The Hon Gemma Arias-Vasquez MP, Minister for Health, Care and Business

 

Madam Speaker,

I beg to move the motion standing in my name which reads as follows:

 “THIS HOUSE:

WELCOMES the tabling of the Mental Health Board Gibraltar Annual Inspection Report 2023 by the Minister for Health and Care, the Hon Gemma Arias-Vasquez MP.

NOTES the contents and recommendations of the report, as set out therein.

THANKS the Mental Health Board for their work in producing such a detailed report.

BELIEVES the general overarching view of the report when read in full demonstrates a clear and significant improvement of Mental Health Facilities in Gibraltar.

FURTHER BELIEVES that His Majesty's Government of Gibraltar will continue to work tirelessly, to ensure that Mental Health continues to (i) improve and (ii) remain a priority on His Majesty’s Government of Gibraltar's agenda.

AND CALLS on His Majesty's Government of Gibraltar to consider implementing any recommendations contained in the report which remain outstanding and are in the interest of mental health service users in Gibraltar.”

 

Madam Speaker,

This is my maiden speech to this house.

I am really pleased to be able to bring this motion, Madam Speaker for two reasons:

1. It shows the seriousness which this Government gives the issue of Mental Health;
2. I am pleased to be able to move a motion in this house, which presents the subject matter, warts and all, in an attempt to improve the service.  It is an attempt, Madam Speaker, to show that this is a matter which, to my mind, transcends party politics.  It is an attempt Madam Speaker, to get into the guts of the issue and determine how to improve Mental Health Services in Gibraltar.  I will endeavour as far as possible to steer clear of party politics in this motion.

 

I believe that this is the manner in which many issues need to be addressed in this Chamber.

Particularly when it comes to the larger of my portfolios – Health, ERS and the Care Agency.

Unfortunately, this did not get off to a very good start last week, Madam Speaker, but I hope that the Honourable Leader of the Opposition will be able to confirm that the report was laid in this house, exactly as I said it was. 

I hope he will confirm that they have had an opportunity to review it in detail. 

And that I am certainly not trying to self-congratulate or bring the motion prematurely.

As I have previously stated the motion and the report were filed simultaneously. 

The order in which this was received by the Honourable Members Opposite was simply procedural.

I am hoping – at least – for an acknowledgement from the LOTO that this is the case and that we can proceed from there.

I go further Madam Speaker.

I have a legal obligation pursuant to the Mental Health Act to file the report in parliament. 

I do NOT have an obligation to file a motion in parliament. 

I have done so, in order to properly ventilate the issues. 

To highlight what is outstanding; and to highlight what we intend to do.

Not to congratulate myself, Madam Speaker.

I do not brush things under the carpet – as I have been accused of doing. 

I address them.

It is the only way I know of bettering the system.

The report by the independent Mental Health Board contains many positives – and some negatives.

Whilst I acknowledge that going through issues of mental health with children is difficult, I want parents to know that we are committed to try and improve the proposition for children.

I want people to understand that we are fully committed to providing a community mental health service in the centre of town, that not only does everything that Coaling Island currently does – but goes further. 

With the efficient use of resources.

Let me be clear – this is NOT an attempt at trying to score political points, or to through digs at the Opposition.

It is an attempt to show commitment to these issues.

It is instead an attempt to use this motion and the recent Mental Health Awareness Week to raise awareness of Mental Health issues and in particular to highlight where we are in terms of Mental Health service provision locally.

Madam Speaker, this is the 5^th Annual Report addressed to Parliament since 2019.

This is the opportunity to be publicly held to account on all matters relative to Mental Health.

For the sake of transparency, there is an obligation on me as the Minister for Health to publish this report, which I of course am committed to doing as set out in law. Which I have done at the earliest opportunity after meeting them to discuss.

Madam Speaker, turning now to the report, the board state that this “is neither a critique of the current mental health system not a celebration of it. It simply tried to give a snap shot in time of where we are and where we should be heading.”

It is on that basis, as I have already set out, that I intend to address the House today.

In 2021, the GHA published its Mental Health Strategy which is in place until 2026. For this, Madam Speaker, I thank my predecessor, the Hon Samantha Sacramento for the work done and the foresight she had in producing this strategy.

This strategy, in my view, whilst not perfect, has been fundamental in revamping our Mental Health service provision in Gibraltar.

I am pleased that the board has recognised this saying that the strategy has given the service “a new impetus” which it says it so badly needed.

We now have a direction of travel.

It is the intention to continue the plan set out in the strategy and to continue to review it beyond 2026 such as is recommended in the strategy.

For Mental Health – and indeed all health matters – are matters which do not stand still.

They need continuous review.

Madam Speaker, I think a matter which cannot, in my view, be of dispute between us and Members Opposite is that our Mental Health services have greatly improved in recent years.

Whilst I stand here today, Madam Speaker and fully accept that there is more that needs and must be done in this area, I think we must pause to reflect on how far we have come.

And that is a view which I think is clearly set out by the Board in their report.

Again, whilst this may appear party political – I am echoing the boards view on the subject and applauding the work of the professionals in this area who often times work in very difficult circumstances.

 

WHERE WE ARE NOW

Madam Speaker, I am pleased to report that admission to Ocean Views are at a record low.

This I believe must be, to a very great extent, thanks to the brilliant work being done in the community.

I would like to take this opportunity to thank the front line Mental Health Liaison Team who, as recognised by the Board, have built stronger and closer links with other stakeholders such as the Housing Department Outreach Team and the Care Agency in particular. 

In this, we must go further – and indeed we will. 

The new Community Mental Health facility will build on the fantastic multi-disciplinary service currently offered, and strengthen links which are currently existing in the community.

I will go into this in greater detail later.

The first ever Registered Mental Health Nurse training is due to commence in September 2024, running for three consecutive years.

The BSc programme has been developed to meet Gibraltar’s local needs and is in line with the Mental Health Strategy, where we emphasise care in the community over in-hospital admissions.

This, again, is something highlighted by the Board as a positive development which we must welcome.

Madam Speaker, crucially, in my view, the GHA has re-organised its psychological services and I am pleased to report that there is now a full complement of psychologists and psychiatrists in posts.

This has meant that historical waiting times are now starting to be reduced and every effort will be made going forward to reduce this even further.

To quote the report:

“This in no way underestimates the historical issue of waiting times. However, it does point to the awareness that there is a need for action and everything possible is being done to alleviate the situation, while at the same time deal with the new referrals”.

 

SUCCESSION PLAN

Madam Speaker, the Board calls for the GHA and Government to “develop a local succession plan so that many of our future psychiatrists, psychologists and counsellors can be locally sourced”.

I could not agree more and I am pleased to tell the House that I have asked the GHA Director General to work together with his team on developing a local succession plan, looping in the Department of Education if necessary, and report back to me before the end of the year

We are indeed already looking to use locally trained counselors to fill positions. 

 

SMOKING

Madam Speaker, the Board consistently addresses smoking amongst patients as a significant issue, especially concerning mental health patients, where rates are disproportionately high.

Smoking exacerbates health conditions and can alter medication’s effectiveness which in turn may mean patients needed higher doses.

Whilst this is not an easy issue to tackle, as recognised by the board itself, I think we can do more to explore ways of trying to reduce the “smoking culture” that presently exists.

Public Health alongside the Mental Health team has set up a “coalition of the wiling” to assist those who wish to quit smoking. 

There is a specific nurse who has set up a smoking cessation support group in Clubhouse and offers Nicotine Replacement Therapy.

Again, Madam Speaker – I take this opportunity to recognize the fantastic support which are offered by mental health charities in Gibraltar.

 Clubhouse, GibSams, Childline, the Gibraltar Mental Welfare Society all provide valuable support to our services. 

And this support needs to grow and be encouraged – as it will be with the new Community Mental Health facility.

Again, Madam Speaker, we achieve better outcomes when we work collaboratively – GHA, Public Health and all the charities.

 

ACTIVITY CO-ORDINATOR

Madam Speaker, moving on, I am absolutely delighted that the report reflects the incredible work being done by the Ocean Views Activity Coordinator.

I know that this has been an outstanding issue and I am pleased we have now been able to resolve it, as recognised by the Board when they say “the new impetus given to the importance of activities to improve self-worth and physical health” which, they say, is now embedded in the system.

We will look to the recommendations made by the board here, in terms of job-description, which is an issue which I was not aware of.

I am absolutely committed to ensuring activities of the kind currently being organised at Ocean Views are continued and that we look into ways of enhancing this provision even further, centrally, at a new Community Mental Health Facility

We are of the view that it is through social prescribing that we will keep people OUT of Ocean Views, and ensure that matters are properly dealt with in the community.

We will be starting programmes in September under a “Covenant for Health”, which encourages people to stay healthy.

Regarding the “self-care” elements of the Mental Health Strategy – the aim – again – is to keep people healthy and in the Community.

This is all interlinked.

I am also pleased to confirm that one of the issues raised by the board relating to blinds in the balconies and shading in the garden has been addressed and works are on-going at Ocean Views.

 

DEMENTIA

Madam Speaker, I turn now to the board’s comments regarding Dementia Patients at Ocean Views.

The Government recognises the vulnerabilities of all its patients at Ocean Views and in particular those with Dementia.

Due to the complex needs of patients living with Dementia, for example, their predisposition to becoming confused, scared or frightened of their surroundings when they are not familiar with them, the Government agrees with the Board that Dementia patients are best placed at ERS facilities, where their needs can be better dealt with.

However, due to the large and growing number of Dementia patients in Gibraltar, our capacity at ERS is at a maximum and this has meant, at times, an overspill into Ocean Views.

This is NOT ideal, and the Government does not want to continue this practice for a moment longer than is necessary and I am pleased to report to the House that the Government is currently exploring ways to significantly enhance its capacity for Dementia provision in Gibraltar.

Whilst I would love to make an announcement on this today, we are not there yet but I am committed, as set out in our Manifesto, to working closely with GADS and our National Dementia Coordinator on this and all issues Dementia related.

The Government will, of course, make an announcement as soon as it is ready to do so but, Madam Speaker, I ask for a while longer on this front.

 

 

 

SOAD & CODE OF PRACTICE

Moving on now to the Boards comments about a “lack of Second Opinion Appointed Doctor”, I am pleased to tell the House the issues set out by the board in their report have been resolved.

A Second Opinion Appointed Doctor has now been appointed to undertake these functions, something I am sure Members Opposite and indeed the whole House will welcome.

Similarly, Madam Speaker, the Code of Practice is now at a very advanced stage.  We are awaiting input from third party stakeholders (Care Agency, Police and Education) prior to publishing the same.

I look forward to this being published in the very near future.

 

ELECTRONIC DOCUMENT MANAGEMENT SYSTEM

Digitalization is taking place and progressing – admittedly not at the speed that any of us want.

 

COMMUNITY MENTAL HEALTH

Madam Speaker, I turn now to Community Mental Health.

The Board found that the changes resulting from the Mental Health Strategy and managerial restructuring continue to benefit both patients and staff at CMHT.

Compared to 2021, there are fewer clinic cancellations, clearer objectives, and, according to the board, a greater sense of purpose.

A new appointment reminder system has been implemented meaning that the number of patients not attending has decreased significantly.

Madam Speaker, it is clear from the report that its main concern in this area is the need to re-locate the CMHT from its current premises at Coaling Island.

And Madam Speaker, I have already informed this House that we have already commenced discussions on the relocation of the Community Mental Health Team.

A new site has been identified and I was pleased to announce last week that the new Community Mental Health Team facility will be based in the heart of town. 

I am hopeful that I will be able to make an announcement at the budget on the location and funding of this new facility.

Discussions on this are progressing and a project board has already been set up to take everyone’s views into account.

The Mental Health Team has also decided to assess the current model of care in order to develop an improved and modern approach to how we can help its service users better integrate into our community.

The new model of care will encompass mental, physical and social health in its programme, where the service users will have a wraparound service which will help to meet their holistic needs.

Programmes to include Education and Housing will also be facilitated. Again – the aim is to keep people OUT of hospital and properly supported in the Community.

I would like to take this opportunity to thank the staff at the CMHT for their work in what I know is not the best of working environments.

And for the reasons I have just explained, Madam Speaker, we are absolutely committed to re-locating the CMHT as soon as possible.

 

G.Y.M

Madam Speaker, turning now to Gibraltar Young Minds.

The Gibraltar Young Minds team has undergone a significant transformation.

They now have 1 Registered Mental Health Nurse, 2 Enrolled Nurse, 2 Counsellors, 1 Child Psychologist, 2 Psychiatrists, and 1 part-time external Child Psychiatrists.

Madam Speaker, I am pleased to inform the House that this restructure has greatly reduced the waiting list for children to be seen within the service.

This year, on average, from time of referral to first contact with the team was 2 weeks.

The Gibraltar Young Minds team conduct allocation meetings every weekly attended by all professionals within the team, together with the Head of Child Social Services and a representative from the Department of Education. This process reinforces accountability and governance to all referrals made to the service.

I would like to take this opportunity to thank all the staff of Gibraltar Young Minds for their efforts and dedication to improving our children’s mental health services in Gibraltar.

As I have stated numerous times in Parliament, it is difficult for a population of our size to have a full time child psychiatrist.

For this reason, we have opted to have the virtual consultations.

We are committed to improvements in this area.

If once the neurodevelopmental pathway - which I am happy to say I am meeting Hon Members Opposite on tomorrow - is established there is still a need for a child psychiatrist, we will review the complement or the composition of the complement.

The report deals squarely with the ASD/ADHD Pathway. 

This will be published in the next fortnight in the next fortnight as the new neurodevelopmental pathway.

A multi-disciplinary team has now agreed the approach which they are able to take for diagnosis and follow up of children with neurodevelopmental issues.

Prior to publishing this pathway, we agreed to share this with the opposition.

I am aware that the Honourable Member Opposite will have a knowledge of the subject, which only a parent can have as she has spoken publicly about this. 

The Honourable Shadow Minister for Health has also written about a personal interest in this subject.  As such, we have agreed to de-politicise this issue and work together, united, on a matter of such interest to our people.

For Madam Speaker throughout this speech, I want to make abundantly clear that in all these issues there is more that unites us than that which divides us, in the infamous words of the late Jo Cox MP.

In these issues, as a mother I can only (1) apologise to any parent whose child has not been diagnosed quickly enough, and (2) assure those parents that the Pathway will be published, certainly before the Budget, with (I am optimistic) the approval of Honourable Members opposite, as well as the Psychiatrists, Pediatricians, OT’s, Educational Psychologists, Physiotherapists and Speech Therapists. 

Not an easy task, Madam Speaker.

But with that pathway we hope to ensure (1) quicker diagnosis and (2) better follow-up.

 

MENTAL HEALTH LIASON TEAM

Moving on, Madam Speaker.

The Mental Health Liaison Team started in 2020 with two Registered Mental Nurses (RMNs) providing a day service.

This was later expanded to a 24/7 service with five RMNs.

Their efforts must be acknowledged by the House as, in my view, and indeed that of the Board, this significantly impacted mental health services locally by reducing admissions to Ocean Views.

Madam Speaker, as we have discussed in this house during Question time recently, the Mental Health Liaison Team operate near A & E to respond promptly to crises, supporting both hospital patients and those in crisis situations.

Madam Speaker, over the next financial year we will look at ways to further expand the service which is already proving to be extremely successful.

Madam Speaker, there is a lot of content in the Mental Health Board report and it is just not practicable for me to go through everything.

I am, however, in the interest of time, willing to deal with any such issues that Members Opposite which to raise, which I may not have raised in my speech, during the course of my Right of Reply.

Madam Speaker, in closing therefore, the Government I am proud to form a part of feels a deep sense of responsibility and commitment to the cause of mental health awareness and to enhancing service provision in our community.

Today, I have outlined the progress we've made, the challenges we face, and the path forward.

We must acknowledge the huge strides we've taken, the work done as part of our Mental Health Strategy, which has never previously existed, and the dedication of our mental health service workers.

Yet, we cannot afford complacency, as it is clear there is still much more ground to cover – which this Government fully accepts.

We must re-double our efforts to enhance our mental health services, ensuring accessibility, quality, and inclusivity for all those who need it.

As we move forward, let us all pause a moment to reflect on that fact that mental health knows no boundaries – it does not recognise politics or partisanship.

It is a shared responsibility, a collective endeavour that should, in my view, transcend party lines.

In the words of the Mental Health Board, lets continue to aim for a future where our Mental Health services reflect the compassion, dignity, and respect that every individual deserves.

Let us aim to de-stigmatise mental health – and this will only be achieved by speaking about Mental Health issues openly and addressing them.

Together, let us build a Gibraltar where mental health is not just a priority but a fundamental aspect of our collective consciousness.

Madam Speaker, before I end I must take this opportunity to thank the Mental Health Board, ably chaired by Mr George Parody, for the way in which they have carried out their work.

Their report is 68 pages, Madam Speaker.

There is a huge amount of detail which I am sure many will want to closely examine, but there can be no doubt that, despite many challenges and the need to improve further in many areas, mental health provision in Gibraltar has NEVER been so good.

Madam Speaker, I commend the Motion to the House.

ENDS