Tag: fatti

  • FATTI: Has Mental Health Investment Achieved a Transformation?

    FATTI: Has Mental Health Investment Achieved a Transformation?

    In October, Prime Minister Robert Abela was hugging people near the parliament, promoting the message “Your mental health matters”.

    It’s a message we’ve heard before. A focus on mental health and the introduction of a new hospital were offered in both the 2017 and 2022 ruling Labour Party’s electoral manifestos. Malta has had a mental health strategy in place since 2020.

    The government promises ‘transformation’, but is it delivering on key mental health needs?

    “None of us can feel secure unless we know that mental health is taken as seriously as physical health by our healthcare systems,” the Prime Minister said in his 2023 speech at the UN.

    “To help provide [the needed] reassurance, in Malta we have implemented a comprehensive mental health strategy to build capacity, address causes, and offer continuing support to individuals with mental health needs, and their families,” he added.

    Lydia and Robert Abela

    His wife, Lydia Abela, also proclaimed, “Going for a mental health check-up should be as normal as going to see your doctor.”

    For Health Minister Jo Etienne Abela, the Government’s strategy is based on the protection of mental health in every aspect of society: “Mental health care is a national priority. We believe in one healthcare system, and the first step to breaking the stigma is to combine healthcare that includes mental health as well as physical health.”

    Minister Jo Etienne Abela. Photo credit: DOI

    However,  when conditions in Mount Carmel hospital, the facility that currently provides inpatient treatment for acute cases (among other services), were criticised, Minister Abela told journalists that “we’re talking about a ward that is giving refuge to people who would otherwise have problems on the streets”, adding that “these are not patients, these are not persons who have been committed to a mental institution”, and are free to leave.

    “Many of these people will be suffering from what is known as a dual diagnosis [substance use disorder (addiction) combined with a psychiatric disorder], but their acute phase of the psychiatric disorder is over.”

    What is Malta’s state of mental health?

    The share of Maltese who reported emotional or psychosocial problems over the past year is 67% – far higher than the EU’s average of 46%. Of those who did, Malta reported a larger share of those who did not seek or find help.

    According to Eurobarometer 530, roughly one in eight Maltese respondents saw a psychiatrist for their mental health problems over the past year, and 7% saw a psychotherapist.

    A third of Maltese respondents reported they or their family had experienced difficulties accessing mental healthcare – a higher proportion than across the EU. Over half of them complained of long waiting lists and high costs, and a third tried to wait out the problem.

    Photo credit: Africa Studio

    According to the government’s consultation paper, over 15% of adults live with a diagnosed mental disorder – anxiety is the most common among them.

    Between 2010 and 2024, Malta recorded 437 suicides (365 male, 72 female). This peaked at 35 in 2021. Comparatively, Malta’s suicide rate is low.

    In 2024, there were 26 suicides among residents (22 male, 4 female) and 6 among non-residents (5 male, 1 female), the highest non-resident count on record.

    The number of people using services at Mount Carmel has steadily increased over the years, almost doubling from 1,129 in 2010 to 2,171 in 2024.

    Meanwhile, the number of persons using Mount Carmel’s inpatient services (both men and women) has increased and exceeded pre-pandemic levels, suggesting continued reliance on hospitalisation.

    The number of helpline users, and the number of persons making use of community mental health clinics grew as well.

    According to the National Youth Council’s 2018-19 survey, many young people in Malta believed there were insufficient mental-health services, and fewer sought help than the number of those who needed it. Subsequent awareness campaigns have been implemented to increase help-seeking, though publicly reported data confirming an increase in service uptake remain limited.

    Key mental health services are provided in the following facilities:

    • During the first year of its operation, the Crisis Resolution Home Treatment Team, which can address acute mental health crises without hospitalisation, received 276 cases, and 17 of them had to be hospitalised;
    • The Crisis Resolution Home Treatment (CRHT) served 409 patients in its inpatient service in 2024 – the number has been increasing since 2022;
    • The number of children aged 10-17 using inpatient services jumped between 2015 and 2016, initially peaked in 2017 before starting to decline before and during the pandemic, and grew again to 120 in 2024;
    • Usage of inpatient psychogeriatric services leaped from 42 in 2023 to 169 in 2024;
    • As of 2021, there were eight hostels housing 35 mental health patients; data from 2025 shows that 152 people live in mental-health-supported accommodation in Malta, showing NGOs carry a major share of long-term psychiatric housing;
    • The use of outpatient services at various clinics soared five times between 2021 and 2022 and grew to 23,429 users in 2024;
    • Helpline usage jumped by 29% between 2023 and 2024;
    • Patients needing help with eating disorders were predominantly female throughout the years. The number of patients using residential services has been declining, but the use of outpatient services has bounced back post-pandemic, reaching 262 in 2024, the largest number since 2014. A small number of patients used day services. 

    Noticeably, men make up roughly 83.5% of suicides in the data. This reflects the overrepresentation of men in other areas.

    Between 2010 and 2024, 17,358 men utilised services at Mount Carmel Hospital, compared to 7,593 women.

    On the other hand, according to an OECD report, depression is more commonly reported to affect women and people on low incomes.

    Patients at Mount Carmel Hospital. Data provided by the Ministry for Health and Active Ageing

    Addictions & Dual Diagnosis:

    As noted in the mental health strategy and reiterated by Minister Abela, “Mount Carmel Hospital is partially serving as a place of last resort and final safety net for a significant number of individuals who… do not require hospitalisation in a mental health institution”.

    “This situation places further strain on the already stretched resources and can detract attention from seriously ill mental health patients who require hospitalisation.”

    Some estimates suggest that dual diagnosis patients (addicts) may constitute between a third and a half of Mount Carmel Hospital’s patients.

    For example, the 2023 annual report from the Commissioner for Mental Health found that around 37 patients subject to involuntary admission were found to be homeless.

    A study published by the Ministry for Social Policy and Children’s Rights stated that 1,927 individuals were treated for ‘problem drug use’, with the primary drug predominantly being heroin. In 2022, Malta registered four overdose deaths.

    Department of Health’s data shows that as of 27 October 2025, 240 patients (176 male, 64 female) were admitted for addiction treatment. Men made up about 73% of all inpatient admissions for addiction treatment.

    Community mental health clinics (Paola, Qormi, Floriana, Mtarfa, Mosta, Qawra) handled cases of drug addiction, alcohol addiction, gambling disorder, and dual diagnosis. The Bormla Community Mental Health Clinic separately reported dual diagnoses cases: it handled 45 males and 34 females this year.

    Alcohol addiction cases are concentrated among older men (50+), particularly in Qormi and Mtarfa. Drug addiction cases span up to age 77, indicating ongoing treatment needs in older adults.

    Figures from Sedqa, Malta’s national agency for substance misuse, show the number of cases worked with, including both inpatient and outpatient interventions, has fluctuated over the past decade, with inpatient cases falling sharply from 287 in 2011 to 119 in 2020, before rising again to 313 in 2024.

    Meanwhile, outpatient cases have steadily increased, reaching 1,737 in 2023, and more people started using Richmond Foundation’s neuropsychiatry services.

    Crisis Resolution Home Treatment (CRHT) handled nine primary addiction crises in 2025: alcohol (3), cannabis (3), cocaine (2), and polysubstance abuse (1). It also handled 15 secondary addiction-related cases (mainly alcohol and cannabis). Overall, at least 24 CRHT contacts involved addiction. Cases span from 20-year-olds to men in their 70s.

    Children & youth:

    Malta has among the loneliest teenagers in the EU, according to the Health Behaviour in School-aged Children study (2022).

    Among 11-year-olds, 11% of boys and 16% of girls in Malta reported feeling lonely most of the time or always, placing them among the higher-ranking EU countries for loneliness in this age group. For 13-year-olds, 13% of boys and 27% of girls reported frequent feelings of loneliness, again ranking Malta above the EU average. Among 15-year-olds, 19% of boys and 30% of girls reported feeling lonely, higher than in other small countries such as Cyprus and Slovenia.

    Although the situation for 15-year-olds is somewhat less severe compared with some other EU countries, the proportion of adolescents reporting loneliness remains concerning. Data on 15-year-olds’ mental health well-being indicate that Malta also ranks relatively low within the EU.

    UNICEF data based on estimates from the IHME, Global Burden of Disease Study, 2019 shows that more than one in six of Malta’s adolescents (aged 10-19) had a mental disorder and that over 7,000 children and teenagers were in need of care. 

    In response, specific services target young people:

    • The Child and Young People’s Services  at St. Luke’s Hospital offers multidisciplinary services available by referral from a general practitioner;
    • The Child & Adolescent Psychiatric Emergency Services offers emergency services for young people aged 3 to 18 years;
    • The Crisis Intervention and Home Treatment team offers an intensive intervention to young people recently discharged or require extra support;
    • The Generic child and adolescent mental health clinics offer an assessment and intervention to all young people aged 3-18 years;
    • Family Focused Clinic provides a service to children and young people whose mental health is being negatively impacted by family dynamics;
    • The Anger Management Group Therapy trains young people to control their anger outbursts better;
    • The Young People’s Unit at Mount Carmel Hospital separates young patients between the ages of 12 and 18.

    Malta’s two public education institutions, the University of Malta and MCAST, run their own mental health services. According to official data, 33 MCAST students are currently in active follow-up with the Paola mental health clinic (19 males, 14 females). The University of Malta’s Health and Wellness Centre recorded 4,165 student consultations since 2020, with 44 students seen in 2024.

    Non-Maltese residents:

    A Mental Health Strategy for Malta 2020-2030 acknowledged that “The risk of admission to the psychiatric in-patient facility, Mount Carmel Hospital, for non-Maltese persons is 2.2 times that of the general population, whilst for persons from low and middle-income countries residing in Malta, the admission rate is 5-fold that of the general population”.

    Mount Carmel Hospital. Photo credit: Wikimedia

    The Commissioner for Mental Health’s 2023 report states that among patients subject to involuntary admission, almost 30% were non-Maltese (188 patients), and over half of them came from non-European countries.

    How does Malta invest in mental health?

    In the mental health strategy, the government acknowledged that “the focus of the mental health sector regretfully remains somewhat hospital-centric” while community care services were “generally understaffed”.

    A 2022 study stated that substantial reform in mental health services only started during the pandemic, despite attempts starting in the early 1990s. “Past attempts at reforming this sector were stifled due to insufficient and unsustained political commitment, leaving it direly under-resourced,” the authors wrote.

    The budget for mental health services has been gradually growing: from more than €42 million in 2019 to €71 million in 2025. However, the demand for outpatient services skyrocketed between 2021 and 2022, with an increasing overall trend.

    Mount Carmel Hospital is the institution that provides inpatient mental health services, residential treatment centres, community mental health centres, and outpatient clinics.

    Budget documents over the years show that investment in the Mount Carmel hospital skyrocketed in 2020, then declined, and picked up again in 2023, when “acute psychiatric hospital” became a separate expense category. Crisis intervention’s budget has been stable since 2019, except for a temporary dip in 2022.

    Clyde Caruana. Photo credit: DOI

    The Commissioner for Mental Health noted that, as of 2023, the lowest-quality treatment wards suffered from “poor facility upkeep, poor ventilation, lack of designated smoking areas, lack of activities and privacy in the bathroom and toilet areas, as well as in the sleeping areas.”

    The Commissioner went on to call for “increased allocation of funds in the next national budget to better assist patients with a dual psychiatric disorder and substance misuse.” 

    However, the only time substance abuse/ misuse is mentioned in the budget 2026 document is the allocation of funds for the Advisory Group/Committee on Substance Abuse. It will receive less money than in 2025.

    The 2022 study showed that the sector suffers from a shortage of nurses and social workers – key staff essential for the desired transformation.

    The study’s authors noted that the government was not leading the way in the reform – it reacted to pressure from the mental health commissioner, the National Audit Office, local media, non-governmental organisations (NGOs) and professionals.

    Politicians’ recent claims on mental health policy concerned promises of a ‘transformation’ in service provision with an inclusive, patient-centred approach. Robert Abela spoke of a mental health strategy that has already been implemented.

    According to researchers, “The lack of sustained political commitment and investment greatly undermined mental health reform in the past, while strong advocacy from stakeholders was key to bring mental health back on the political agenda”. 

    Since then, the government has promised to integrate physical and mental health, build capacity, and make the system more accessible. A range of services for children and young people is available to address the pressing needs of this population.

    Meanwhile, data shows that Malta’s state of mental health is rather alarming: a significant share of individuals experiencing problems do not seek or find help, and available resources are not addressing key gaps: social isolation among adolescents, exclusion of migrants, and complex needs of substance addicts.

    Allocations for mental health services have been increasing over the years, and funding for Mount Carmel Hospital recovered in 2024 after a decrease. However, crisis intervention, which experiences a high demand, has not seen an increase in its budget. 

    Despite financial improvements, there is no evidence of earmarked budgets to address the most pressing needs, namely, training and recruiting more nurses and social workers to address the shortages of this essential personnel. Some efforts to recruit cultural mediators are included in the integration strategy.

    Thus, although a reform has been taking place and resources have increased, the impacts fall short of a fully fledged transformation. The claim is only somewhat true.

    This project is supported by the European Media and Information Fund. The sole responsibility for any content supported by the European Media and Information Fund lies with the authors and it may not necessarily reflect the positions of the EMIF and the Fund Partners, the Calouste Gulbenkian Foundation and the European University Institute.

  • Fatti: Has Defining Femicide In Malta Really Made A Difference?

    Fatti: Has Defining Femicide In Malta Really Made A Difference?

    • Malta’s 2022 reform introduced femicide and misogynistic motives into its Criminal Code, one of the few EU states to do so.
    • However, it has had a limited tangible impact. No court ruling has applied the law so far.
    • Gender-based violence remains pervasive. Domestic violence reports have almost doubled since 2015, reaching 4,439 in 2024. One in four women in Malta reports experiencing intimate partner violence.
    • Convictions remain low. Police issued 17,486 domestic violence charges between 2021 and mid-2025 but secured only 933 convictions, roughly one for every nineteen charges.
    • Delays in the justice system continue to undermine victims’ rights, a human rights case is being prepared.
    • Recent murders reveal persistent failures in prevention and protection. The killings of Bernice Cassar and Nicolette Ghirxi followed prior police reports or warning signs.
    • Gender inequality and institutional gaps remain unaddressed.
    • Progress is visible in awareness and institutional reform, but not yet in outcomes.

    In the wake of the murders of Paulina Dembska and Rita Ellul in 2022, Malta updated its legislation to strengthen punishments for femicide, one of the few OSCE countries to do so.

    Robert Abela at CoE. Photo credit: Council of Europe / Alban Hefti

    “Malta under my watch (…) took the step of introducing the concept of femicide into our criminal code to acknowledge this gender-based crime, raising public awareness and to send a very clear and unequivocal message that there will be no leniency for perpetrators of this horrific crime,” Robert Abela told the Council of Europe’s Parliamentary Assembly in June. 

    But have the amendments fulfilled the demands of women’s rights defenders and made a difference on the ground?

    “The state, the country and society did not do all that is required,” Abela told Malta Today in 2022, referring to the murders of Dembska and Bernice Cassar. 

    “These reforms stem from the need and responsibility to respond to what’s happening in our society: from the duty not to ignore anyone’s reality. Only by doing so can we truly represent the people and ensure that what we hear from them in the streets leads to real change and necessary reform. (…) That is what brought us to today’s legal amendments,” Abela told parliament in February 2022 .

    Jonathan Attard. Source: DOI

    He also said, “What we are talking about today makes a difference in the life of each and every one of us.”

    Abela told the diplomatic corps he was ‘particularly proud’ of the femicide law. Meanwhile, Justice Minister Jonathan Attard cited the recognition of femicide as proof of Malta’s “commitment to comprehensive legislative and institutional reforms” at a Council of Europe event this year. 

    What was the amendment about?

    The legal amendment was introduced in June 2022. Now the court must consider several femicide criteria when deciding on a punishment for the homicide of a person of the female gender. 

    These are:

    • Intimate partner violence;
    • Family member violence;
    • Sexual violence or sexual acts;
    • Misogynist motives;
    • Reasons related to honour, reputation, religious or cult practices; 
    • Motives based on the gender, or gender identity, or sex or sexual orientation of the victim;
    • Related to sexual exploitation (including commercial) of the victim.

    “Following the murder of Paulina Dembska there was quite a public outcry, both because of how it happened – the fact that it was very random, there was no connection with her killer, that it took in a public place, and was also very brutal,” lawyer and human rights activist Lara Dimitrijevic, who worked on the wording of the bill, explained to Amphora Media.

    Official data reveals that 3 out of 16 women murdered in gender-based crimes between 2012 and 2022 had previously sought support from the national social welfare agency ahead of the crime.

    The amendments limited the grounds to render femicides excusable when “committed by any person acting under the first transport of a sudden passion or mental excitement”, as formulated in the Criminal Code.

    It also brought the concept of misogyny into law for the first time, which Dimitrijevic described as “quite a win in itself”.

    Lara Dimitrijevic with Owen Bonnici and Edward Zammit Lewis at a presentation of the legal amendments on femicide in 2022. Photo credit: DOI

    But femicide is not an aggravation, which means that the punishment for willful homicide is not increased because it is a femicide; it just cannot be decreased. 

    “I frankly think that [the excuse of sudden passion] should be removed across the board. It’s an extremely old concept that has been removed in many other jurisdictions,” Dimitrijevic said.

    “[The legal amendment will] not create a separate legal offence. Rather, it will encourage the judiciary to take into account violence against women, because they are women, when handing down sentences for the already-existing criminal offence of wilful homicide,”the National Commission for the Promotion of Equality (NCPE) said at the time the amends were discussed. 

    Is this what women’s rights defenders called for?

    The European Institute for Gender Equality (EIGE) considers femicide to be “the most severe forms of gender-based violence” and “recognising it as a separate criminal offence “could bring numerous benefits in terms of awareness raising, prevention and applying the law”.

    In 2022, NCPE said Dembska’s murder was “a wake-up call to seriously examine and address the unequal power relations between women and men in our society.”

    “Gender inequality needs addressing through gender-sensitive policy making and policing as well as the eradication of sexism from all spheres of life, including online and broadcast media, as well as institutionalised sexism,” the NCPE stressed.

    Exhibition on violence against women at the Parliament in 2023. Photo credit: DOI

    By 2024, the NCPE warned that “the deep connection between gender inequality and this pervasive violence, a relationship that remains largely unaddressed”.

    “While the introduction of the femicide law in Malta was a significant step in the right direction, more work needs to be carried out to address the underlying structures that make such violence possible in the first place,” it said.

    In an EU programme, Aleksandar Dimitrijevic (Lara’s husband) representing NGO Men Against Violence, described how the Maltese justice system is “notoriously slow when dealing with cases of domestic and gender-based violence” with two magistrates presiding over 1500 cases of domestic violence as of February 2025.

    According to the EU’s justice scoreboard, Malta has one of the longest estimated time to resolve judicial cases for all crimes.

    In 2022, the Women’s Rights Foundation, which has set up the Observatory on Femicide in Malta, has recommended mandatory training to legal practitioners, court staff and judges dealing with violence against women, immediate and effective protection for victims, better enforcement of protection orders, and GPS monitoring of suspects on bail.

    Lara Dimitrijevic, one of the authors of the report and WRF’s board member, is preparing to initiate a human rights case related to the delayed proceedings on behalf of the family of Chantelle Chetcuti, who was murdered in February 2020.

    “Unfortunately, the judicial process is very lengthy and very burdensome on the victims, i.e. the members of the family. In fact, (…) I will be filing a human rights case on behalf of Chantelle’s family, as we are still awaiting the jury. In the meantime, her mother has passed away. Her father became unwell. Her sister is really suffering, not to mention her children too.”

    “Life went on for [the accused], whereas for this family, life will stop. I argue that this is a breach of their human rights. It’s continuously subjecting them to revictimisation. It’s really affecting their right to private life, because they cannot move on. (…) Some of the members of the family will have to testify again now, after so many years, within a trial by jury.”

    What has happened since?

    Since the femicide amendments were introduced, three women have been murdered: Bernice Cassar, Sandra Ramirez, and Nicolette Ghirxi.

    Bernice Cassar filed multiple domestic violence reports against her estranged husband – the man accused of killing her – up to the day before she was murdered. Just two days earlier, her lawyer had reportedly urged police to take action against him for breaching protection orders.

    In the inquiry into her death, retired judge Geoffrey Valenzia concluded that the “state system” had failed Cassar, citing a lack of court and police resources, as well as the increasing workload faced by magistrates, which led to significant delays in scheduling and hearing cases.

    The accused has since been charged with the murder, and his lawyers reportedly challenged the new femicide law on discrimination grounds.

    Nicolette Ghirxi emailed the police a few days before her murder, expressing concern after encountering her ex-boyfriend, who later died in a standoff with police. She had also reported harassment months earlier, in April, but declined a risk assessment at the time.

    The Police Complaints Board later cleared the officers involved, stating they had acted within their powers and found no evidence of an imminent threat. 

    Sandra Ramirez was reportedly stabbed 26 times by her former partner. When he appeared in court, he attempted to have the femicide charge dropped, arguing it was a “crime of passion”, which was rejected.

    There has not yet been a published court judgement applying the amended legal provisions in an actual case of the murder of a woman.

    “We’ve had more femicides in a short span of time after the introduction of the law. So that, I think, speaks for itself,” Lara Dimitrijevic said.

    Conviction rates remain low

    Data provided by the police shows that between 2021 and July 2025, there were 933 convictions related to domestic violence, compared to 17,486 charges issued during the same period.

    This means that, on average, there has been roughly one conviction for every 19 charges over the past few years.

    “We really need to work much, much harder on the prevention element, both in terms of prosecution and protection,(…)  and to have dissuasive punishments. Very rarely do we see, for example, effective imprisonments in cases of intimate partner violence,” Lara Dimitrijevic said.

    The number of domestic violence charges has also been rising: from 2,929 in 2021 to 4,439 in 2024. 

    According to the 2024 Crime Malta report, a trend of increasing reports has been observed since 2007. However, the growth is mostly attributed to the rise in reports of psychological harm, and stronger awareness may have also played a role. Parliamentary questions filed in recent years reveal that reports of domestic violence to the police have nearly doubled since 2015.

    By July 2025, 2,427 charges had already been filed, as an early warning, this year is also on track to surpass the 4,000 mark.

    Psychological violence has grown the most rapidly

    In 2024, Council of Europe’s experts found that the police have implemented “comprehensive reforms” to address gender-based violence and that “Malta has adopted a more robust multi-agency approach at all levels of decision-making”.

    Who has experienced intimate partner violence?

    According to the Survey on Safety and Well-being carried out in Malta and Gozo in 2022, 19% of men and 26% of women reported having experienced intimate partner violence. For over half, the violence resulted in an injury, and more than half have felt that their life was in danger.

    According to the European Institute for Gender Equality (EIGE)’s country report on Malta in 2022, the year the femicide law was introduced:

    • 79% of recorded victims of intimate partner violence were women, and 69% of victims of domestic violence were women.
    • 1,091 men were reported for intimate partner violence against women, and 538 were prosecuted.
    • 1,364 men were reported for domestic violence against women, and 1,210 were prosecuted.
    • The police recorded a greater number of offences of intimate partner violence (1,099) than the number of victims (831). This difference suggests that several women victims were subjected to violence by a partner multiple times in a single year.
    • Between 2020 and 2022, four women victims of intentional homicide were recorded by police. During the same period, police recorded three women victims of intentional homicide committed specifically by an intimate partner;
    • Fluctuations between years can be attributed to various social and institutional factors and do not necessarily imply that violence has worsened in the country over time.

    EIGE notes intimate partner violence is not explicitly defined in Malta’s Criminal Code, and  “no data is available on protection orders for victims of violence” or “on perpetrators sentenced or held in prison for these crimes”. This makes it difficult to assess the extent to which men are brought to justice for violence against women”.

    Malta is one of the few countries that has explicitly defined femicide.

    International experts have noted Malta’s progress at the various stages of addressing violence escalation, from training of police to the definition of femicide in the law. Women’s rights defenders have called for a comprehensive approach to the underlying structures, notably inequality. 

    Malta’s statistics of the number of people affected by intimate partner violence and reports of domestic violence suggest that the issue is widespread and shows no signs of subsiding. Meanwhile, the murders of Cassar and Ghirxi have raised concerns over the police’s ability to prevent femicides before they occur.

    In Malta, the length of proceedings is a repeatedly voiced concern that has not been resolved. According to lawyer and expert Lara Dimitrijevic, an overhaul of the criminal justice system is needed to fully address the issue.

    Politicians’ claims that the femicide law would make a difference are somewhat true. The introduction of femicide is a legal breakthrough. But it is the tip of the gender-based violence iceberg, and the progress in improving the quality of the justice system has been slow.

    This project is supported by the European Media and Information Fund. The sole responsibility for any content supported by the European Media and Information Fund lies with the authors and it may not necessarily reflect the positions of the EMIF and the Fund Partners, the Calouste Gulbenkian Foundation and the European University Institute.