Parliament Speech 15 Sep: Second Reading of The Mental Health (Care & Treatment) Bill

15 Sep 2008

By Khaw Boon Wan

1 Mr Speaker, Sir, I beg to move, that “the Bill be now read a second time”.

2 This Bill is prompted by the Mental Capacity Bill which the Minister for Community Development, Youth and Sports will shortly take the House through.  The Mental Capacity Bill aims to empower individuals to voluntarily plan in advance and appoint a proxy decision-maker for a time when they may lack mental capacity.  It will also allow parents to apply to the court for the appointment of a proxy decision-maker for their intellectually disabled children.  The Mental Capacity Bill will replace and update Part I of the existing Mental Disorders and Treatment Act. 

3 The Mental Health (Care & Treatment) Bill will in turn replace Parts II and III of the Mental Disorders and Treatment Act.  It aims to regulate the involuntary detention of a person in a psychiatric institution for treatment if:

(i) he is suffering from a mental disorder which warrants the detention for treatment; and

(ii) it is necessary in the interests of the health or safety of the person or for the protection of other persons that the person be detained. 

4 Many other countries, including the United Kingdom and Australia, have similar provisions for involuntary treatment for persons suffering from mental disorders whose ability to make decisions about medical treatment is significantly impaired and who are likely to suffer mental, behavioral or physical deterioration without prompt and adequate treatment.  Our Bill will maintain parity with modern best practices to strengthen the safeguards to protect the patients who are involuntarily detained for treatment.  For example, regular inspections have to be conducted by visitors appointed by the Minister and a Magistrate’s order is required for the detention of a patient beyond a certain period.  The improper detention of a person, or wilful neglect or ill-treatment of a patient, will be an offence under the Bill. 

5 Mr Speaker, Sir, let me elaborate on each of the proposed amendments.

(A) DEFINITIONS

6 First, we will replace the term “mental hospitals” with “psychiatric institutions”.  A part of a hospital (for example a ward or a department) may now be designated as a “psychiatric institution” for the reception and treatment of the mentally ill, instead of an entire hospital.  This will give us greater flexibility to alter the capacity to meet changing demand in the future.  

(B) PROCEDURES

7 Second, a patient who has voluntarily admitted himself to a psychiatric institution may now be detained pursuant to an order of a designated medical practitioner, if he is assessed to be a danger to himself or others.  This is to facilitate prompt treatment.  Currently, a detention order may only be made in respect of a person who has not yet been admitted into the mental hospital.   

8 Third, we are reducing the minimum frequency of inspections by visitors appointed by the Minister for Health from once a month to once every three months.  This will enable us to set the frequency in accordance with needs.  For example, where a psychiatric institution has not had adverse reports for a long period, a reduced frequency is justified.  This is a practical step to reduce the load on the visitors.  The visitors are, however, required to submit a report to the Director of Medical Services after every inspection.  Based on these reports, the Director of Medical Services may then direct the visitors to conduct further inspections as necessary.

(C) STRENGTHENING SAFEGUARDS

9 Fourth, after the first month of detention, any further detention, if ordered by two designated doctors, will be capped at a maximum of 6 months.  This is half of the current provision.  For detention beyond 6 months, a Magistrate’s order will be required.  These safeguards are to ensure that patients are not detained beyond what is medically required.

10 Fifth, a detained patient who requires treatment for an acute medical condition other than his mental disorder may now be transferred to another hospital, and be temporarily detained there.  This arrangement is necessary, as psychiatric institutions may not have the necessary facilities for managing these acute medical conditions.  There is currently no such provision in the Mental Disorders & Treatment Act.

(D) PENALTIES

11 Finally, we are updating the penalties for certain offences to ensure that they have a deterrent effect and be on par with equivalent legislation.  We are increasing the maximum penalties of fines and imprisonment for offences committed against patients who have to be detained for treatment.  These patients are in a vulnerable situation and we need to send a clear message that abuse of such patients will not be tolerated.

(a) First, the maximum penalties for ill treating a patient will be raised.  Ill-treatment includes physical or sexual abuse, as well as wilful or unreasonable endangerment or neglect of a patient.  Currently, the maximum penalty is a fine not exceeding $500 or imprisonment for up to 2 years or both.  The Bill increases this to a maximum fine of $5,000 or imprisonment for up to 4 years or both.  If death is caused to the patient, the penalty will be a maximum fine of $20,000 or imprisonment for up to 7 years or both. 

(b) Second, the penalty for having sexual intercourse with a patient will be increased from a fine of up to $1,000 or imprisonment for up to 2 years, or both, to a maximum fine of $20,000 or imprisonment for up to 10 years or both.

(c) Third, the penalty for improperly receiving or detaining a patient will be increased from a maximum fine of $2,000 or imprisonment for up to 2 years or both, to a maximum fine of $5,000 or imprisonment for up to 3 years or both.

(d) Fourth, a police officer is empowered to visit and inspect a mentally disordered person under the care of a person to ascertain whether or not that mentally disordered person is under proper care and control or is ill-treated or neglected.  The Bill enhances the maximum fine for refusing to produce the mentally disordered person for inspection from $1,000 to $4,000.

(e) Lastly, the maximum amount for which a minor offence under the Bill may be compounded will be raised from $500 to $2,000.

CONCLUSION

12 Mr Speaker, Sir, the care and treatment of the mentally ill has evolved over the years and it will continue to evolve, in the light of experience and medical knowledge.  Increasingly, care and treatment for most mentally ill is best done in the community setting.  But it is sometimes necessary to detain some mentally disordered persons in a psychiatric institution, to safeguard the health and safety of the patients and to protect the others in the community.  In such cases, we have to ensure that the power to detain is not abused. 

13 This Bill updates and strengthens the safeguards for the detained patients under such circumstances.  I hope to get the support of all members for this Bill.

14 Mr Speaker, Sir, I beg to Move.