The GMWS has welcomed the Mental Health Board’s 2025 report that was tabled in Parliament on the 18th March.

A statement from the GMWS follows below:

The GMWS welcomes the Mental Health Board’s 2025 report, tabled in Parliament on the 18th March. It is an even more substantial document than the previous ones, and provides an invaluable insight into the workings of the mental health service. We accept the Board´s view that things are generally moving in the right direction but that there are very important isues which still need to be  addressed. 

To mention a few of the positives, we welcome the news that the Lithium and Clozapine clinics are now providing much better regulation, that after years of no psychological input, a new prison counsellor has been introduced, and that a Second Opinion Appointed Doctor has finally been allocated, meeting legal requirements. The use of more counsellors in the GHA has also reduced waiting times for those seeking talking therapies, who do not need to see a psychologist.

However, there are still a number of outstanding matters which have been priorities for the GMWS for many years. We repeat our call for an increase in the number of beds in Assisted Living for those individuals who are incapable of living on their own, even with care packages. We also maintain, as does the Board, that any Assisted Living unit should be supervised by a Registered Mental Health Nurse. Also, central to good mental health provision is a detailed, meaningful care plan which is periodically reviewed and and adapted to the needs of the service user. We believe all patients in the community should have one.

We are glad that the Activities Coordinator in Ocean Views now has a formal job description but the lack of remuneration that should go with these added responsibilities undermines the importance of  the role. Moreover, we believe that there needs to be a minimum of two staff undertaking this role to ensure sustainability, and to avoid cancellation of activities due to staff shortages. The necessary resources for activities also need to be guaranteed. 

Staff shortages remain an ongoing problem. Fortunately, a new cohort of RMNs is currently being trained at the Gibraltar University and we hope that this course will continue to be offered in order to ensure the required complement of RMN's is sustained into the future. In the meantime, some contract staff has had to be recruited. The report states that 70% of Ocean View's beds are occupied by people inappropriately placed or awaiting housing; discharges are delayed by lack of housing. This is a problematic situation which needs to be resolved urgently. Also in relation to service users, who transition into the community, it is important to note that there is no budget for basic furniture and household essentials. As a result,  the outreach team spend a lot of time and energy trying to acquire stuff from a number of charities. We think this is totally unacceptable. We agree with the Board that there should be a minimum fund available to cover the cost of all vital requirements, to ensure that service users living in the community feel they are being treated with dignity.The Board continues to express concern about the Detox pathway: based on medical evidence all detox should be at St Bernard’s due to clinical risk. However, some patients needing detox are still referred to Ocean Views, which isn’t set up for high-risk cases. This situation needs to be put right, once and for all.

On another note, the s.106 Code of Practice  has still not been published. This is the statutory guidance that sits alongside the Gibraltar Mental Health Act 2016. Without it, clinicians and managers have no authoritative benchmark for how the Act should be applied in day-to-day decisions (detention, consent, treatment, safeguards). This situation forces reliance on individual interpretation or precedent, which leads to inconsistency between teams and shifts. The Board believes that publication of the Code of Practice, even partially, while it is being finalised, would be beneficial. This would provide consistent standards for practice, decision-making and patients’ rights. Very importantly, it would include the role of Independent Mental Health Advocates[IMHA]. We agree that there should be no further delays on this matter.

The need for IMHAs, a role presently included in the UK Code, is another matter which the GMWS has been campaigning on for a number of years. These advocates would provide an essential safeguard for patients' rights, especially those without family and friends to support them,  who are usually the most vulnerable service users.

We were very concerned to learn from the report that a part time psychiatrist post (0.5) was not renewed after a 2023 admin error. This means that the service has 4.5 psychiatrists and not 5, which would be considered a full complement. This has clearly had a negative impact on service users. The Report also points out that the GHA lacks NHS-style junior support.  As a result, senior  psychologists and psychiatrists face increased management and supervision tasks, thereby reducing direct clinic times, and allowing them to see fewer patients than they otherwise would.This would partially explain why waiting times for these professionals are still months long.

Other pending matters include the lack of a mental-health suite provided in A&E, despite ministerial commitment on this matter; lack of space for Gibraltar Young Minds, which is otherwise working very well- the Board believes that this problem could be fixed easily if there was better management of the space shared between departments. The Mental Health Liaison Team is also lacking a suitable office space.A smoking-cessation programme is still due in the service, as is the move to electronic notes and data.

The most significant improvement to the service will be new Mental Health Hub which will be housed in Joshua Hassan House. One of the many improvements that this Hub will provide, with its “new model of care”, is having a GP embedded in the system. The Society agrees with the Board that there is no reason why a GP has not already been allocated to the present Community Mental Health Team. There is no need to wait for a new building before this is done.

The GMWS acknowledges that mental health provision in Gibraltar is clearly being given much more importance than in the past and that there is an increasing awareness of its importance in ensuring the wellbeing of the community. The commitment to a new mental health hub, offering a much more coordinated and enhanced provision across the service is a very exciting project but only if it does provide the new model of care that it promises to deliver. We find that at times aspects of the service exist in theory but fall short in practice. This is what needs to change. We need to have mental health provision which can be relied on to work very well, most of the time- as we do with physical health. We appear to be moving in this direction  but we´re not there yet.