Facts
1.
On
14 April 1016, the State Courts issued a 2-week remand order to place me in the
IMH for a psychiatric assessment. When I was admitted to the forensic ward of
the IMH at around 10pm, I asked nurses for written regulations governing the
rights and duties of the detained individuals and the IMH. No document was provided.
The
1st interview
2.
On
the morning of 15 April, a psychiatrist interviewed me for the first time. I told
him the course of my suit against the police for false imprisonment. In
addition, I challenged the lawfulness of the remand order by pointing out that
the lawfulness of the arrest hadn’t been determined by the court in the first place.
In response to my request to write a letter (or a writ of Habeas corpus[1])
to the High Court Registry to review the legality of the detention, the
psychiatrist suggested that I should do so after I was discharged from the IMH.
I explained that an individual would not be in a position to write such a
letter if he was released from the detention. There was no direct response from
the psychiatrist.
The
transfer
3.
On
the morning of 18 April, I managed to write the letter in front of a social
worker Roger and a case manager but was told that the letter couldn’t be mailed
out without the psychiatrist’s approval. While the case manager informed a
nurse that she would get back to me later that afternoon, at dinner time (5pm) I
checked with a nurse and found that she was gone. I checked with a senior staff
member who later turned out to be a nurse clinician about the status of my
letter (or whether it was mailed out) but the nurse clinician ignored me.
4.
I
explained to him that the request was made under my constitutional right so he was
obliged to respond to it; however, my
explanation didn’t work. After I raised my voice to emphasize the absolute
supremacy of constitutional rights, the nurse clinician simply made an order to
send me to a single-bed room (seclusion room) that was specifically designed
for troublemaker patients. I didn’t resist in any way and no explanation was
provided to justify the transfer.
The
2nd Interview
5.
On
the morning of 19 April at around 9am, the psychiatrist interviewed me for the
second time and he finally concluded that I didn’t suffer from a major mental
disorder. However, he didn’t give a direct response to my request for an early
release on the ground of my normal mental state[2]. I
reported the transfer of me to the seclusion room to him and asked for a
written justification but he simply treated the transfer as a “response” but
not a “punishment”. Due to my persistence, the psychiatrist allowed me to write
a complaint letter to the management of the IMH. I was sent back by the
security guard to the seclusion room at around 10am.
3
questions
6.
From
10am to 1pm, I waited in the seclusion room to be called out to write the
letter. I also talked to a number of nurses about the psychiatrist’s permission
but they all replied that they were too busy to handle my request. In fact,
what the nurses supposed to do was to provide me with a pen and a piece of
paper so I could write the letter in front of the security guard only. I also requested
the security guard to talk to the nurses on my behalf, there was still no
response.
7.
At
around 1pm, I asked 3 questions to a nurse who happened to pass the seclusion
room. The first question was “Can I write the complaint letter?” This nurse declined
my request on the ground of their busy work schedule. The second question was
“Why did you give priority to other jobs assigned by the psychiatrist but not to
my request?” This nurse simply replied that my request was “less important “and
didn’t provide any justification. The third question was “When can I write the
letter?” This nurse replied “I have no idea”.
Physical
restraint
8.
Given
the facts that I had waited for 3 hours and I had got the psychiatrist’s
permission, I thought this nurse had denied me my constitutional right to
freedom of expression so I kicked the lower part of the door continuously to
express my unhappiness. The nurse set off the alarm and after a short while,
over 10 persons gather outside the seclusion room. A male ward manager told me
to get out of the room and they wouldn’t apply force on me. He told me to lie
on a hospital bed and as soon as I did so, they immediately applied hand and
feet restraints on me to tie me to the bed. I didn’t resist in any way but expressly
told them of the psychiatrist’s diagnosis of my mental state. I also requested
to see the psychiatrist, there was simply no response.
9.
I
was placed inside the seclusion room and after a short while, a female doctor came
and asked me whether I had got any injury. I told her what happened to me and expressly
informed her of the psychiatrist’s diagnosis, however, she simply ignored me
and left. A nurse told me that she was the only doctor I could talk to.
10.
From
1pm to 1:30am, for over 12 hours, I was restrained in bed and I kept shouting
“release me” and “protest against the IMH for false imprisonment” and also
condemned the nurses but no one dealt with my request. A nurse told me that
“the harder you try, the less likely you will write the letter”. At 5pm, a
nurse told me that he would release me on the condition that I would have dinner;
I refused because I was on a hunger strike.
Chemical
restraint
11.
At 1:30am of 20 April, 3 nurses came into the
room to stop me from shouting. I expressly told them the psychiatrist’s diagnosis
and asked them to justify the use of restraints. One nurse shouted at me that “You
have no right” and added that “We come to release you but you talked so much so
we don’t release you”. He suggested to his colleague that “if he continues to
make noise, we give him a shot”. I immediately stopped making noise and requested
for a release but they simply left. A few minutes later they came back and gave
me an injection, regardless of my protest. When questioned why to give me a
shot since I had already stopped making noise, a nurse answered “to make you
rest well”.
12.
I
was told that my blood pressure would be measured every 15 minutes in the first
hour after the injection and I could only recall the first measurement. When I
woke up in the morning, I found I was lying in a mattress on the ground. When I
got up, I felt dizzy. I continued my hunger strike to protest against the
hospital brutality until the dinner time of 22 April, when I was confirmed that
my complaint letter wrote on 21 April was sent to the CEO of the IMH. There is no
response.
The
nurse clinician’s explanation
13.
I
came across the nurse clinician and asked him for a written justification for
his transfer order. On the morning of 22 April, he showed me a copy of internal
regulations made by the IMH in which the rights and the duties of the IMH and
the detained individuals were set out. He added that a detained individual was
not allowed to have a copy of it.
14.
With
respect to the transfer order, he explained that it was meant to protect me
because he believed that “other detained persons wanted to beat me after I
raised my voice on 18 April”. When questioned why he didn’t put me in a multiple-bed
room as the isolation had caused me great stress, he replied that I had
attitude problems so must be isolated. With respect to the physical and
chemical restraints applied on me, he explained that I should be more patient
and allow for the nurses’ delayed response to my request due to their tight
work schedules.
15.
When
I pointed out that I was a normal person by telling him the psychiatrist’s
diagnosis of my mental state, he paused for a second and answered that he
needed to check with the psychiatrist. In addition, he insisted that the IMH had authority to give psychiatric
treatment to everyone detained in the IMH under Criminal Procedure Code
(CPC) regardless of their mental states, pursuant to the clause 1
of the regulations he produced. [emphasis added]
After
the torture
16.
Despite
my numerous requests to talk to the psychiatrist for his opinion on the
restrains, he became not available for comment. The last time I saw the
psychiatrist was on the morning of 19 April. On 25 April, exactly one week
after I was put in the seclusion room, I was transferred to my original
multiple-bed room. No justification was provided. On 28 April, I reported the torture to the
State Courts for investigations on the ground that the court owed me a duty of
care to ensure my safety in the 2-week detention in the IMH. The judge rejected
my request and directed me for independent legal advice, without providing
justifications.
Discussions
(torture vs normal psychiatric
treatment)
17.
The
use of physical and chemical restraint on me constituted a torture or psychiatric
malpractice because I was already diagnosed as having a sound mind at the point
when the restraints were applied. The
malpractice was caused by the IMH’s misunderstanding of the law.
3
issues
18.
There
are three issues in this case. The first issue is about the lawfulness of the
IMH’s internal regulations which authorize its staff members to apply
psychiatric treatments including restraints and seclusion to every detained
individual under Criminal Procedure Code. The second issue is whether there was
a breach of professional integrity on the part of the psychiatrist because he
refused to free me from the seclusion room after his diagnosis. The third issue is whether the staff members
have breached their duty of care by not checking with the psychiatrist for his
diagnosis and by their failure to observe the guidelines for the use of
restraints and seclusion rooms.
19.
For
the first issue, the clause which reads that “these [internal] regulations are
applicable to each individual detained in IMH under Criminal Procedure Code” is
apparently unlawful because it has contradicted the Constitution[3]
and the Mental Health Act (CAP 178A)[4].In
other words, the IMH’s internal regulations are only applicable to an
individual who is diagnosed with mental illness or who is reasonably suspected
of suffering from mental illness by a designated medical practitioner.
20.
It
should note there are 3 types of persons detained in the IMH. The first type is
the Real patients or those who have diagnosed as having mental illness. The
second type is Patients To Be or those whose mental states are to be assessed
by a psychiatrist. The third type is Normal persons or those who has been
excluded from having mental illness by a designated medical practitioner. It is
self-evident that a normal person’s right to liberty and body integrity is
guaranteed by the Constitution, so psychiatric treatments including the
restraints and seclusion are not applicable to normal persons like me. In fact,
pursuant to s10(6) of the Mental Health Act, I should be released from the IMH
on 19 April after the psychiatrist reached his diagnosis[5].
21.
For
the second issue, the psychiatrist must provide justifications as to why I was
put in the seclusion room after diagnosis. The psychiatrist, on behalf of the
court and the IMH, owed me a duty of care so he needs to justify his inaction
on the correctness and the lawfulness of the use of the physical and chemical
restraints on me after the torture.
22.
For
the third issue, the relevant nursing staff needs to answer the following
questions:
a)
Given
the fact that my 3 questions were apparently rational, why my kicking the lower
part of the door made me an agitated patient so physical restraints were
applied to me?
b)
The
time limit for the application of physical restraints on an adult (usually it
is 4 hours) ;
c)
Why
didn’t the nurses consult with the psychiatrist about his diagnosis after the
use of physical restraints?
d)
Why
didn’t the female doctor assess my mental state on the spot in the seclusion
room or consulted with psychiatrist for his diagnosis?
e)
Given
the fact that I informed the nurses of the psychiatrist’s diagnosis at 1:30am
on 20 April, by what authority did the nurse use chemical restraint on me
without my consent?
Conclusion
and request
23.
For
the reasons set out above, I conclude that the physical and chemical restraints
and the seclusion applied on me constitute a torture. I request the IMH for a public
explanation.
Yan Jun (S7684361I)
4 May, 2016
[1] Pursuant to Article 9(2) of the Constitution of
Singapore which reads “Where a complaint
is made to the High Court or any Judge thereof that a person is being
unlawfully detained, the Court shall inquire into the complaint and, unless
satisfied that the detention is lawful, shall order him to be produced before
the Court and release him”. See http://statutes.agc.gov.sg/aol/download/0/0/pdf/binaryFile/pdfFile.pdf?CompId:62847936-2328-4409-aa97-2ff69536bc2a
[2]
Pursuant to s10(6) and s2(1) of Mental Health
Act (CAP 187A). s10(6)
reads
that “A person shall not be detained
at a psychiatric institution for treatment unless —(a) he is suffering from a
mental disorder which warrants the detention of the person in a psychiatric
institution for treatment; and (b) it is necessary in the interests of the
health or safety of the person or for the protection of other persons that the
person should be so detained. s2(1) reads that “treatment”
includes observation, inpatient
treatment, outpatient treatment and rehabilitation”. See http://statutes.agc.gov.sg/aol/download/0/0/pdf/binaryFile/pdfFile.pdf?CompId:a623c1d9-a2ed-4de7-9ada-d3bc2f51027e
[3]Pursuant to Article 9(1) of the Constitution of
Singapore which reads “No person shall be
deprived of his life or personal liberty save in accordance with law.”
[4] Supra
note 2.
[5] Ibid.
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