Psychosis Archives - Promises Healthcare
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What is the Lasting Power of Attorney (LPA)?

What is the Lasting Power of Attorney (LPA)?

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 up LPA 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:

  1. an Accredited Medical Practitioner;
  2. lawyer; or
  3. registered psychiatrist

As the writer of this article is none of the above, we recommend that you speak to your chosen LPA certificate issuer to fully understand the nuts and bolts of the LPA.

Nobody wishes to have the eventuality of an LPA come to pass, but we hope you will consider that “a stitch in time saves nine”. For Singapore citizens, the LPA Form 1 is free, until 31 August 2020.

Please refer to the MSF’s LPA FAQ for further details.

 


  1. Singapore Mental Health Study, 2016.
  2. Psychosis – Institute of Mental Health. https://www.imh.com.sg/clinical/page.aspx?id=258, accessed 8/6/20
  3. SA Chong, et al. A Risk Reduction Approach for Schizophrenia: The Early Psychosis Intervention Programme, Annals Academy of Medicine, Sep 2004 Vol 33 No. 5.
  4. Photo by Scott Graham on Unsplash
An interview about Psychosis on Vasantham’s En Ullae S2 with Dr Rajesh Jacob

An interview about Psychosis on Vasantham’s En Ullae S2 with Dr Rajesh Jacob

Vasantham (Mediacorp’s Tamil & Hindi TV Channel) studios reached out to Promises Healthcare’s Senior Consultant Psychiatrist, Dr Rajesh Jacob, in the name of bringing greater mental health awareness to the Indian community in Singapore.

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.

 

(Click on the link for a version with English subtitles. Remember to click on the ‘Settings’ button to reveal the English subtitle selection. https://www.mewatch.sg/en/series/en-ullae-s2/ep6/952940 )

Psychosis

Psychosis

Psychosis can be a debilitating experience for individuals experiencing it. Hearing voices or thinking unusual or disturbing thoughts is common in psychosis. Having psychosis makes it difficult to figure out what is really happening and there is a break from reality. It results in individuals not being able to do the things they usually do—such as going to work or school and enjoying time with friends and family. Family members may also struggle as to how to help their loved ones through these experiences.

The truth is that psychosis is a treatable condition. Treatment for psychosis is provided by healthcare professionals and support groups. This involves a number of different approaches which include medication, therapy and peer networks. At Promises we provide support through doctors, Counsellors and Case managers. There are peer groups in which our clients attend to hear the shared experiences of individuals who have lived through periods of psychosis. So do know that help and options are always available.

At Promises Healthcare, we are committed to helping you through your journey to recovery. Please contact our clinic for inquiries and consultations.

Written by Jesudas Soundhraj, Therapist, Promises Healthcare Pte Ltd