Justice, mercy and a long road to recovery: An in-depth look at criminals with mental illness in Singapore
Accused people with mental illness are given special treatment in Singapore's legal system, but how exactly does the court decide the extent of the role a mental condition plays, and what happens to the accused person when he goes into prison and thereafter?
SINGAPORE: When he was 18, Ng Say Tiong started taking heroin, egged on by bad company in the Tanjong Rhu area where he lived with his parents and two younger brothers.
The son of a coolie and a hawker was arrested and sentenced to three years in a Reformative Training Centre for taking drugs.
He continued to commit crimes after his release from the reformative training centre. For this, Say Tiong was jailed on more than 10 occasions, mostly for drug offences but also for hurting others. He would take drugs, drink alcohol and attack others with weapons when he felt enraged by what they said.
“I would feel frustrated,” Say Tiong, now 61, told CNA in a mix of Mandarin and Hokkien. “When I’m frustrated, I cannot think (straight).”
The repeated heroin use, revolving door experience with prison and a brother with developmental problems weighed heavily on him. He said he felt sad and depressed.
In 2002, at the age of 44, he was diagnosed with depression by psychiatrists at the Institute of Mental Health (IMH) while serving a 10-year prison sentence.
There are others like Say Tiong, whose troubles and mental conditions form a backdrop against which they commit crime.
1 IN 10 PRISONERS HAVE MENTAL DISORDERS, DEPRESSION 'MOST COMMON'
The Singapore Prison Service (SPS) told CNA that about 10 per cent of prisoners here are diagnosed with mental disorders, the most common being insomnia, adjustment disorder and depressive episodes.
Criminal defence lawyers told CNA that depression is perhaps the most common mental illness they have seen among accused persons.
Lawyer Sunil Sudheesan, who has handled about a thousand cases in his 14 years of practice, said about 300 to 400 of his clients had some sort of psychiatric issue, with depression being the most common.
“The core of depression is that it results in a person behaving in a way which they would not normally behave because you can’t deal with your problems and therefore your ability to control your reactions sometimes is affected significantly,” he said.
While mild depression may not excuse a person from criminal liability, lawyer Eugene Thuraisingam said severe or moderate depression can impair a person’s judgment and become a mitigating factor in sentencing.
Mr Shashi Nathan, a partner in criminal litigation at Withers KhattarWong, said: “Ultimately, there is also the issue of whether the mental illness has any causal link to the offence. For many persons, the mental illness is merely a condition which may not have a determining effect on the criminal act.”
HOW ARE THEY TREATED IN PRISON?
Inmates with mental illnesses receive treatment for their conditions by a team of psychiatrists and medical officers while they are incarcerated. A team of correctional rehabilitation specialists and psychologists also give them counselling and therapy.
According to Dr Christopher Cheok, senior consultant at IMH’s department of forensic psychiatry, the process in prison is no different from hospital clinics.
“Patients are assessed, given medication as needed and provided with psychotherapy and occupational therapy. The only difference is that they are seen in a secure setting,” he said.
He added that the goals of treatment are the same - to reduce psychological suffering and manage the mental illness.
Despite their condition, most will be assessed to be well enough to mingle with the general prison population and can be put through work and rehabilitation programmes.
Only those with severe mental conditions are separated from the general population. They are treated for their condition by a team of IMH psychiatrists, psychologists, and occupational therapists who work closely with SPS’ psychologists. The aim is to help these inmates understand and manage their mental disorders and prepare to reintegrate them into the general inmate population.
While the law accords the same rights to people with mental illnesses as any other person, there are special provisions for those whom the court finds unfit to plead because they are of unsound mind, said a Ministry of Law (MinLaw) spokesman.
Their plea will not be taken and the court will order the person to be examined by a medical practitioner or remanded for observation in a psychiatric institution for up to a month.
If the medical practitioner certifies that the person is incapable of making his defence, the court may release him if it is certain that he will receive proper care and would not harm himself or others.
The alternative is for the matter to be referred to the Minister for Law, who may order the person to be confined in a psychiatric institution or any place of safe custody for treatment, said the spokesman.
Their mental state will be reviewed by independent experts at least once every six months and they may be discharged on the minister's order following a review, said MinLaw.
Ex-convicts may continue their treatment with IMH after their release from jail. The institute began the Forensic Psychiatry Community Service in 2012 to provide continued treatment and service to ex-convicts with a psychotic, affective or anxiety disorder diagnosis, supported by case managers and medical social workers. More than 460 patients who are ex-convicts have completed this voluntary one-year programme.
After this one year period. they could either be transferred to IMH care teams handling the general patient population for treatment and support or receive care from community partners if their conditions are less complex and have stabilised.
HOW ARE ACCUSED PERSONS WITH MENTAL ILLNESS DEALT WITH IN COURT?
Accused people could be given non-jail sentences that focus on rehabilitation.
Singapore's community court, which has a problem-solving approach and an emphasis on rehabilitation, was set up in 2006 for special cases including offenders with mental conditions.
It can now impose mandatory treatment orders (MTOs) for up to three years, where offenders must undergo psychiatric treatment as an alternative to imprisonment.
Other than MTOs, the community court could impose community service orders; day reporting orders where offenders must present themselves to a reporting centre for monitoring, counselling and rehabilitation programmes; or short detention orders.
Following recent changes to the Criminal Justice Reform Act, MTOs can be imposed on offenders convicted of a prescribed list of more serious offences, which are punishable with up to seven years’ imprisonment, up from offences punishable with up to three years’ jail.
WHEN DOES MENTAL ILLNESS PLAY A PART?
Each case is unique and is dealt with on its own set of circumstances, lawyers and psychiatrists told CNA.
Criminal defence lawyer Eugene Thuraisingam said mental illness can come into play at two other stages in the court process, with the first in considering some defences in certain types of crime. For example, having a mental condition could allow a person accused of murder to argue for the defence of diminished responsibility, he said.
The second is in sentencing, where the courts could give a reduced punishment if an accused person’s mental illness is shown to have played a part in his commission of the offence.
But just because an accused person has a mental illness does not mean he gets a reduced sentence or a community-based sentence, and not all types of mental illnesses are given weight as a mitigating factor, they said.
For example, an accused person suffering from paedophilic disorder may not succeed in using that in mitigation, said Mr Thuraisingam as “it’s not the type of offence which affects your judgment”.
“A paedophile is predisposed in a particular way but there’s nothing affecting his judgment as to whether to do something right or wrong. It must in a way affect your ability to resist (committing the crime),” he explained.
“It is different for someone with impulse control (disorders) which affects his judgment on whether to do something or not,” he said.
“In the event that the suspect is diagnosed with a mental disorder, the psychiatrists will further assess if this has impaired the suspect’s judgement at the point of committing the act,” said IMH’s Dr Cheok.
Private psychiatrist Dr Munidasa Winslow, who was previously with IMH, said beyond making the assessment, he would also make recommendations to prevent the person from reoffending.
The judge will look at the psychiatric reports tendered by the prosecution and defence in coming to a decision on how much mitigating weight to give, if at all, to the offender’s mental condition.
THE JAIL QUESTION, AND HOW LIKELY RECOVERY IS
Jail time may not necessarily be the best option for accused persons with mental conditions, said lawyers.
Lawyer Mr Thuraisingam said: "(For) a normal person, you jail him once, he will think - I don't want to do this again, because I don't want to go to prison. But a person who has mental illness may not think that way."
Criminal lawyer Sunil Sudheesan said jail is too "short-term". "Because you come out and there's nothing," he said. "You're left in the wilderness."
Jail will not work "all the more" for recalcitrant offenders with mental conditions, as "there needs to be a more interventionist sort of MTO" which could involve a stay in a psychiatric institution, said Mr Sudheesan.
He cited the case of Goh Lee Yin, a woman diagnosed with kleptomania who committed suicide in 2017 after repeatedly being convicted of shoplifting.
"You know the entire stigmatisation of the criminal justice process and the trauma involved there, sometimes it’s clearly too much for people to bear,” he said.
Psychiatrist Dr Winslow who was involved in the case, said he knew she needed "a lot more help for her mental condition", adding that the legal criteria for how a condition contributes to a crime and mental health criteria "are not exactly aligned all the time".
PROGRESS AND WHAT MORE CAN BE DONE
But Dr Winslow said he sees progress.
“If they have committed a crime, they want to be able to punish them for the crime, but there’s a greater emphasis overall than when I first started in the 1980s towards restorative justice, they want to see that people who have mental health conditions get the help for those mental health conditions and that is something that I see a lot more strongly than before,” he said.
Mr Nathan said family members can also help by being more open about those with mental illnesses.
"Pretending that a condition doesn't exist or sweeping it under the carpet could ultimately cause more harm to the offender. Ultimately, we all have to remove the stigma attached to mental illnesses," he said.
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Dr Winslow added that there seems to be a greater awareness of mental health conditions that makes people more willing to talk about them to their lawyers or doctors.
He said the solution is for people to recognise if they have got issues, to persistently seek help and be aware that, sometimes, it takes time.
“After you restore hope, and tell people you actually have a condition that can be treated, life can change,” he said. “Maybe I’m a little bit more of an optimist, but I think that even judges like to see lives saved rather than just putting people into prison.”
SALVATION A LONG JOURNEY
For Say Tiong, salvation came after a long journey and near-death experiences.
While he was in IMH after a referral there by the court, one of his ward mates asked him to join him in killing himself. His ward mate died, but Say Tiong was saved by a nurse and was later told that his mother had died the night before.
He had tried committing suicide seven or eight times in various ways over his lifetime - but was not fully cognisant that he suffered from depression until he was admitted to IMH on a court order.
“I would think - I should die. Living has no meaning. I felt very sad,” he said. “I asked myself why did I become like this - I kept taking heroin, why did no one save me? Why was my mother in a wheelchair, and my brother had brain problems. I would drink and drink and drink, before smoking heroin.”
Looking back on his life, Say Tiong said he took drugs as a form of escape each time.
Say Tiong, who still visits IMH from time to time, has managed in recent years to cut down the dosage of the medication he takes for his depression.
He no longer leads a life of crime since his release from prison in 2012, after meeting a fellow inmate who introduced him to Christianity.
“I took drugs because I felt frustrated - why would I take drugs, why did I take this road? I knew it was wrong, but I kept doing it. I couldn't help myself,” he said. "Now I don't need to escape anymore. Now I am happy."