry and the former ministry for education and family."

In 2007, the National Commission for Mental Health Reform warned health minister Louis Deguara it would resign en masse if its proposals to widen the mental illnesses covered by free medication remain ignored by the government.

Before the reforms, most of the medication given for free to mental health suffers had to be prescribed under the false diagnosis of schizophrenia, simply to fall under Schedule V, the list of chronic illnesses meriting free medicine.

That meant that those suffering from illnesses such as bipolar affective disorder or chronic depression, amongst others, were not eligible for free medicine because they were not listed under Schedule V.

So most of the medication given for free as prescribed under the misdiagnosis of schizophrenia or schizo-affective disorder, formerly the only two illnesses eligible for free medication under Schedule V.

"The system is wrong because everyone is virtually classified as a schizophrenic even if they have 'mere' chronic depression, challenging behaviour and learning disabilities," a psychiatrist had told MaltaToday. "It is wrong because it's unfair on the patients to be misdiagnosed, it's unfair on the system itself because of the chaos it creates in treatment, and it's unfair on all those who resist being mislabelled as schizophrenics but still require free drugs."

This also meant that health records were largely inaccurate and causing chaos in treatment, the commission maintains.

"This is a very important stepping stone in community mental health in Malta and Gozo. The Foundation has lobbied for such change for years and such news is received with great satisfaction," Saliba said.

In 2010, Richmond Foundation organised a petition and collected 3,266 signatures urging the government to amend and expand the eligibility criteria of Schedule V. The petition was presented to the Prime Minister Lawrence Gonzi on 1 November 2010.

"Richmond Foundation believes that service users should be at the centre of our psychiatric services. It promotes legislation and policies that respect and enhance the rights of service users. Right-based legislation and policies tackle the prevalent stigma which is still a major issue within our society at large even though 25% of the Maltese population experience mental health problems per year," Saliba said.

Since 2008, the cost of medicinal provision has increased from €56 million to €64 million in 2011. But the changes to the regulations should not add much to the financial burden, since most of the medicine was still being given for free to deliberately-misdiagnosed patients.

The national mental health commission has argued that on the contrary, making medications more accessible would probably decrease admissions to hospital, which are very expensive, and decrease costs.