Developing the 2020-2030 mental health strategy for Malta: Addressing the needs of a small island state undergoing rapid socioeconomic transition

Malta has embarked on a renewed national endeavour to reform the mental health sector, prioritising mental health in the context of the national health strategy post 2020. Past attempts at reforming this sector were stifled due to insufficient and unsustained political commitment, leaving it direly under-resourced. An interplay of factors over recent years has rekindled political and public interest in mental health. These include: the establishment of a mental health commissioner; indictment from a National Audit Office report; and coordinated public pressure from local media, non-governmental organisations and professionals. Government responded by publishing a mental health strategy to address both long-standing and new challenges arising from rapid socioeconomic changes which have put further strain on an already overstretched system, demanding urgent action. The concept of strengthening resilience is put forward as a central tenet in the strategy and a combination of initiatives were proposed for the prevention of mental illness, investment in physical and human resources and the creation of a new service framework. Successful implementation of this strategy is dependent on continued political commitment, visible leadership, ongoing investment commitment, and meaningful engagement by key stakeholders. Ongoing stakeholder advocacy appears to be crucial to ensure that mental health continues to be considered as a national priority.