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Insight-Out: Reflection Article

Details of Webinar: 16th March 2021, Tuesday, 1600-1800


Speakers:
 

  1. Dr Christopher Cheok, Senior Consultant Psychiatrist, Institute of Mental Health (IMH)
  2. Ms Rashida Mohamed Zain, Senior Psychologist, Singapore Prison Service (SPS)
  3. Mr Glenn Lim, Founder – Chairman, Architects of Life (AOL)

 

Background

How did we decide on the theme of the webinar?

 

We wanted to explore an area of forensic psychology that was not being openly discussed between experts from both the private and public sector, an area that has often been neglected and ignored – the mental health of accused persons. After agreeing on the broader overarching theme of the webinar, we decided to narrow down the focus to the rehabilitation of Offenders with Mental Disorder (OMD) since the recidivism rate in Singapore has been rising despite rehabilitation efforts by the Institute of Mental Health, Ministry of Social and Family Development, organisations like The Yellow Ribbon and Architects of Life. We were interested to find out how these organisations design programmes and treatment for OMD who are “doubly discriminated” because of their mental health issues and criminal record. Later, we felt that focusing only on rehabilitation without considering reintegration will not provide a holistic account and picture of the overall process that OMD have to go through. Apart from recovering, OMD still has to face another major barrier – reintegrating into society. It would be interesting to hear what the experts would think of the reintegration scene in Singapore given the slow improvement in employment rate despite the rise in number of social enterprises that employ ex-convicts (e.g. Breakthrough Cafe, Soon Huat Bak Kut Teh, PopJai, etc).


Webinar Proper

Brief Introduction of Panelists

Directed Questions

 

A series of directed questions were posed to Dr Cheok, Ms Rashida and Mr Lim. We have categorised the questions according to three broad themes:

 

  1. Understanding the Mandatory Treatment Order (MTO) scheme
  2. Understanding how the Singapore Prison Service (SPS) intervenes to help OMD rehabilitate
  3. Understanding the approach taken to help OMD reintegrate back to society

 

Understanding MTO

Dr Cheok briefly shared that the Mandatory Treatment Order (MTO) is a community-based sentencing or a diversionary approach to rehabilitation that is offered to the accused or convicted persons whose mental condition(s) contributed to the offence committed. For these individuals, there will be a court order, requiring them to seek treatment at the Institute of Mental Health (IMH) instead of serving a jail term or a fine, with hopes that the treatment will help in reducing their risk of reoffending.

 

According to Dr Cheok, the law states various requirements that accused or convicted persons have to fulfil before they are considered for MTO. These requirements include:

 

  1. Treatability: The mental disorder identified has to be treatable, with disorders such as depression and schizophrenia being more treatable.
  2. Willingness: The accused or convicted person is willing to receive treatment at IMH for his conditions.
  3. Financial Capabilities: The accused or convicted person should be able to afford the treatment. If not, government and/or social welfare funding will be made available to them.

Understanding how SPS intervenes to help OMD in the rehabilitation process

 

Ms Rashida shared that inmates will be assessed for their medical needs in prison through an admission medical check, routine medical checkups and observation by prison officers, workshop supervisors, rehabilitation programme facilitators or psychologists. For inmates who experience mild symptoms, medication and brief counselling sessions will be provided. On the other hand, inmates with more severe symptoms will be transferred to the prison’s psychiatric housing units (PHU) to receive immediate treatment or intervention. The PHU works with various professionals from the IMH such as psychiatrists, psychologists and occupational therapists and vendors to provide therapeutic needs. The PHU also works closely with prison officers who have received advanced training and are skilled in detecting and engaging with OMD.

 

As for treatment and intervention plans, Ms Rashida shared that the prison looks at various sources of information (E.g., Court documents) to identify the symptoms and diagnosis that inmates have. Additionally, the formulation of treatment plans will also depend on the inmates’ risks, assessed using evidence-based tools and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Responsivity factors such as their language and comprehension ability will also be assessed. Overall, these factors will affect the level and modality of intervention.

 

As motivation is an important factor affecting one’s prognosis, Ms Rashida also shared that SPS works with inmates who lack motivation for their treatment through methods such as cost-benefit analysis. Such tools are used to help them understand what they want in their lives, increasing their motivation to actively seek treatment.



Understanding the approach taken to help OMD reintegrate back to society

 

Mr Lim shared that employment is a priority for most ex-offenders that he had worked with. His organisation, Architects of Life (AOL), adopts a holistic approach to address any employment or vocational issues that ex-offenders face. This approach includes personal development skills training, vocational skills training, upgrading, mentoring, and counselling. Mentors at AOL often work with case management teams and industry experts to support the ex-offenders in their reintegration journey. In some cases, AOL also tries to ensure that the families of ex-offenders are supportive and nurturing, aiding the ex-offenders in their reintegration process.

 

Lastly, Mr Lim highlighted that the current pandemic has aggravated OMD due to the heightened level of stress caused by the instability and uncertainty stemming from potential unemployment, affecting their livelihoods. Some workers with mental disorders react to this stress by heaving in an unhealthy way at their workplaces. This is especially concerning as employers often do not have the knowledge or skills to deal with mental disorders’ episodes, which may precipitate the problem of layoffs and contribute to a cycle of failure, rejection and anxiety.



Panel Discussion

During the Panel Discussion, some of the key issues that OMD face in their rehabilitation and reintegration journey were addressed. The questions are listed below, with responses from Dr Cheok, Ms Rashida and Mr Lim.

 

Question 1: Can you address some misconceptions surrounding OMD (if any)?

 

Dr Cheok shared that it is really challenging for OMD to reintegrate back into the workforce and society as a whole due to the widespread misconceptions and stereotypes surrounding OMD. However, it remains a fact that OMD is a part of our society. According to Dr Cheok, if we do not take measures to help them, it will eventually become a societal problem. Hence, he thinks it is important to get them back into the workforce and nurture them to be self-reliant. This is a long-term strategy that aims to mitigate their risk of re-offending by minimising issues such as unemployment and social isolation.

 

Ms Rashida shared that OMD that are released from prison face many difficulties, ranging from work-related problems to relational issues with family and friends. It will be even more acute if they are struggling with their mental disorders at that point in time. Thus, it is important to address the common misconceptions surrounding OMD and break the perpetual cycle of societal non-acceptance, making it less of a struggle for them to reintegrate back into society.

 

Mr Lim emphasised that the stigma against OMD is very real. According to him, the common perception from the general public towards OMD is that they have a “disease” and should seek professional medical help. In his opinion, this perspective is “overly-clinical”. He is an advocate for the strength-based approach and the introduction of human factor through mentoring. He strongly believes that if people can exercise more compassion and perceive others for who they are, OMD can live better lives.

 


Question 2: What are some practical problems that OMD face during their rehabilitation and reintegration process?

 

Dr Cheok shared that OMD face a myriad of challenges and it depends on various factors such as their background, the amount of family support, their financial status, and their employability skills. According to him, it is important to help OMD secure their housing, social network, and financial stability. Without all these, they may not have the motivation to seek treatment after they are released especially since treatment is voluntary. This may hinder their recovery process. Hence, it is crucial to overcome their social problems first before thinking of hospital treatment.

 

Ms Rashida shared that for OMD with more severe mental disorders, it is quite challenging for psychologists or the people around them to provide treatment or intervention. They may be incoherent or have active symptoms which require constant management, hindering the rehabilitation process. For those with developmental needs, their comprehension level is being compromised and Ms Rashida has to exercise creativity and patience during the intervention. For example, she will repeat her points in different ways till her client understands what she is conveying. Ms Rashida has also agreed with Dr Cheok that it is really important to fulfil the basic needs of a person such as accommodation and finance. If these are not in place, there will be very poor compliance in terms of getting treatment for their mental disorders. OMD will be thinking about ways to buy their next meal instead of focusing on their treatment. She also added that there is a group of OMD who rely a lot on their family members or friends for support. Without which, they are unable to function as they are incapable of working or looking after themselves. In such situations, SPS will assist by providing accommodation amongst other things. Fortunately, the prison works closely with IMH and family resource centres, organisations that are able to assist effectively.

 

Apart from these practical problems, Mr Lim also emphasized the psychological repercussions. According to him, when OMD constantly face rejection and ostracization, their self-esteem will hit rock bottom, further reinforcing their victim mindset. These feelings of low self-esteem and inferiority complex will also negatively influence their behaviour and performance, making it a vicious cycle. That being said, Mr Lim acknowledged that not everyone expresses it in the same way – there are groups who exhibit signs of superiority complex instead even though they suffer from the same discrimination. For example, they may “talk big”, portray gangster mannerism, or even narcissism. They are aggressive and are polar opposites of the behaviour typical of those who have low self-esteem. However, it is merely a façade to hide their pain and low self-esteem.


Question 3: Since there are stigmas associated with mental health and incarceration, do you think OMD are “doubly” discriminated against in the society? What are your views regarding this?

 

Dr Cheok shared that discrimination do exist and it is a matter of whether it is subtle or explicit. He gave an example in the context of employment. Although companies do not officially discriminate, it is almost inevitable for recruiters to make subtle judgements which may influence their hiring decisions. Furthermore, some may not even be conscious about it. Unless the OMD attended a very dedicated programme such as the Yellow Ribbon, they are likely to have lower chances of being hired in an open employment market. Even though discrimination exists and it is negatively affecting OMD, he believes that it is human nature to form such judgements of people and it is not easy to detect and eliminate such biases.

 

Ms Rashida agreed with Dr Cheok that there is definitely discrimination, especially against OMD. That being said, she is optimistic about the future as there are plenty of ongoing efforts to mitigate this stigma. With respect to the stigma surrounding mental disorders, the Ministry of Health (MOH) and IMH have been providing psychoeducation to the public about mental health. Ms Rashida believes that such programmes and educational efforts would be useful as much of the stigma actually stems from the lack of understanding about mental disorders. As for stigmas surrounding incarceration, Singapore Prison Service (SPS) has introduced befriending programme, where volunteers get to provide pro-social support to the inmates while they are incarcerated and later, released back to society. This interaction would allow members of public to gain a better understanding of the inmates and hopefully reduce their negative biases and correct their misperceptions towards OMD. The feedback has been positive thus far and the inmates really look forward to their befrienders visiting them. Lastly, Ms Rashida believes that it is crucial to engage the community in this de-stigmatisation process and employers can facilitate by providing employment opportunities.

 

Mr Lim added by stating that ex-offenders and mental health patients are probably the most stigmatised groups in Singapore. Thus, there is no doubt that OMD are “doubly” discriminated. He shared that OMD may perceive themselves as the bottom of the social strata and have low self-esteem as a result. He would not blame them for feeling that way but hopes that such discrimination can be alleviated in the near future.

 


Question 4: Has working with OMD affected how you view crime, perpetrators of crime, or the criminal justice system?

 

Dr Cheok shared that the general public tend to form quick judgements about OMD after watching reported crimes on the news as compared to those who are working in this field. He emphasized that there are two different groups of OMD – one suffers from mental disorders as a result of adverse childhood while the other is antisocial in nature. From his experience, a significant proportion of them belong to the former. They went through a traumatic childhood plagued with physical abuse, emotional abuse, and neglect, which set them up to a relatively disadvantageous teenage life and early adulthood. They may be inclined towards thrill-seeking behaviour as a means to cope with their challenging family backgrounds and end up violating the law. Dr Cheok expressed sympathy with this group of OMD and derives motivation from helping them turn over a new leaf. He shared this in hope that people will not simply see OMD in a negative light because some are driven to crimes by their circumstances. He also hopes that there will be more bottom-up societal efforts as this pertinent issue will continue to affect future generations if it is not dealt with properly.

Through her interactions with OMD, Ms Rashida realised that each offender has their own unique story, and it is important to understand them before being able to appreciate the offences that they have committed. Only by understanding the background of an individual, can the risk factors leading to the commission of crime – such as personality issues, trauma, abuse, or negative peer influence be discovered. This would be useful for correcting some of their maladaptive behaviours which may pose a danger to themselves or the people around them. Ms Rashida also expresses the need for OMD to gain insights into their own behaviour as they may not even be conscious about the underlying reasons behind their antisocial behaviour. For example, if they are being abused since young, violence may be the only means they know to solve problems. Hence, she believes that it is crucial for them to receive professional help and intervention, not just during incarceration, but also after their release. Although this rehabilitation process will take time, or perhaps even a few incarcerations, Ms Rashida is optimistic that with the support of the community as well as their own self-motivation, they can eventually stay away from crimes.

 

Despite not having vast working experience with OMD specifically, Mr Lim has been actively working with the ex-offender community for the past 15 years and this has strengthened his resolve in believing them. He has personally witnessed the change and growth of many ex-offenders when they are placed in the right environment and when opportunities were given to them. He strongly believes that by creating communities around them and including them into the ecosystem of nurturing, supportive environments, they have the potential to thrive. The slogan of his social enterprise, Architects of Life, “from stereotypes to archetypes”, reflects his belief that negatively-stereotyped individuals have the potential to become societal role models when given the right resources.

 


Question 5: Are there any gaps or areas for improvement in the rehabilitation and reintegration efforts of OMD in Singapore?

 

Dr Cheok stated that there are not enough professionals working in this field. In his opinion, the discrimination against OMD extrapolates to the workforce context, not pertaining to just the employment of OMD, but also the hiring of professionals to work with OMD. It is not easy to find people who want to do mental health work, not to mention working with mental health patients who were ex-offenders. There is a constant struggle to find people with the right attitude and skillset to enter into this profession.

 

Ms Rashida stated that the stigmatisation against OMD needs to be corrected. Although there has been ongoing efforts to mitigate this, she sees the need to raise more awareness of the challenges faced by OMD. She also suggested allocating more resources to help OMD seek better accommodation, employment and other services, adding that it will be really beneficial for them in their rehabilitation process.

 

Mr Lim believes that there is a need to have more opportunities for positive engagement. He further elaborated that there are two ways to do this: i) adopt strength-based approaches to help OMD identify their own talents and skills, as well as ii) allow OMD to give back to the society. For the former, he gave an example of how he holds the notion that most ex-offenders make good entrepreneurs. They think out of the box and see things differently. These characteristics may perhaps be the main reason which got them into trouble in the first place. However, they are also good entrepreneurial traits. These characteristics can be identified and applied to new ventures that are positive. For the latter, they can either volunteer their time or work on projects with targeted beneficiaries. By giving them these opportunities, they begin to see beyond themselves and their victimised situation, which will help them break out of their victim mindset. By being able to contribute to society in their own ways, they will also start to perceive themselves as assets instead of liabilities. Mr Lim believes that this is very powerful as he has personally lived through such situation as an ex-offender himself. He credited his current success to people who have believed in him, provided him with the much-needed opportunities, and helped him establish his sense of self. Hence, he hopes to contribute back to the society and improve the lives of other ex-offenders through such means.


Overall Group Reflection

 

During the webinar, we were able to hear diverse views on the issue of rehabilitation and reintegration of OMD and these perspectives have provided us with a more complete picture of the mental health scene for offenders in Singapore. It is heartening to know that the various organisations that we have invited for this webinar have been working with one another to provide a more holistic approach to help offenders/ex-offenders suffering from mental disorders. Before this webinar, some of us are more familiar with the in-care rehabilitation of OMD or the legal avenues available to help them. However, after attending the webinar, we got a better understanding of the multi-pronged approach undertaken by the various organisations and the aftercare programmes available for OMD.

 

Our biggest takeaway from this webinar was understanding how the different organisations work with one another to provide the care and support that OMD require. There is a systematic flow in the rehabilitation and reintegration process. For instance, the IMH and SPS work with one another to provide the clinical support that OMD need for their treatment while AOL works at a community level to provide the social support, reinforcing and cementing the current efforts by IMH and SPS. Prior to this webinar, some of us had the preconceived notion that treating OMD would be just like treating any other patient. However, this is not the case as many OMD often face challenges that may impede their progress in their treatment such as being unemployed. Additionally, many OMD often face the additional stigma of being both an offender and a patient with mental disorders which makes it even more difficult for them to reintegrate into society. As such, these real-life struggles often add additional considerations when treating OMD. As Mr Lim has shared, many employers are often not equipped with the knowledge and skills required to deal with OMD in their workplace, which may worsen the current cycle of unemployment and stress. As such, a greater emphasis on educating leaders in workplaces on dealing with mental disorders will not only help OMD to cope better during stressful situations but also help them to stay away from crimes.

 

Initially, some of us were also not very sure of the priorities to focus on when OMD get released from prison. However, we later learnt that it is important to first help them with their basic and social needs before embarking on medical treatment. Only when their mental health is stable, can we, more effectively provide them with the opportunities for positive engagement. This will allow them to see beyond themselves and also enhance their sense of self-worth. That being said, we also agree with Mr Lim that more opportunities should be provided for ex-offenders since the current initiatives are mostly focused on meeting their basic needs instead of empowering them. In order to help them break out of the vicious cycle, it is equally vital to empower them. Hence, government or VWOs could perhaps explore more of such options.



Authors Bibliography

Loh Jing Jie is a 3rd Year Law Undergraduate minoring in Political Science. He has a deep interest in exploring the various ways behavioural psychology has been applied in legal settings (interrogation room, courtroom). As one of the project managers of CJC-F (Psychology Division), he is in charge of planning and executing various projects. As a member of the editorial team, he curates, edits and delivers new content for CJC-F’s weekly newsletter publication and social media outreach. As a firm believer in ensuring fairness for all in the criminal justice system, Jing Jie explores how the study of forensic psychology can help law enforcement officers, lawyers and judges make better decisions. He hopes that the articles, social media posts and seminar will generate awareness, develop empathy and shed light on the problems surrounding offenders with mental disorders, traumatic victims and vulnerable witnesses.





Soh Xin Hui is a Year 4 undergraduate student majoring in Psychology, with a minor in Forensic Science. As the project manager for Forensic Psychology in CJC-F, she is in charge of coordinating, advising and working together with her team to spread awareness of the use of forensic psychology in the legal setting. Intrigued by the marriage between her two academic backgrounds, she is interested in exploring the use of psychology in legal settings and seeks to champion its importance.







Tan Wei Liang is a Year 4 Psychology undergraduate, with a minor in Forensic Science. With a strong passion in forensic psychology, Wei Liang aims to pursue his postgraduate studies and subsequently a career in this field. As one of the project managers of CJC-F (Forensic Psychology Division), he spearheads the project’s programme planning and newsletter publication. Ultimately, he hopes to raise awareness about the field of forensic psychology and advocate for its application in the criminal justice system.





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