believing in 2 nd chances: social work services under the mandatory treatment order in singapore

Believing in 2Believing in 2ndnd chances: chances: Social Work Services under the Mandatory Treatment Order in Social Work Services under the Mandatory Treatment Order in

SingaporeSingapore26 July 201426 July 2014

Loving Hearts, Beautiful Minds


• Total land area: 712.4 sq km or 275 sq mile• Total GDP: $257,640.4 million• Total population: 5,076m • Population profile by race:

• Chinese 74.1%• Malays 13.4%• Indians 9.2%• Others 3.3%

•Four official languages: English, Malay, Chinese and Tamil. English is used administratively and as medium of instruction in education and at work

Singapore General Quick Facts 2010Singapore General Quick Facts 2010


OutlineOutline

1. Forensic Psychiatry Services in Singapore

2. Community based sentencing orders in Singapore

3. What is Mandatory Treatment Order (MTO)

4. Case example: Role of social work in the MTO

5. Issues faced in MTO

6. Future directions


Diversion Programme

Psychiatric Assessment

Report(including

PACP)

Court Appearance

PACP

Psychiatric Housing Unit

Mandatory Treatment

Order

CPC

Forensic Psychiatry Community Service

Forensic Mental Health Services provided by IMH

Police arrestCourt

hearingServing sentence

Released from sentence

Other services

MHCTA(Form 3 & 5)

Preparation for step-

down care


Community Based Sentencing in SingaporeCommunity Based Sentencing in Singapore

Community-Based Sentencing (CBS)

•Introduced in the Criminal Procedure Code 2010 to provide greater flexibility in sentencing.

•Implemented in January 2011.

•CBS includes:

1.Mandatory Treatment Order (MTO)

2.Community Service Order (CSO)

3.Day Reporting Order (DRO)

4.Short Detention Order (SDO)


MTO Programme CharacteristicsMTO Programme Characteristics

Definition:

A sentencing option that allows the Courts to order an offender to undergo compulsory psychiatric treatment for a period not exceeding 24 months.

(Section 339 of Criminal Procedure Code)

Objectives:

1. Effective and targeted approach to rehabilitating mentally ill offenders

2. Better utilization of resources which would otherwise be allocated to incarceration

3. “Second chance” for mentally ill persons charged with (relatively) minor offences


Eligibility Criteria

1. Offenders with recognizable and treatable psychiatric illnesses

2. A causal, or substantive link between the psychiatric condition and the offending behaviour

3. Must be willing to undergo monthly psychiatric appointments for up to a 2 year period

4. Willing to be compliant to prescribed treatment in any form

5. Be prepared to be contacted/home-visited regularly by clinical staff

6. Adequate family/social support (preferred)

MTO Programme CharacteristicsMTO Programme Characteristics


MTO Treatment FrameworkMTO Treatment Framework

Court

SentencingPotential for

community based sentencing options

No potential for community based

sentencing

Jail/Fine etc

Potential for MTO

CWO, DRO etc.

Psychiatrists to assess by MTO service provider

(IMH)

Not suitable for MTO

Suitable for MTO& upon approval by

Courts

Processes•Appointment of bailer•Treatment program

•Submission of 6-monthly progress report

•Funding & payment

Completes treatment

Defaults treatment / does not improve

Refer to Court for follow-up

action


FY2014:•1 Program Director (Senior Consultant Psychiatrist)•1 Program Executive•4 Case Managers•3 Medical Social Workers•1 Administrative Assistant•1 Clinic Coordinator•1 OT •1 Psychologist

MTO TeamMTO Team


Illness Inclusion & Exclusion Criteria

Generally, diagnoses which are included (DSM-IV-TR/ICD-10)

• Psychotic Disorders – Schizophrenia, delusional disorder

• Mood Disorders – Depression, bipolar disorder

• Anxiety Disorders – GAD, phobic disorders, panic disorder, anxiety disorders (e.g. OCD), PTSD

Generally, diagnoses which are excluded:

• Purely Personality Disorders, Substance abuse & addictive disorders, Intellectual disability


Operations Flow for MTO assessment


MTO Dashboard as of 11 July 2014MTO Dashboard as of 11 July 2014

Assessments since January 2011

N = 523


MTO Duration (by months)


Age at time of MTO assessment


GenderN = 297


Index offences


Diagnosis


MTO status


Case ExampleCase Example

Kat (not her real name)

Demographics:

• 44 year old female / Malay / Muslim / Married

• Employment status: Unemployed. Previously helped mother in her stall.

• Education: Primary 5

• Diagnosis: Depression (1st treated in 2008, irregular)

• Suicidal history: Attempted suicide in 2010 with 6 tablets of panadol

• Substance use history: Nil reported

• Forensic History: Nil reported

• Accommodation: 4 room purchased apartment


Family GenogramFamily Genogram

Father, Retiredin Malaysia,

65yo

Mother,Housew ife in

Malaysia, 60yo

Mary, Worksw ith Computers,

45yo

Kat,unemployed,

44yo

Jane,Works in abank, 39yo

Bob,Mechanic,

43 yo

Jack,student,

10yo

Jim,student,

8yo

Jerry,4yo

Sarah,Childcare

teacher, 23yo

Harry, Polystudent,

19yo

M. 1987, D. 1992

M. 2000

55yo


Index offence:

•Voluntarily causing hurt to a domestic helper by slapping her cheek, pushing her, burning both her arms with heated iron and injuring her with a knife at her stomach area.


Court outcome: Kat was granted MTO for Court outcome: Kat was granted MTO for 24 months24 months


Social Work Services under the MTO

•Financial Assistance

-Applied for assistance for treatment fees

-Referral for financial assistance schemes

•Family Work

-Referred Kat to therapy services: work on her coping with divorce proceedings (3 sessions)

-Family conflict

•Employment assistance

-Contacts for child care services given

-Kat set up a food stall in a school

-In other cases, referral to Job Club or employment placement services



Case ExampleCase Example• Family Violence Intervention

- Home visit was conducted: Eldest son and 2 youngest sons seen

- Bedroom doors were removed, door knob was missing

- Worked out safety plans for family – stay in a cheap hostel till court hearing

- 3 days later, Kat informed that family moved to stay in a park

- After returning to the flat, Bob hit the 2 youngest children (with a belt and torchlight) and the children were admitted to a hospital

- Kat decided to apply for protection order for her children

- Family stayed at the hospital for the time being

- Therapy was closed due to crisis management


Case ExampleCase Example• Referral to/Liaise with external services

- Referred Kat to a Family Service Centre (FSC) for safety monitoring

- Case conference: Clarification of roles of agencies

• Accommodation assistance

- Referred Kat to a crisis shelter

- Kat stayed at friends place, moved to stayed in school but was warned by the police, then shifted to a rental place (Daughter stayed separately)

- In other cases, social worker refers patients to psychiatric residential centres, halfway houses



• Child Risk management

- 11 year old son reported to a school counselor that Kat wanted to throw her 5 year old son from an 11th floor, and was stopped by her other children

- When questioned, Kat admitted having such thoughts, saying she felt very stressed then as the family had no place to stay

- Referred Kat to Child Protection Services

- Kat received emergency funds, which

addressed her stressors

- No further risk was assessed towards children



Updates:

•Completed her MTO

•No longer given any appointments in IMH

•Kat had divorced and was selling the matrimonial flat

•Working as a cook in a childcare

•FSC will continue to explore alternative housing and assist her in parenting her children


Issues faced in MTOIssues faced in MTO

1. Assessor vs Treating role – Need for role clarity

2. What is defined as treatment? – Need for engagement

3. Managing expectations of family members/service providers – Being aware of limitations and powers

4. Role of rehabilitation vs role of supervision - Firmness with flexibility


Future DirectionsFuture Directions

1. Research

2. Review on effectiveness of MTO

3. Focus on criminogenic factors

4. Expansion of criteria?

believing in 2 nd chances: social work services under the mandatory treatment order in singapore

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