The idea of becoming mentally incapacitated is often so frightful that most people simply avoid the issue. Discounting the various other ways someone can lose control of their mental faculties, in Singapore, 1 in 10 people above 60 will succumb to dementia and 3.6% of people will suffer from obsessive-compulsive disorder, 1 in 50 people will experience a psychotic episode at some point in their lives, and 1% will suffer from schizophrenia, all conditions that might precipitate the loss of mental faculties. It’s a statistic that we’ve not brought up to alarm you, but simply to help you decide if you have someone in your life you trust to protect your interests, in the realm of your personal welfare, and property and affairs.
You simply have to be above the age of 21, by law in Singapore, to appoint one or more “donees”, who are people you trust “to make decisions on your behalf, in your best interests”. You, as the appointer of your donee(s), are known as the “donor”.
The Ministry of Social and Family Development suggests that it is beneficial to make an LPA as a protective measure against any untoward happenstance as it relates to your mental well-being. It is obviously best to decide what the best permutation for you is while you are capable of making rational decisions on your own behalf. Broadly, your appointed donee(s) will have control over one or both of the following aspects of your life: your personal welfare; and your property and affairs.
The LPA is designed to safeguard your interests, so it grants you the latitude of choice in deciding if: you want a single donee, whose powers are defined in Part IV of the Mental Capacity Act, or multiple donees. In the event that you decide that you would prefer multiple donees, you also have the power to decide if you will allow any one of them to act alone in making a decision on your behalf, or have them come to a consensus on undertaking a decision.
The difference between LPA Form 1 and LPA Form 2 is that LPA Form 2 allows you to appoint more than 2 donees, more than 1 replacement donee, or grant your donee(s) customised powers above the general powers with basic restrictions that donees are granted under LPA Form 1. LPA Form 2 requires the services of a lawyer.
After you have decided what’s best for you, and filling upLPA Form 1, or LPA Form 2, which you can do with the help of a lawyer, there is a “critical safeguard” in place to ensure that the LPA is not made under duress. This means that your LPA form will have to be witnessed and certified by an LPA certificate issuer, which can be:
This episode of En Ullae touches on psychosis. This case study was about a man who had developed schizophrenia and became obsessed with the ‘spiritual safety’ of his partner. The building tension served to demonstrate the dangers of ignoring the symptoms of psychosis, which his partner was predisposed to do, in her untoward position as the long-suffering partner in a dangerously unstable relationship. Dr Jacob characterised psychosis as rooted in an unshakeable belief in false delusions – people who suffer from the condition are often willfully blind to reason, which he cautions against trying to impose on them when the time is inclement.
Prem, the unfortunate man with all the symptoms of hallucinatory schizophrenia, began to cast an evermore imposing spectre in the relationship, causing much distress to Rani. His delusions began to take such a toll on their relationship, with even the good tidings of a baby in the oven twisted into a string of abortion by Rani, afraid that he would bring harm to her and any prospective child she would bequeath upon them – he professed to see the child as a harbinger of doom, as the embodiment of the devil. Midway through the episode, the viewer is treated to the appearance of two ambiguous personalities – a man and a woman, whose blue lanyard faintly conveyed some sense of authority. We are left uncertain as to their actual responsibilities – they are at times quizzical, unwilling to manifest the “good cop, bad cop” trope. No matter, it is not the point of the episode to further entangle the convoluted plotlines – they serve as plot devices which encourage Prem’s own narrative to unfold – to the end, he remains stolidly convinced that his stabbing of Rani had taken her to a better place, the expression on his face almost beatific at times.
Dr Jacob, at this point, sees fit to caution the viewer against harshly attributing homicidal tendencies to persons with psychosis. He presents the statistic that even less than 15% of homicides are perpetrated by people mentally unsound. Noting the prevalence of drug use and antisocial tendencies that colour this 15%, he confidently steers the viewer away from making too quick a conclusion – it is in everyone’s best interest to step back and evaluate statistics grounded in good science, instead of leaping to the easy conclusion that Prem was beyond rehabilitation.
First published on Wan Bao Fu Kan on 19 Jan 2020 in Mandarin
Many years ago, whilst I was a trainee, I used to work in the Institute of Mental Health. One night, while I was on duty in the emergency room, an old lady in her 90s brought her 60-year-old daughter to the clinic. With a calm and friendly smile, she told me that her daughter had relapsed. It turned out that her daughter had been suffering from schizophrenia for many years, with frequent relapses that required innumerable hospitalizations. At the age of 16, she started to suffer from hallucinations and paranoid delusions. She became suspicious of others, and her temper became extremely volatile. In the early days, she resisted taking medication, resulting in a rapid deterioration in her condition. Within a few months, she was forced to drop out of school. Subsequently, she did try to work, but was unable to hold on to a job. Without a stable income, she was unable to support herself and was unable to lead an independent life. Moreover, her psychotic symptoms worsened, impacting on her self-care. She had to stay at home near-daily, relying on her mother to care for her.
The old lady was a senior nursing officer in our country before her retirement. She made many important contributions to our country’s healthcare system and she was a pioneering leader in the nursing profession. Unfortunately, her husband passed away early on, and she had to raise all their three children by herself. Her eldest son went abroad to start a business and now has a successful trading company in the United States. Her second child also did well in her studies. After getting her master’s degree, she taught at the university for several years but decided to become a housewife after getting married. The third child was originally the smartest and most sensible amongst the three children. She studied hard since young, and did well academically, with excellent grades every year. She was a filial child, who would always help her mother with housework. In short, she was never a trouble to her parents.
Unfortunately, she fell ill during the first year of junior college, resulting in a dramatic change in her personality and behaviour. Formerly a cheerful, vivacious and enthusiastic young lady, she became irritable and impulsive. Her paranoia resulted in her isolating herself from her friends and loved ones. The old lady took care of her with infinite love and silently accepted this difficult mission. But the eldest brother and the second sister refused to associate with her, and did not welcome their visits even during the Lunar New Year.
The years gradually passed. The old lady is now retired and the frailties of age took a toll on her physical health. In her twilight years, she sincerely begged her two elder children to take care of their sister. But they both adamantly refused to accept this burden. After asking several times, and after having the door literally closed on them on the 2 older children, the old lady finally understood. She courageously continued her lifelong mission and patiently looked after her daughter. By then, she was in her early 90s, and her daughter was in her 60s. That night, she quietly told me: “I’m actually tired, but I cannot die. Because she still needs me.”
That night, I truly understood the greatness and self-sacrificing nature of a mother’s love.
Schizophrenia is a serious, long-term disease. The support of family members is very important to the patient’s recovery. Without the help of family members, even if you take the best medicine and see the best doctor, it will be to no avail.