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A look behind bars for inmates with complex mental illnesses

A hospital cleaner told the police he molested a paralysed patient because he heard voices telling him to touch her and that he had skipped his medication.

But a psychiatrist from the Institute of Mental Health (IMH) found that even though the 52-year-old has schizophrenia, he had not relapsed at the time of the offence.

On Friday (April 22), the man, whom The Straits Times did not identify as there is a gag order on the hospital's name, was sentenced to two years and two months' imprisonment.

ST looks at how inmates who are diagnosed with complex mental illnesses are rehabilitated while serving their time behind bars.

Upon entry into prison, inmates are assessed by mental health professionals on the state of their mental health, risk of reoffending and rehabilitative needs.

Singapore Prison Service (SPS) said about 5 per cent of inmates in prison last year were diagnosed with mental health conditions. This, in the light of annual prison statistics which state that there were 8,160 in-care inmates last year, makes up about 410 people.

The most common conditions inmates suffer from are adjustment disorder and depressive episodes.

The diagnoses of their mental health conditions are consistent with codes and manuals set out by the American Psychiatric Association or World Health Organisation.

Inmates diagnosed with mild mental health conditions are housed with the general inmate population and reviewed regularly by prison psychiatrists.Those with more complex disorders, including schizophrenia and bipolar disorder, who are assessed to need more psychiatric rehabilitation, are housed in the Correctional Unit (Psychiatric) (PCU) at Changi Prison Complex.

Singapore Prison Service said about 5 per cent of inmates in prison in 2021 were diagnosed with mental health conditions. ST PHOTO: ARIFFIN JAMAR

The PCU, renamed earlier this month from Psychiatric Housing Unit, was started in 2011 and is run with support from IMH. It holds up to 150 male inmates. There is a separate unit for women in the women’s prison.

The unit uses classes and counselling to improve inmates' functioning skills and give them better insight into their mental illnesses.

The reoffending rate among inmates who have been housed in the PCU is not tracked.

But, among all offenders, SPS said earlier this year that the two-year recidivism rate, which refers to offenders committing crimes within two years of their release, was at 20 per cent for the cohort released in 2019.

When ST visited the unit last week, classes were being conducted by IMH specialists in classrooms and comprised four to five inmates dressed in white T-shirts and shorts.

In one class, called nursing, inmates discussed how to act in social settings.

Across a corridor, another class called occupational therapy had inmates drawing trees with colourful marker pens to represent their support system.

Consultant and deputy chief of the department of forensic psychiatry at IMH Jason Lee told the media that the classes and treatment inmates go through in PCU are similar to those in the community.

"We will ensure that inmates with mental health needs are not deprived of the opportunity for psychiatric rehabilitation, and our programme will allow them to better integrate into the society upon their release," he said.

Inmates who still require psychiatric treatment after their sentence is served can have outpatient arrangements made for them by SPS and community partners such as IMH.

Inmates in occupational therapy class draw trees to represent their support system. ST PHOTO: ARIFFIN JAMAR

One inmate currently housed in the unit is Vin (not his real name), who suffers from schizophrenia.

The 50-year-old told the media that he has been in and out of prison and boys' homes since he was 14 for drug abuse. When he was 30, he started hearing voices and seeing things that were not there.

Vin (not his real name) in the indoor garden in the Correctional Unit (Psychiatric) (PCU) where inmates grow plants. ST PHOTO: KUA CHEE SIONG

Vin's latest incarceration - an eight-year stint - comes after he assaulted someone while on drugs. He tried to "self-medicate" to stop negative voices in his head that sometimes swear at him in Hokkien. He was diagnosed during a previous prison stint but was not sent to the PCU then.

"The classes taught me that we're not the only ones suffering from mental disorders and there's room for recovery to lead a normal life like others.

"The occupational therapy class taught us to do things that can elevate our sense of accomplishment, and we can feel the positive energy flow in us after every class," he said.

Vin added: "For me, I can see the good signs... I won't be coming back."

Helplines

• National Care Hotline:

1800-202-6868 (8am - 8pm)

Mental well-being

• Institute of Mental Health's mental health helpline:

6389-2222 (24 hours)

• Samaritans of Singapore:

1800-221-4444 (24 hours) /1-767 (24 hours)

• Singapore Association for Mental Health:

1800-283-7019

• Silver Ribbon Singapore:

6386-1928

• Tinkle Friend:

1800-274-4788 and www.tinklefriend.sg

• Community Health Assessment Team:

6493-6500/1 and www.chat.mentalhealth.sg

Counselling

• TOUCHline (Counselling):

1800-377-2252

• TOUCH Care Line (for seniors, caregivers):

6804-6555

• Care Corner Counselling Centre:

1800-353-5800

Online resources

mindline.sg

My Mental Health

Fei Yue's Online Counselling Service

Tinkle Friend

Community Health Assessment Team

PRISONSMental Health