THE TEMASEK REVIEW

By Dr Albert Lin and Eugene Yeo

I was alerted to the plight of Mr Gary Tan by Eugene who emailed me to ask if a Deputy Public Prosecutor (DPP) has the right to admit a person to IMH on the grounds of a mental disorder.

According to a blog post by Mr Chia Ti Lik, the lawyer for Mr Gary Tan on 3 June 2009:

“DPP John Loo had instructions to apply for Gary to be remanded in the IMH for 3 weeks on the basis that he is delusional in his blog postings and that he had been allegedly remanded in IMH before in 2006.” (read article here)

I never did a posting at IMH as a medical officer. My only knowledge about its modus operandi comes from friends who had done a posting there and as a MO at NUH A&E where we refer psychiatric cases to the psy MO on call pretty often.

To my limited understanding, IMH has a stringent set of criteria for admission. It has a A&E run 24 hours a day by a medical officer on call.

The few instances when admission is seriously considered are:

1. Patient is at high risk of suicide or deliberate self-harm if not admitted.

2. Acute psychosis where the patient is deemed to be a threat to the lives of himself and others.

3. Severe depression in which the patient refuses any food or drinks.

[We have a few readers here who are psychiatrists. Please feel free to contribute to the discussion]

The MO on call does not decide on the admission. He/she has to consult a senior doctor, usually a Registrar who has passed his Masters in Medicine (M.MED) examination in Psychiatry to determine if the case warrants an admission.

The majority of patients residing at IMH are chronic schizophrenics who are incapable of self-care or are abandoned by their families.

IMH now prefers to discharge the stable schizophrenics back to the community where they can be close with families and friends so as to facilitate their re-integration into society.

The reasons cited by DPP John Loo for remanding Mr Gary Tan at IMH are not clinical decisions and neither are they justifications for admission.

In the first place, DPP John Loo is not medically trained in psychiatry to diagnose Mr Gary Tan as having a delusional disorder based on his blog postings alone. Even a family physician like me will have to refer him to a psychiatrist for further evaluation.

Furthermore, delusional disorder is not a criteria for admission to IMH unless it can be established that the patient is a danger onto himself and others as a result of his delusion. A previous admission to IMH was never a criteria to determine if the patient requires an admission which is based solely on the result of the psychiatric examination at the point in time.

In this case where Gary’s mental fitness to plead is of suspect, he can be referred for a psychiatric evaluation which can be completed within a day where a psychiatrist can determine if he needs to be remanded on clinical grounds.

Based on the information provided by Mr Chia, I can only conclude that the Attorney-General Chambers may have a prior arrangement with IMH to remand suspects of “unsound mind” which are beyond the jurisdiction of their in-house psychiatrists.

This arbitrary confinement of suspects at IMH has the double effect of casting doubts on their mental capacity and preventing their side of the story to be heard at an open trial in court.

Besides Gary, there are other high profile cases where the suspect is remanded at IMH without going to trial.

In January 2009, Ong Kar Chua was remanded at IMH for torching PAP MP Seng Han Thong. He was never charged in court, his defence was not heard and Singaporeans may never know the real motives behind his act.

Boon Suan Ban, a stock remisier from Hwang-DBS Group, was sentenced to be detained in Institude of Mental Health until it pleases the president, as a result of his financial disputes involving Chief Justice Yong Pung How.

Mr Robert Ho, had been detained in Institude of Mental Health several times. Robert is a writer and internet activist, who whistle-blowed about the alleged polling fraud during General Election 1997, at hot contested Cheng San GRC.

We need to take the government to task and to hold them accountable for their actions:

1. Do the AGC, DPP or District Court have the power to order the detention of persons at IMH without the input of a psychiatrist?

2. What rights do these detainees have?

3. What does this say about the rule of law in Singapore?

The apparent arbitariness exhibited by the authorities in ordering the detention of persons at IMH with little transparency or accountability leaves much to be desired and leave citizens at the mercy of an all-powerful government.

Don’t dismiss the PothePanda case as an isolated incident which does not concern you for as long the existing laws are not changed, it may happen to you or me one day and we will have no revenues to seek legal redress.

Singaporeans must be educated on their basic human rights and to call on the police to shed more light on how the internal decision-making process to determine if a person should be remanded at IMH.

Are we a modern democracy or a police state like Burma and North Korea where political dissidents can be made to “disappear” from society without a fuss?

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