Hansard, 2008-09-15

Under the provisions of clause 2(d) of Article 46 of the Constitution of the Republic of Singapore, the following Members have been granted permission to be or to remain absent from sittings of Parliament (or any Committee of Parliament to which they have been appointed) for the periods stated: Name From (2008) To (2008) Dr Balaji Sadasivan 29 Aug 30 Aug 02 Sep 06 Sep 08 Sep 10 Sep 16 Sep 22 Sep Mdm Ho Geok Choo 02 Sep 04 Sep 16 Sep 18 Sep Mr Khaw Boon Wan 02 Sep 06 Sep 21 Sep 25 Sep Mr Seah Kian Peng 02 Sep 05 Sep Mr Sam Tan Chin Siong 03 Sep 05 Sep Mr Charles Chong 06 Sep 08 Sep 16 Sep 18 Sep Mr Wong Kan Seng 06 Sep 06 Sep RAdm [NS] Lui Tuck Yew 07 Sep 14 Sep Mr Teo Ser Luck 07 Sep 14 Sep Assoc. Prof. Dr Yaacob Ibrahim 07 Sep 10 Sep Mr Tharman Shanmugaratnam 08 Sep 11 Sep Mr K Shanmugam 09 Sep 10 Sep Prof. Thio Li-ann 10 Sep 30 Sep Ms Jessica Tan Soon Neo 12 Sep 14 Sep 15 Sep 15 Sep 16 Sep 21 Sep Dr Vivian Balakrishnan 12 Sep 14 Sep Ms Cham Hui Fong 15 Sep 17 Sep Mr Lee Kuan Yew 15 Sep 15 Sep 20 Sep 28 Sep Column: 7Dr Loo Choon Yong 15 Sep 15 Sep Mr Chan Soo Sen 16 Sep 19 Sep Mdm Cynthia Phua 16 Sep 18 Sep Mr Goh Chok Tong 16 Sep 28 Sep Mr Inderjit Singh 16 Sep 19 Sep Mr Liang Eng Hwa 16 Sep 18 Sep Dr Lim Wee Kiak 16 Sep 18 Sep Mr Cedric Foo Chee Keng 18 Sep 26 Sep Dr Ong Seh Hong 19 Sep 20 Sep 23 Sep 26 Sep Assoc. Prof. Koo Tsai Kee 21 Sep 21 Sep 24 Sep 25 Sep Mr Teo Chee Hean 22 Sep 26 Sep Ms Ellen Lee 26 Sep 28 Sep 09 Oct 14 Oct Mr Mah Bow Tan 26 Sep 27 Sep Mdm Halimah Yacob 02 Oct 07 Oct 13 Oct 16 Oct Mr Abdullah Tarmugi 06 Oct 09 Oct Mr Wee Siew Kim 07 Oct 17 Oct Mr Heng Chee How 30 Nov 08 Dec Mr Zainudin Nordin 08 Dec 28 Dec

Dr Loo Choon Yong

ABDULLAH TARMUGI Speaker Parliament of Singapore

The following Bills were assented to by the President of the Republic of Singapore on the dates stated:

5th September,2008 (1) Public Transport Council (Amendment) Bill 9th September,2008 (1) Parliamentary Elections (Amendment) Bill (2) Consumer Protection (Fair Trading) (Amendment) Bill (3) Patents (Amendment) Bill (4) Legal Profession (Amendment) Bill (5) Skills Development Levy (Amendment) Bill (6) Estate Duty (Abolition) Bill (7) Singapore Tourism (Cess Collection) (Amendment) Bill ABDULLAH TARMUGI Speaker Parliament of Singapore

The following Question stood in the name of Mr Arthur Fong:

1. To ask the Minister for Trade and Industry whether rising business costs faced by SMEs have dulled their competitiveness and what measures will be initiated to assist SMEs in these trying times, given the economic landscape over the next six to 12 months.

Question No. 1, Sir.

Mr Speaker, Sir, business costs have indeed gone up. Rental and manpower costs have risen. Global commodity prices remain high compared to their level a year ago, and this has been reflected in higher fuel and

materials costs for our SMEs. But this is not unique to Singapore. SMEs in other countries are similarly affected.

Feedback we have received from SMEs indicate that higher costs have squeezed their profit margins. But they remain financially sound. Loan default rates and rental arrears are stable. Industry feedback is that SMEs’ business expectations for the next six months are still moderately positive.

Our SMEs have highlighted that manpower, raw materials and rental are the key components contributing to the rising business costs. With the continued rise in global commodity costs, it is unlikely that the price pressure on raw materials will ease significantly. Nevertheless, we have put in place several measures in areas within our control to address manpower and rental costs, so as to help SMEs meet the challenges as well as tap opportunities of the current economic environment.

Mr Speaker, Sir, we have sought to lower business costs by easing manpower constraints through various avenues. Working with MOM and WDA, we have reached out to economically inactive residents (housewives and mature workers) to encourage them to join the workforce. We have also provided greater flexibility in our foreign worker policy since January 2008. As a result, while we have been seeing some increase in labour costs in the recent months, this is still at a reasonable level compared to labour costs in previous years.

We have also sought to ease rental rates. Part of the current rental escalation could be attributed to the spillover effects from the short-term office crunch. To mitigate this, the Government has released more transitional sites and vacant State properties for office use, which will come on-stream in about a year.

The Government has also similarly increased space available for industrial and retail developments, which have also led to a moderation in the industrial and retail rental growth rates. By next year, there would be more forward supply which will gradually be realised over the next few years to ease demand. Nonetheless, we are already seeing a moderation in industrial rental growth rates. For the second quarter this year, industrial rental growth was at about 2.3%, down from about 7.8% in fourth quarter 2007.

We will also ensure that SMEs continue to have access to credit through our Local Enterprise Finance Scheme (LEFS), Loan Insurance Scheme (LIS) and Microloan Programmes. With these available loans, our SMEs will be able to continue financing their current operations while investing in capabilities to fuel future growth. Based on our monitoring of these loans and feedback from private financial institutions, there does not appear to be much credit tightening for SMEs. For instance, the amount of outstanding LEFS and LIS loans to SMEs for the first seven months of 2008 has grown by more than 50% over the same period last year. The percentage of SME defaults on bank loans has also remained stable. We are monitoring these trends carefully and will increase Government loans to SMEs if necessary.

These challenging economic times also provide new opportunities for SMEs to grow. IE Singapore has stepped up its efforts to support SMEs expanding into emerging markets such as Latin America, Middle East, Russia and Vietnam, which still present opportunities despite the current global slowdown. For example, SMEs can now tap on IE’s new Exporters Development Programme, which develops our SMEs’ skills and knowledge in export activities.

Certain industry sectors also continue to see sustained growth despite uncertainty in markets and high business costs. The overall services sector, for example, which comprise largely SMEs, grew by a healthy 7% in the second quarter of 2008. In particular, sectors such as medical technologies, oil and gas, environment and renewable energy, healthcare and wellness, education and lifestyle products and services are expected to demonstrate good growth, going forward. We will support the development of these industries as well as the development of capabilities of SMEs in these areas. Such investments will ensure that our companies continue to retain their competitive edge during this period of economic uncertainty.

2. Mr Gautam Banerjee asked the Minister for Trade and Industry (a) what action does the Government plan to take given the decline in both tourist arrivals and tourist spending in June this year; (b) how does Singapore’s performance compare with other tourist destinations and convention cities in the region such as Bangkok, Hong Kong and Macau; and (c) how much of an impact does the shortage of hotel rooms and the steep rise in hotel room rates have on turning potential tourists as well as conventions and conferences away from Singapore.

Mr Speaker, Sir, my Ministry closely monitors the performance of the tourism sector together with the Singapore Tourism Board (STB). Visitor arrivals registered the first decline in June after 51 months of uninterrupted growth since February 2004 and fell by about 3.8% year-on-year in July. Visitor arrivals in Singapore have

slowed in line with the slowdown in the global travel industry, arising from the weaker external macro-economic environment and rising fuel prices.

In the immediate term, STB will be working closely with industry partners to target key source markets using marketing initiatives such as the Uniquely Singapore Weekends campaign, which has been successful in drawing in visitors since its launch in August 2007. STB will also leverage on upcoming signature events, such as the inaugural Formula One race and the Singapore GP Season in September, as well as the year-end holiday season, to boost visitor arrivals and tourism spending.

The recent slowing of tourist arrivals to Singapore is also experienced by other regional economies. Singapore received about 5.1 million visitor arrivals in the first half of this year, registering a 2.9% growth when compared to the same period last year. This was on par with Malaysia’s visitor growth rate of 2.6% and better than the 0.5% contraction in Australia, though slower than Hong Kong’s 9% and Macau’s 18%. Hong Kong and Macau have registered strong growth, as they continue to benefit from rising tourism traffic from China. In Macau’s case, the opening of new casino resorts has also helped. However, the growth momentum of visitor arrivals has slowed down in both cases. Mr Banerjee has also asked about Bangkok. There are no city-specific data for Bangkok and Thailand has not released their first-half numbers for OATF.

Notwithstanding the slowing growth, Singapore remains a choice venue amongst business travellers. In the recently-released annual ranking by the International Congress and Conventions Association (ICCA), Singapore was again found to have hosted the third highest number of international meetings in 2007 – ahead of regional and international

business capitals like Beijing, Hong Kong, Brussels, London and Paris. In fact, Singapore has remained within the top three positions in the city rankings in the past three years (from 2005 to 2007) with an average of about 120 meetings per year. Singapore has also consistently performed well under the Union of International Associations (UIA) rankings for international meetings. Singapore emerged as the top international meeting city in 2007 ahead of perennial favourites like Paris and Vienna – an improvement over our third place position in the 2006 ranking.

Mr Banerjee also asked about the impact of high hotel occupancy and rising hotel room rates on tourists and business events in Singapore. While we recognise that rising room rates may affect visitor arrivals to some extent, Singapore remains a competitive travel destination. Our average room rate of about S$250 in the first half of the year is comparable to Hong Kong and Tokyo, whilst still about 20%-30% lower than New York and London. At 82% to 84%, the average occupancy rate for Singapore hotels is also comparable with the average rate of other global cities and remains within the level for optimal service delivery for the industry. Hotel room supply is estimated to increase by 12,000 rooms over the next three to four years, and STB will continue to work closely with other Government agencies to ensure that hotel capacity does not constrain future tourism growth. STB has also been working with various stakeholders to profile the career opportunities in the hotel industry as well as with the WDA to put in place the training programmes to ensure that there is sufficient manpower to meet future tourism demand.

While there are challenging times ahead, the future outlook for the tourism sector remains positive. The diversity in Singapore’s tourism source markets has helped to cushion the impact of a slowing

global economy, with key source markets such as China, India and Australia continuing to demonstrate good growth in visitor arrivals. STB’s efforts in developing emerging markets such as Vietnam, Russia and the United Arab Emirates have also paid off, with visitor arrivals from these regions registering strong double-digit growth in the first half of the year.

Besides the line-up of upcoming major events such as the Formula One race, the Volvo Ocean Race and the Youth Olympics Games, Singapore will be transformed with the completion of the two Integrated Resorts, Gardens by the Bay and the new International Cruise Terminal. All of these will add to the vibrancy of our city and allow Singapore to remain a compelling destination for different tourist segments.

Mr Speaker, Sir, I would like to thank the Senior Minister of State for the very comprehensive answer. We have a dearth of three- and four-star hotels and this could affect our competitiveness. As cost is an important factor, particularly for the new destinations such as China, India and Vietnam, should we have more three- and four-star hotels to make us more competitive?

Mr Speaker, Sir, our approach towards the entire hotel room situation is to allow the market forces to determine the quantity needed and also the pricing to be determined by the balance between demand and supply. Mr Banerjee's point is whether we need more three- and four-star hotel rooms. It is not for the Government to assess this as much as the market – between the travel industry players and the hoteliers, and so on.

Having said that, we have made a significant number of hotel sites available. In this case, in the second half of this

year, there will be 13 Government Land Sales (GLS) sites with a capacity for more than 5,000 rooms – if I remember correctly – and these are available for different quality hotels. Mr Banerjee might also be aware that there is a significant development, in fact, in the three- and four-star segment of our hotel industry today in several locations. For example, in the Serangoon area, there have been major developments, because that is one area where a lot of the three- and four-star type of demand is concentrated. That remains a major possibility – what is already in the pipeline and through the GLS sites. In addition, we also have some adaptive reuse kind of possibilities for disused Government buildings. Those are also available.

In sum, the supply is there and the potential supply availability can be boosted through this adaptive reuse and land sites. The important thing is for the market place to assess where these needs are and to respond to them.

3. Mr Zaqy Mohamad asked the Minister for Transport (a) if his Ministry has plans for public consultation at the grassroots level on improving bus route planning once it has taken over the centralised planning of bus routes; and (b) how does the Ministry plan to engage the public users to make bus routes more relevant.

4. Mdm Ho Geok Choo asked the Minister for Transport (a) whether he will give an update on the upgrading exercise of the public transport system; (b) whether there has been an increase in the frequency of buses and trains and, if so, by how much; and (c) if there is a measure of the number of passengers per

train/bus and whether this figure has fallen.

Mr Speaker, Sir, may I have your permission to take Question Nos. 3 and 4 together as they are related?

Yes.

Sir, since the completion of the Land Transport Master Plan (LTMP) early this year, LTA has been rolling out various initiatives to improve the public transport system. I will briefly report the progress in four key areas: (i) immediate improvements to train capacity, (ii) immediate improvements to bus capacity, (iii) providing more and better public transport travel information, and (iv) other medium-term initiatives to improve the overall system.

First, on train services. LTA has worked closely with the Public Transport Operators (PTOs) to increase the capacity of the Mass Rapid Transit (MRT) system. Since February this year, SMRT and SBST have injected some 800 additional train trips per week. This has led to shorter waiting times and less crowded trains around the peak hours and lunch time. For instance, the waiting time for a southbound train at Toa Payoh MRT station during the morning peak period, between 8.00 am and 8.30 am, has been reduced by about 15% to about 2 minutes. This means that even if a commuter may not be able to board the first train that arrives, he need not wait too long to board the next or subsequent trains.

In addition, with the additional train trips, crowding has been kept manageable despite a 13% surge in train ridership on the North-South East-West line between February and July 2008. At the most crowded stretches during peak hours,

we

are still seeing an acceptable level of loading of between 1,300 and 1,400 passengers per train – or to put it in more concrete terms – approximately 4 persons/sqm. This is comparable if not better than other major cities such as Hong Kong, New York or Tokyo. Where train loading is persistently high, we will consider allowing bus services to run parallel to the MRT lines during peak hours, to help take some of the load off the trains. For example, Service 128 now runs parallel to sections of the North-South Line, from Ang Mo Kio to the CBD.

Second, on bus services. Since June 2008, all trunk bus services plying along corridors affected by the ERP changes this year have improved their headways from 15 minutes to 12 minutes during peak hours. This will be further improved to not more than 10 minutes by 1st August 2009. In addition, the Public Transport Council (PTC) has tightened the Quality of Service (QoS) standards such that bus operators must operate at least 85% of their feeder bus services at headways of not more than 10 minutes during peak hours with effect from August 2008. This standard will be further tightened to 90% of feeder bus services by August 2009.

To meet the tighter QoS standards, and also as part of their continuous efforts to improve services, the PTOs are adding more buses and renewing their bus fleet. For example, SBS Transit recently announced that it will put 400 new Euro V buses on the road next year, at a cost of $147 million. Aside from basic bus services, we have also increased the number of premium bus services to 74, surpassing our initial target of 72 services. For commuters, premium bus services offer greater choice in the form of a faster, more direct and more comfortable journey.

In tandem with the increase in bus capacity, bus ridership has increased, by about 6% for the first half of 2008,

compared to the same period last year. Crowding levels on our buses are regulated under the QoS standards, which the PTC administers. The PTC reviews the PTOs' compliance with the QoS standards, including passenger loading levels per bus, every six months. It is expected to provide the next update in October.

Third, we are in the process of providing more and better public transport travel information. Commuters are currently already able to use an online Journey Planner on the Transitlink website to work out what services they need to take to reach their destination. This journey planner is integrated across operators and bus and rail modes. If they would like to suggest a new premium bus service route, they can also visit the online premium bus service demand aggregator tool, on LTA's website. If there is sufficient demand for a particular route from the community, LTA will approach operators to examine the viability of launching a new premium bus service.

Fourth, in terms of the medium-term initiatives, LTA will be injecting greater contestability into the bus and rail sectors, by shortening the length of rail licences and tendering out packages of bus routes. Also, the PTC will introduce a new system of distance-based through fares by 2009, to give commuters greater flexibility in choosing the travel options that best suit their needs, including transfer journeys, without having to pay an extra fare penalty. The first step in this transition was announced last Friday, when the PTC said it will raise the transfer rebate from 25 cents to 40 cents. Also, by 2009, LTA will assume the role of central bus network planner, to ensure better optimisation and integration of bus and rail services, so that the entire public transport network including bus routes is designed holistically and with the commuters' interests in mind.

All these initiatives mean change. Mr Zaqy has asked if we plan to consult community stakeholders and those affected by the changes. I would like to assure him that we will certainly do so. Currently, there is already extensive engagement at the grassroots and community level on transport issues including bus routes. Teams of managers from LTA's Community Partnership Division are assigned to each constituency, and have established strong relationships with local residents and grassroots leaders. If there are issues or suggestions on bus routes and services, LTA's officers will surface to the PTC for consideration. This process will continue, and as LTA takes on the bus planning role, LTA will also examine how to further engage community stakeholders to ensure bus routes will better meet the transport needs of the community.

Three supplementary questions for the Minister. As Singaporeans are encouraged to use public transportation, are there measures to review our Park-and-Ride Scheme?

Second supplementary question would be: how does the Ministry propose to fund the support measures that were announced, such as increasing the number of full-day bus lanes, managing demand for road space through congestion pricing and making travel information more accessible?

The third supplementary question would be: when will these support measures be installed?

Sir, I have previously taken a question on the Park-and-Ride Scheme, so I will not repeat the answer I had given, except to say that this will be part and parcel of the overall plan to shift more people towards public

transport. The Park-and-Ride Scheme is currently under review and the Ministry will make an announcement in due course.

As regards Mdm Ho's questions on the funding of the different support measures, my Minister has also previously in this House elaborated quite substantially on all the different plans in terms of both the implementation timeline as well as the different measures that will be taken to finance the rollout of all the different pillars of the land transport plan. A large part of these, in terms of the investment in the rail as well as the road infrastructure, will no doubt be publicly funded.

5. Dr Lam Pin Min asked the Minister for the Environment and Water Resources in view of the rising sea levels due to climate change, what long-term measures are contemplated to protect Singapore's coastline and to avoid major catastrophes.

6. Mr Low Thia Khiang asked the Minister for the Environment and Water Resources whether his Ministry has assessed the recent findings that the Greenland ice sheet is melting faster than expected and what impact, if any, would these findings have on Singapore.

7. Mr Low Thia Khiang asked the Minister for the Environment and Water Resources whether the Government is prepared for a possible rise in sea level and, if so, what measures have been planned in response.

Mr Speaker, Sir, with your permission, can I take Question Nos. 5, 6 and 7 together please?

Yes.

Sir, climate change is a global challenge. The direct effects of climate change include shifts in temperature, rainfall patterns, storm surges, and many others. In recent years, many countries have experienced more frequent occurrences of extreme weather events, such as the Hurricane Katrina in the US, Cyclone Nargis in Myanmar and episodes of severe floods in India and China.

The United Nation's Intergovernmental Panel on Climate Change (IPCC) projected in its Fourth Assessment Report, which was released last year, that climate change could result in sea level rises of between 18 cm and 59 cm by the year 2100. This does not factor in the rapid melting of Greenland or Antarctic ice sheets, as the understanding of these effects is too limited to assess their likelihood or provide a best estimate or an upper bound for sea level rise. Scientists are currently working to better understand and project the rate at which the ice sheets may melt, as well as the resulting impacts.

As a relatively low-lying, densely populated island in the tropics, Singapore is vulnerable to climate change effects like sea level rises, which can lead to inland flooding. However, as a result of our environmental and developmental planning in the past, we already have existing measures in place that significantly reduce our exposure to the risks.

Since 1991, all new reclamation projects have to be built to a level 125 cm above the highest recorded tide level. This requirement is 66 cm more than the IPCC's projected highest sea level rise of 59 cm by the end of the 21st century in the worst case scenario. Singapore is as such well prepared for any further increases in sea level arising from climate

change within the range of over one metre.

The development of drainage infrastructure in Singapore over the last 30 years has also reduced flood-prone areas from 3,200 ha in the 1970s to 98 ha today. PUB will reduce it to less than 48 ha by 2011 through the development and improvement of drainage infrastructure in Singapore, such as the widening and the deepening of drains and canals. While the objective of this is to reduce the flood-prone areas and alleviate flooding today, the overall enhancement in the drainage system helps to reduce the possibility of upstream flooding when heavy rain coincides with high tide or sea level rise due to climate change. The completion of the Marina Barrage project has also enhanced our flood alleviation capabilities.

However, we cannot be complacent in our efforts. It is important that we continue improving our understanding of the specific effects and impacts of climate change on Singapore. I announced last year that NEA, in consultation with other Government agencies, has commissioned a two-year study to understand the specific implications of climate change in Singapore, based on the IPCC studies. These include sea level and temperature changes, flooding and coastal erosion.

This study into Singapore's vulnerability to climate change is expected to be completed next year. It will help us better understand how Singapore will be affected and what needs to be done to protect Singapore and ensure that we are able to adapt to these impacts. We also continue to monitor closely the developments in scientific understanding of the melting of ice sheets and its impacts. Our study will give us modelling capability to factor in any new scientific findings to assess the localised effects on Singapore. This information will help in reviewing the

adequacy of the existing adaptation measures and whether further enhancements are needed.

Sir, given that Singapore is a low-lying island, can I ask the Minister whether there are further moves to study from the Dutch about building dykes, given that we are very vulnerable to flooding?

Sir, there is an inter-agency task force led by MND to review existing infrastructure adaptation measures as part of the overall Government's response to climate change. This task force will look at measures for Singapore to adapt to the sea-level rise through the protection of foreshore and coastal areas.

But as I have mentioned earlier, our reclaimed land today is well above the highest recorded tide, so this will provide some protection against any sea-level rise due to global warming. But this is based on current information. So the task force, when they review their adaptation measures, will consider the findings from the vulnerability study which I have mentioned earlier. The study is not over yet. Once it is over, we will look at it and see whether we need to enhance existing measures or introduce new ones. At the moment, I think the task force is looking at all options.

Mr Speaker, Sir, may I have two supplementary questions please? May I ask the Minister how does he protect Singapore shores against a rising sea-level of 140 cm, a possible figure, according to one international study, and the same figure I posed to him at last year's COS debate on the same issue?

Secondly, the Minister said last year at the COS debate that they have

commissioned a study to better understand the possible long-term effects and the impacts of climate change on Singapore. He did say that he will get the preliminary reports after one year and, therefore, may I ask him after one year, what are these preliminary reports?

Sir, we have to go by the best available report, and in this case, the IPCC. So I am not sure where the Member has got the figure of 140 cm, but we will be most happy to receive that particular report from her and study it.

We have to go by the IPCC because IPCC is a collection of experts across the world looking at various scenarios and the best estimate in the report, as I have mentioned in my reply, is between 18 cm and 59 cm. But having said that, we will continue to study any further scientific reports, including the one that was reported earlier, which is the question filed by Mr Low and Dr Lam, and we will study all these as part of the vulnerability study.

On her second point as to whether we have completed the interim study, the answer is yes. The findings are preliminary in nature because this is a long-term study. It will take us two years as we need to drill down the IPCC report to our context in Singapore which is located near the Straits of Malacca and South China Sea. From what we can understand, the preliminary findings show that the projection for sea-level rise is between 4 cm and 5 cm per century, and the sea level will increase over the global mean projection of 21 cm to 48 cm.

So based on the preliminary findings, our requirement of 125 cm above the highest recorded tide-level is sufficient to deal with the estimates given by the preliminary findings. With that, we are now going into the second phase of the study where we are going even deeper

into some other aspects of the effects of climate change on Singapore.

Dr Neo, last question.

Thank you, Mr Speaker. I was asked on where I got my report. I just want to say that this report came from Global Research on Oceans Warming and Rising by International Federation of Environmental Journalists and is done by using data from US National Aeronautics and Space Administration, or NASA, by a German professor.

8. Dr Lam Pin Min asked the Minister for the Environment and Water Resources if he will provide an update on Singapore's effort in achieving self-sufficiency in our water needs.

Mr Speaker, Sir, we have over the years developed a diversified and sustainable supply of water through our Four National Taps strategy, ie, water from local catchments, imported water, NEWater and desalinated water.

While continuing to rely on imported water, we are increasing the amount of water that we collect from our local catchments. The construction of the Marina Barrage has been completed and that of two new reservoirs at Punggol and Serangoon are scheduled to be completed next year. Together, they will increase our catchment area from half to two-thirds of Singapore’s land area.

Since the launch of NEWater in 2003, we have been successful in substituting potable water with NEWater for non-potable use, conserving precious potable water for drinking. The construction of our fifth and largest NEWater plant at Changi is currently in progress. When

completed, NEWater will be able to meet 30% of our water needs by 2011, up from the current 15%.

Our fourth tap is desalinated water. The SingSpring desalination plant in Tuas was commissioned in 2005, and can supply up to 10% of our water demand.

In summary, the implementation of the strategies under our Four National Taps approach ensures a robust and sustainable supply to meet Singapore’s long-term water needs, and to be self-sufficient, if need be.

I would like to ask the Minister, in addition to the current available water technologies, what other R&D project is the Government investing towards water self-sufficiency and maybe even more affordable modalities of fresh water generation? And the second question is: are there plans to continue importing water beyond the said agreement?

Sir, let me reply to the second question first. We have two agreements with Malaysia, one is expiring in 2011, the other one in 2061. The previous Minister and myself have mentioned in Parliament that we will not renew the 2011 agreement and we have communicated this to the Malaysians. For the 2061 agreement, it is still a long way to go. We will continue with that until the time comes for us to review it whether we want to prolong that or not.

On the first question as to whether we are exploring other means, the answer is yes. We are exploring all other available technological solutions to harvest as much water as possible from Singapore's land area. NEWater has been our great success but we are not being complacent. For example, we have put a request for research proposal in which Simens has been awarded the contract to investigate

how best we can reduce the energy costs for desalination. So we will try our very best to provide affordable water to Singaporeans and use technology to improve our water harvesting. Another example would be the Variability Salinity Plant, which is a water plant which can take both brackish water and river water at the same time. So we can change between slightly desalinated water and slightly fresh water and clean the water up. This allows us to put these plants at the various mouths of the canals across Singapore and thereby increasing the water harvesting in Singapore.

The PUB is committed to finding new ways and means to improve our water supply but the solution lies in technology because Singapore is such a small space. We do not have enough catchments and, therefore we have to find some other ways of using technology to harvest all the rainwater that falls onto our land.

I would like to ask the Minister how the water self-sufficiency programme, and whatever that we achieve, would benefit Singaporeans, in particular, whether when we achieve water self-sufficiency, the water tariff will be reduced and water conservation tax will be abolished.

Sir, the water conservation tax will never be abolished because it is the tool that allows us to actually conserve water and therefore providing more water for Singaporeans. It is put in place to send an important message to Singaporeans that water is a strategic resource. Use it by all means but use it judiciously. It is an important lesson for us, as mentioned by Minister Mentor during the Singapore International Water Week, that we do not want to be thirsty any longer. So it is important for us to send that message and I do not think, at least in my time as

Minister, that we will remove the water conversation tax. But I do not think the Singapore Government is also keen to remove it. What happens is that we will help people at the bottom who may have difficulties.

In terms of the water tariff, we will continue to monitor the impact of energy price and other impacts on our water tariff. We will adjust it accordingly if there is a case to be made. At the moment, the water tariff is about the right level and we will keep it that way.

On the benefits of self-sufficiency, obviously, we will feel secure as there will be the constant supply of water to meet both our domestic and non-domestic needs. As I mentioned in my reply, if need be, we can be self-sufficient. At the moment, we have the Four National Taps and they are in place to give us the diversification and reliability of our water supply system and we will keep it at that. But, meanwhile, we will continue to explore new technologies to find other ways in which we can increase the yield from Singapore's land area.

Miss Penny Low, last question.

Miss Penny Low (Pasir Ris-Punggol): Mr Speaker, surely increasing the supply of water through water harvesting and technologies is one part of the spectrum, the other part of it is managing the demand for water itself. I am wondering whether there is any indication of the trend, whether we are going to face an increased demand in water in future and, also, what measures are there that the Government might be putting in place or giving incentives for the reduction, or managing the demand for water.

Sir, I thank the Member for the question because it is an important part of our equation, which is managing water

demand. For both the domestic and non-domestic sectors, we have different strategies. But, ultimately, the aim is for them to reduce water consumption as much as possible. At the moment, if my memory serves me right, our consumption is about 158 litres per person per day. We have a target of trying to achieve 155 litres per person per day by 2012, which is our green plan.

We will continue to review this, taking into account factors such as population increases. At the same time, we will continue to reach out to the community to help them to reduce water consumption as much as possible by giving them tips and things that they can use at home, for example, thimbles in which they can fix into their faucets and taps. For the non-domestic sector, the PUB has launched a 10% reduction, called the 10% Challenge, to help the non-domestic sector to reduce their water consumption. And this can be done in two ways. Firstly, by reviewing their whole water consumption and the areas in which they can be cut back.

Secondly, PUB has gone, together with some of the industry players, to see how at the initial stage, in the design stage, what are the water efficient measures that they can put into their plant and to ensure that the water consumed is at the right level. So these are the efforts by the PUB and we hope that through these efforts, Singaporeans, both domestic and non-domestic, will respond to the call from the PUB to try and use water as judiciously as possible.

9. Er Lee Bee Wah asked the Minister for Community Development, Youth and Sports whether the Ministry will consider extending the Baby Bonus cash gift to the fifth child and beyond.

Mr Speaker, Sir, prior to the 2008 Marriage and Parenthood Package, the Baby Bonus benefits were only extended up to the first four children. The 2008 Marriage and Parenthood Package has extended the Baby Bonus co-saving component to the fifth child and beyond.

For these children, the Government will now match up to $18,000 of savings put in by parents. The total amount of support provided by the Government to the fifth child and beyond, which is $18,000, is no less than the support provided for the first four children. For the first and second child, the total amount of cash gift and co-saving amount to $10,000 per child. For the third and fourth child, the total amounts to $18,000 per child. Thus, parents who have five children or more and who are able to co-save are in no way disadvantaged. We have deliberated carefully on whether we should extend the Baby Bonus cash gift to the fifth child and beyond.

While we want to support parents who wish to have five children or more, we do not want to inadvertently encourage those who cannot afford it to do so through the provision of a large direct cash gift. For parents who are financially less able to support a large family, we would like to encourage them to focus on raising the quality of life for their existing children instead.

After careful consideration, we have decided not to extend the cash gift to the fifth child and beyond. Nonetheless, we will continue to review and monitor the Baby Bonus scheme to ensure its relevance for all Singaporeans.

Mr Speaker, Sir, in addition to Baby Bonus, parents with five children or more

can benefit from other schemes. Tax incentives such as the qualifying child relief, working mother's child relief and parenthood tax rebates have also been extended to the fifth and subsequent child. The enhanced childcare and infant care subsidies will also be extended to the fifth and subsequent child. Parents with more children will also benefit from the enhanced leave benefits such as the extended maternity leave, extended childcare leave and new infant care leave. So, overall, parents with five or more children are well supported financially and otherwise.

I thank the Minister of State for the answer. I would like to ask, for the last five years, do we have figure of how many of these child births are under the fifth child or more, and from which category of family income are they from?

Mr Speaker, Sir, let me go through the Baby Bonus history a little bit. When we started on 1st April 2004, the first child received no cash gift, no CDA; second child received $3,000 cash and $6,000 CDA; third child, $4,000 cash, $12,000 CDA; fourth child, no cash, no CDA; and fifth child, no cash, no CDA.

From 1st August 2004 to 16th August 2008, we gave the first child cash but no CDA; second child, $3,000 cash, $6,000 CDA; and third child, $6,000 cash, $12,000 CDA; fourth child, $6,000 cash, $12,000 CDA; fifth child and above, no cash, no CDA.

This year, the Government has made changes from 17th August by giving a cash gift of $4,000 to the first child, CDA, $6,000; second child, cash $4,000, CDA, $6,000; third child, cash $6,000, CDA, $12,000; fourth child, cash $6,000, CDA, $12,000; and the fifth

child, for the first time, we give CDA, $18,000, but no cash. You can see that it is the policy to help those who can afford to have more than five children and above. In terms of CDA, that means the co-payment from Government and other benefits, they did not lose out. But for those low-income group, I do agree that they face financial difficulty, but it is the policy that we do not encourage them or incentivise them to have more children, especially because of this big cash bonus. We hope that they should raise their existing children properly and educate them well, and hope that they can get out from poverty. For these children, like I said, we do give them KiFAS bursaries, and so on. But for those who can afford, then we encourage them.

10. Assoc. Prof. Kalyani K Mehta asked the Minister for Community Development, Youth and Sports whether he will consider expanding the provision of utility vouchers to vulnerable families to all Community Development Councils (CDCs) so that such families living outside the North West and South West CDCs' boundaries may not run the risk of having their power supply cut off.

Mr Speaker, Sir, the Government provides extensive help for needy families. Under the $3 billion package which will be given to Singaporeans this year, low-income households will receive Utility-Save (U-Save), Service and Conservancy Charges and rental rebates on top of the GST Credits, Senior Citizens Bonus and Growth Dividends. These families will

also receive top-ups to their Medisave accounts and their children's post secondary education accounts. Prime

Minister Lee had also announced an additional support package amounting to $256 million during the National Day Rally. This comprises a 50% increase in the total amount of Utility-Save rebates and a 50% increase in the remaining instalment of Growth Dividends (GD) to be given out in fiscal year (FY) 2008. With this 50% increase in Utility-Save rebates, HDB households could receive between $120 and $330 in total Utility-Save rebates in 2008, depending on their flat type. Taking all this help together, a low-income family of three living in a 3-room HDB flat could receive benefits of about $5,400 this year. This sum includes Utility-Save rebates of $310 and would help to offset the recent increase in their cost of living.

HDB households will also continue receiving Utility-Save rebates over the next three years as part of the GST offset package which was announced in 2007. Those living in smaller HDB flats will get more rebates. This will help low and middle-income households to offset utility bills directly.

Nonetheless, there will be those families who need more help. The ComCare Work Support Programme is a nationwide workfare-based programme which seeks to help workers upgrade their skills and find a job. In the interim, it provides such families with financial assistance, help for their utilities, rental, and service and conservancy bills, childcare and student care subsidies, and medical and educational assistance. Currently, about 4,000 households benefit from the Work Support Programme.

As part of the Many Helping Hands approach which encourages active partnership between the Government and organisations from other sectors of society, Singapore Power Services has offered the "Pay-As-You-Use" (PAYU) scheme to help families with significant arrears to have their power supply

reconnected while allowing them to settle their arrears over time. PAYU also enables households to better manage their electricity consumption.

Mr Speaker, Sir, Community Development Councils (CDCs) are free to formulate their own schemes and programmes which are tailored to best meet the specific needs of their local communities. North West and South West CDCs' provision of utility vouchers to vulnerable families within their districts are commendable examples of such ground-up efforts. Besides utility vouchers, there are also other avenues available for families who need assistance with utility bills. For example, grassroots leaders can tap on the Citizens' Consultative Committee (CCC) ComCare Fund to provide needy families with temporary cash assistance to settle the bills. As announced in March 2008, the Government will be topping up the CCC ComCare Fund by $5 million over the next four years. With this boost, there will be $6.25 million per year available in the CCC ComCare Fund.

Besides paying for utility bills, CDCs also have in place programmes to meet their communities' unique and more pressing needs. For example, some CDCs fund meal delivery programmes or food ration distribution efforts for needy residents.

In addition to this, we have in place ComCare Local Networks (CLNs) that encourage greater collaboration between the various social service agencies, such as the CDCs, Grassroots Organisations (GROs) and Voluntary Welfare Organisations (VWOs). CLNs allow these agencies to share best practices and ideas on how to assist the needy in their districts more effectively. CLNs also provide a platform for successful local schemes to be surfaced to the relevant Ministries for consideration of possible replication on a larger scale.

There are adequate resources and many helping hands to ensure that no one falls through the cracks. Those who need help to make ends meet can approach their Community Development Council, Family Service Centre or grassroots leaders for help. They can also call the ComCare Call service at 1800-222 0000.

I would like to thank the Minister of State for her response. I want to find out roughly how many families have benefited from the voucher scheme in these two CDCs.

Like I said, the voucher scheme is a local scheme. It is $10 per voucher, and the South West and North West CDCs give each CCC up to 100 vouchers. So if you ask me, the CCC ComCare Fund available per CCC is about $50,000 to $60,000 a year, which is much larger than the value of these utility vouchers. So we leave it to the Mayor to decide which one is more effective. But we feel that a token of help is still better than none.

11. Dr Lim Wee Kiak asked the Minister for National Development (a) how many couples applying for HDB flats for the first time are on the waiting list currently; (b) what are their chances of success at the first and subsequent balloting for HDB flats; and (c) what measures, if any, are there to encourage them to consider buying resale flats instead.

Mr Speaker, Sir, there are three ways for young couples to purchase

a HDB flat, namely, Build-To-Order (BTO) for new flats to be constructed, Balloting Exercise (BE) for new flats already built or under construction and resale flats. The bulk of new flats for sale is through the BTO system.

The average waiting time under the BTO system is about three years from the selection of flat to the collection of keys. This is the time taken to construct the flats. To shorten the waiting time for a new flat upon marriage, couples can apply under the Fiance-Fiancee Scheme.

HDB has implemented various measures to improve the chances of First-Timers. At least 90% of BTO flats for public applicants are set aside for First-Timers. First-Timers are also given double the chances under the ballot over Second-Timers. They have four chances if they are buying a flat to live near/with their parents under the Married Child Priority Scheme.

Therefore, First-Timer applicants enjoy a very high chance of success in most BTO exercises. In six out of the eight completed BTO exercises between August 2007 and March 2008, 80% to 100% of First-Timer applicants were invited to select a flat. In other words, all First-Timers, in some instances, were invited to select a flat. In the remaining two projects, both located in Yishun, 54% to 65% of the First-Timers were invited to select the flats. In other words, one in two was invited to select the flat.

In May 2008, HDB further refined its application process. To deter repeated non-selection of flats, First-Timer priority will be removed for those who turn down two chances to select a flat. At the same time, applicants who had been unsuccessful at least twice for BTO exercises in non-mature estates will be given additional chances from their third try onwards. Since the refinements, flat buyers have generally become more

considered in their applications and the acceptance rates have improved. This suggests that the measures are effective in helping the more serious applicants to book a flat.

Flat buyers looking for new flats already built or under construction can apply under the Balloting Exercise. However, BE launches are not frequent and consist of balance flats from the Selective En bloc Redevelopment Scheme (SERS). Due to the limited supply and high demand, the chances of selecting a flat under BE are not high.

First-Timers who need a flat urgently can buy a resale flat with the CPF Housing Grant of $30,000, or a higher grant of $40,000 if they stay with or near their parents. In addition, households earning a monthly income of less than $4,000 can also apply for the Additional CPF Housing Grant of up to $30,000.

In recent months, more First-Timers are turning to the resale market to meet their housing needs. In the second quarter of 2008, there were 1,470 cases of First-Timer flat buyers buying resale flats using the CPF Housing Grant. This is a 75% increase compared to the average of about 840 cases per quarter from the third quarter of 2007 to the first quarter of 2008.

The Senior Minister of State mentioned that home ownership in a way is the cornerstone of public housing. It was actually recently reported in the Straits Times dated 30th August that some Singaporeans would prefer to rent a flat as it is more liquid and does not subject a person's wealth to property cycle, so to speak. Is home ownership policy today still relevant, given that 90% of Singaporeans already own their homes? Can the Ministry comment on why it is more advantageous to own a HDB flat rather than rent one in the open market?

Mr Speaker, Sir, with your indulgence, I would like to refer this question to a subsequent Question which will be answered on rental flats.

Mr Speaker, Sir, I would like to thank the Senior Minister of State for her answer. I would like to ask her: what are the obstacles or impediments preventing first-time buyers from buying the resale flats instead of waiting for new flats; is the cash-over-valuation system one of the problems, and is HDB thinking of revamping the cash-over-valuation system?

Mr Speaker, Sir, I think a resale flat has a lot of advantages over a new flat. For example, there is a huge stock available out there and it is suited for applicants who have very locational specific requirements, and if they want to live near their parents for support, that is a very good reason to want to stay in a specific location. So resale flat actually has a lot of advantages. But, of course, cash-over-valuation (COV) is a consideration for many of the First-Timers, and that is really a reflection of the market condition. COV is an issue now, but it has not always been an issue. If you look at the COV in the past, particularly in the years from 2004 to 2006, COV was close to zero. So actually it is a reflection of the market condition, and I would urge First-Timers to basically watch the market carefully. It is a very serious investment to buy a house and therefore choose the right place and pay the right price for it.

I am just following up on the Senior Minister of State's comment earlier. Would MND consider changing the mechanism for the housing grant given to First-Timers buying resale flats? The grant could actually be delivered in cash rather than putting it

straight into CPF, or an equivalent mechanism.

Mr Speaker, Sir, MND would review the housing grant scheme and it has done so regularly over the last few years. We will continue to do so. At the moment, we do not have a plan to allow the use of grant to pay for COV for the simple reason that we believe that valuation is really what the house is worth and therefore we should not encourage buyers to pay above valuation.

12. Assoc. Prof. Kalyani K Mehta asked the Minister for National Development whether his Ministry has any plans to meet the pressing need for one and two-room rental flats by buying back old flats and renting them out if vacant and providing rental options priced midway between open market and current subsidised rentals as changing circumstances require some flexibility in implementing the Government's housing policies.

Mr Speaker, Sir, to meet the pressing need for rental flats, HDB has been converting some of its older unsold flats into rental units. This is in addition to building new rental flats. This year, 930 units of such converted flats at Boon Lay and Woodlands were added to our rental stock. Next year, another 1,900 rental units will become available, of which about half are converted units. In all, about 10,000 new rental flats will be available over the next five years.

As we continue to build more rental flats, we also need to safeguard them for

the truly needy. HDB is reviewing the eligibility criteria so that we can better sieve out the truly needy from the less deserving cases. In the meantime, for applicants on the current waiting list, HDB will give priority to those with more pressing housing needs.

Our Public Rental Scheme is already calibrated according to the family income of the tenants. For a one-room flat, tenants with income below $800 per month pay a nominal sum of $30 per month;

tenants with income between $800 and $1,500 pay a monthly rent at 30% of market rent; and tenants with income above $1,500 pay a monthly rent of 50% of market rental. The last group, those with income above $1,500 monthly should, strictly speaking, not be eligible for subsidised rental flats, but were allowed to stay on a case-by-case basis.

The larger issue in Prof. Kalyani’s question is whether we should provide rental subsidy for families who do not qualify for Public Rental Flats. These are families:

whose income exceeds $1,500;

who have enjoyed two or more housing subsidies; or

who have sold a HDB flat in the last 30 months.

For the first group of families whose income exceeds $1,500, they are better off owning their own homes. The Government has kept home ownership affordable by providing generous housing subsidies, especially for the lower-income group. For example, a low-income family pays $200 a month in mortgage for a two-room flat.

For a household earning $1,000 per month, this can be fully covered by their CPF contributions. In contrast, it costs $1,000 a month to rent a two-room flat in

the open market. Given the affordability of home ownership, subsidised rent should only be provided for the truly needy who cannot afford a basic flat even with the generous subsidies.

Mr Speaker, Sir, with your indulgence, can I respond to Mdm Ho's question earlier?

Yes.

Sir, the question is whether home ownership is relevant or not today, given the circumstances that have been described.

Sir, home ownership remains relevant today. Besides providing a roof over one's head and promoting stakeholdership in the country, an ownership flat is also a store of value which appreciates in tandem with the country's economic growth. It allows Singaporeans to share in the fruits of Singapore's progress. When they retire, they are able to monetise their home ownership flats by either subletting a flat, a room or two rooms to earn rental income, or unlock their housing equity by downgrading to a smaller flat, or a studio apartment, or sign a lease buy-back scheme later next year.

Sir, as mentioned earlier, the Government makes home ownership flats affordable for even the low income. In fact, for the lower-income families who are eligible by the Home Ownership Plus Education (HOPE) Scheme stand to benefit another $50,000 in CPF grants which can also be used for housing. So, technically, a low-income family can easily afford to have a two-room flat with monthly contribution of $200 into their mortgage loan. So, for a small group of needy citizens, as mentioned earlier, who cannot afford to buy a rental flat with our housing subsidies, the Government will continue to help them with a heavily subsidised rental flat.

Sir, I hope that MND is aware that the popularity of the smaller three-room flats has gone up, even though the flats were intentionally designed for low-income earners. But the popularity of the flats is such that now a three-room flat can even go to as high as $250,000. If we are going to build small flats and these flats become popular, what does MND intend to do to control the prices of small flats which are for the low-income families?

Sir, first, we are committed to increase the supply of the smaller flats. We are going to increase the supply of new two-room flats. We are also going to increase the supply of our studio apartments for the elderly to monetise their assets. As mentioned earlier, in this year's COS, we are launching about 240 new two-room flats and more are on-stream.

With regard to maintaining the question of the price, new two-room flats for First-Timers are always subsidised. So, the cost is much lower than the ones in the open market. New flat purchasers can actually access any rental flats. For those who are downgrading and are competing with the lower-income families to get a two-room purchase flat, they actually have to pay a resale levy which will increase the price equivalent to the market rate. With that price mechanism, we are able to control to ensure that the two-room flats continue to be affordable to the lower-income families.

Sir, I would like the Parliamentary Secretary to provide some enlightenment on the issue of older people who apply for rental flats and the fact that sometimes there are changing family relationships and circumstances that may push the older couple to want to move out. They may be even abused by their children, and that may be

one factor to consider as well. Should we not offer a mid-way option?

Sir, first, on the issue of the elderly and how we treat the elderly who need housing. Often-times, the elderly are not First-Timers. They probably would already have access to Government subsidies and purchased their own flats. They would probably also have already monetised or sold their flats. In that sense, what are the other options? I have mentioned earlier, if they want to come back into the purchase market, they will have to pay the resale levy or they will have to buy in the open market or buy studio apartments. Many a times, they come to us asking for rental flats. When we look at that, I think the fundamental issue is not so much that they need housing from the Government, but what is the kind of housing options that they have. We have to look at the larger picture of what it means for us as a society. We have to look again at the roles of their family members. Yes, Prof. Kalyani Mehta said that perhaps family relations have soured and therefore they cannot live with their children. But that does not mean that the children cannot continue to be responsible or be held responsible for providing housing or support for their elderly parents.

We are already dealing with this issue of rental flats and ensuring that rental flats are designed for the truly needy. We are also dealing with an issue of subsidies. Subsidies are not unlimited. Given the two, we should try to focus our subsidies and resources on the truly needy and allow Singaporeans to begin to think how the elderly housing issue should be better dealt with. I think we have to start asking ourselves what is the role of the family and their children in providing for their elderly parents, even if they do

not want to live together and cannot live together. We should start asking what their children should do to provide for their elderly parents.

13. Mr Lim Biow Chuan asked the Deputy Prime Minister and Minister for Home Affairs in view of the large number of people applying for the Certificate of No Criminal Conviction in 2007 with about 68% intending to migrate (a) whether the Ministry will consider conducting an exit interview for Singapore citizens intending to migrate to other countries to ascertain their reasons for doing so; and (b) whether the Government has any plans to reduce the number of Singapore citizens migrating.

Mr Speaker, Sir, we share Mr Lim's sentiments about the importance of ascertaining the reasons why our citizens migrate to other countries, and to take steps to mitigate any push factors.

When a Singaporean seeks to renounce his citizenship, either at the Immigration and Checkpoints Authority, or at our Overseas Missions, our officers will engage him and try and find out his reasons for wanting to do so. The reasons for renouncing Singapore Citizenship vary, ranging from marriage to foreigners, to wanting to live in a different environment. We also take the opportunity to advise him to take some time to reconsider his decision.

Nevertheless, we recognise that a person's decision to renounce his citizenship is usually not taken lightly, and he is likely to have thought through the issue. The Government respects his

decision, however much we would like him to remain our citizen. We are thus mindful to approach such requests to give up Singapore citizenship in a sensible manner without making the process too onerous.

Sir, we focus our efforts on ensuring that Singapore remains an attractive place in all aspects, and that this is the best home for our people, so that Singaporeans would not even contemplate giving up their citizenship. We are reputed to be one of the safest cities in the world and have built up a world-class infrastructure, developed excellent education and healthcare systems. These are big advantages of living in Singapore that Singaporeans sometimes take for granted.

Beyond the fundamentals, we must ensure that there are sufficient employment opportunities for all Singaporeans. We should also press on with our efforts to make Singapore an exciting and vibrant place to live in.

Sir, the Government cannot stop Singaporeans from emigrating. Our education system which teaches in the English language makes them mobile. As a result, some Singaporeans will work and live overseas. We make every effort to keep in touch with them. One such effort is the setting up of the Overseas Singapore Unit (OSU) which drives, coordinates and monitors efforts of our various agencies in their engagement with overseas Singaporeans. The vision is to facilitate the coming together of an inter-connected overseas Singaporean diaspora. This includes Singaporeans who have given up their citizenship.

Sir, in the final analysis, it is about building the Singapore community and working towards a common future, to make Singapore a better place to live in, a place we can proudly call home.

14. Mr Christopher de Souza asked the Deputy Prime Minister and Minister for Home Affairs (a) how many women were arrested for vice-related activities in the past one year; (b) of these, how many were on Social Visit Passes; (c) what steps will be taken to reduce the number of prostitutes working on Social Visit Passes; and (d) what controls does the Ministry have in place to deter human trafficking, particularly within the vice trade in Singapore.

Sir, last year, Police arrested some 5,400 female foreigners for vice-related activities. 4,900 or 91% of these were in Singapore on Social Visit Passes. As a percentage of all social visit passes issued last year, this represents an abuse rate of 0.03%. As I said in this House earlier this year, there will always be a very small number among those who come to Singapore who enter under the pretext of social visits but engage in vice activities. This is a reality that we should expect with an open economy and with tourism as one of our key economic drivers.

Nevertheless, Sir, MHA has in place a number of measures to detect and prevent sex workers from entering Singapore as far as possible under the guise of social visitors.

Certain nationalities are required to apply for visas prior to entering Singapore. This enables ICA to screen travellers against ICA's records before they even travel to Singapore. If a visa applicant has adverse records or there are irregularities in her visa application, she will not be issued with a visa. The visa requirements are regularly reviewed and calibrated to deal with changes in trends and the operating environment.

When a foreigner arrives in Singapore, she is subjected to face-to-face immigration clearance by ICA officers and screened against the various border control systems. Apart from scrutinising travel documents, ICA officers also assess the entry eligibility of each visitor. If the officer suspects that the visitor's intention of entering Singapore is dubious or non-genuine, the visitor will be referred to the Duty Officer for secondary examination. This includes screening the person's fingerprints against a database of immigration offenders. If it is established that the visitor has previous adverse records or is entering Singapore for dubious purposes, he or she will be denied entry.

Nevertheless, Sir, some sex workers will still slip through the system. Such cases are then dealt with through Police enforcement. Last year, Police conducted more than 900 vice-related raids. These include major anti-vice operations as well as licensing checks on entertainment outlets and massage establishments. As a result, some 5,400 foreign sex workers were arrested. We take their biometric data, send them back home and blacklist them from entering Singapore.

Sir, Police is mindful that a woman in the vice trade may have been forced into prostitution or brought into Singapore under false pretences or against her will. Hence, Police has a dedicated vice unit that interviews every foreign sex worker arrested to establish whether there was any coercion or deception. Persons who have committed offences within Singapore will be dealt with in accordance with our laws.

Last year, Police also prosecuted 15 pimps and 30 vice-abetters in Court. Investigations were conducted to establish if any of the prostitutes involved with these pimps and vice operators were

coerced, deceived or lured into vice. None was found to be so.

In short, Sir, Singapore has a comprehensive legal framework and a robust operational framework to deal with vice and human trafficking. We will continue to fine-tune this framework as necessary.

Thank you, Minister, for the reply.

In light of the figures, especially given that 91% of women who are arrested for vice-related activities are either on Social Visit Passes (SVPs) or SVPs that had expired, what will MHA do to enhance the enforcement side, especially for the Anti-vice Branch, to further deter the rise of vice activities in Singapore and to deter the vice activities from encroaching into the heartlands?

Sir, as I have said in my answer, the number of raids, in fact, has increased. About 950 were conducted last year and it is about up 9% from the year before that. And in terms of beefing up of manpower, actually this is what the Police has done. The Criminal Investigation Department (CID) has, in fact, reorganised its branches within the CID so that the four specialist branches – suppression of vice, gambling suppression, secret society, as well as unlawful moneylending – have now been put together under investigation branches that will look into these four topics, and then there is an expert branch that looks at the research or the background. This is because sometimes the areas overlap. So to work in silo is not practical. In this sense, more officers at the CID level are now available to do anti-vice work, including, of course, looking at the larger picture, intelligence gathering, and so forth. And on the ground, currently only selected officers from 'G' Division and 'A' Division have been empowered, under the Women's

Charter, to carry out these vice raids. In fact, there are now moves to empower more officers from the other divisions to do likewise. So I do see a stepping up of enforcement on the ground.

Mr Speaker, I would like to ask the Minister whether he has any statistics on the number of males on work passes or Social Visit Passes who were arrested for vice-related activities and how is enforcement on anti-vice activities actually conducted and coordinated within the heartlands.

As far as the figures go, all the figures are for female foreign sex workers. As far as the heartlands go, in fact, the number of foreign sex workers arrested in the heartlands is very small. It is actually only about 1% of all the foreigners arrested in Singapore. So, it is not a large number.

Last question, Mr de Souza.

I fully appreciate that the economies of scale between the individual agencies will now help in tackling crime. But how quickly will there be officers outside the Golf and Alpha Divisions being allowed to investigate and level charges against vice-related activities? I think time is of the essence.

Sir, this should happen over the next few months.

15. Mdm Halimah Yacob asked the Minister for Health (a) whether it is necessary for hospitals to raise ward charges during this period when people are worried over the high inflation rate; (b) whether there is an increase in the number of patients defaulting in payments of hospital bills compared to 2007; and

how will the Ministry assist these patients.

Sir, the recent high inflation has also impacted the operating cost of public hospitals. Tender prices of medicine and other medical supplies have significantly increased. In line with market movements in wage levels, public hospitals have adjusted the wages of their healthcare workers. In addition, we have made a conscious decision to significantly raise the staff-to-patient ratio, so as to meet rising patients’ expectation for longer consultations and shorter waiting times. All these factors have increased the hospitals’ running costs.

Public hospitals will continue to absorb the bulk of the increases in cost. Our subsidy policy remains unchanged. Some adjustments in patients’ co-payment quantum are therefore inevitable.

As compared to last year, there has so far been no increase in the number of arrears cases. Patient cases in arrears after two months from discharge remain below 4%. Our system of heavy Government subsidies, Medisave, MediShield and Medifund has ensured that basic healthcare services in public hospitals remain affordable to all Singaporeans.

But during this period of high inflation, we have reminded our hospitals to be on the lookout for needy patients who might have a problem paying their bills. Patients can continue to ask the hospitals for their medical bills to be paid through instalments. We have increased the allocation for Medifund reimbursements substantially so that needy patients can get appropriate financial assistance. Two years ago, the Medifund reimbursements amounted to about $40 million. I have raised it to $50 million last year and for this year, the budget set aside is $70 million, which is a very substantial increase from the previous years. We

have also recommended that the Medifund Committees be especially flexible when evaluating the applications by elderly patients for assistance under Medifund-Silver.

Supplementary questions, Sir, for the Minister. Firstly, in view of the increased cost faced by hospitals and to ensure that hospitals can remain affordable, will the Government consider increasing the grants to hospitals? And, secondly, how many patients have asked for payment by instalments?

The answer to her first question is yes, although I could not quite recall the figures. As to the number of patients who applied for instalments, we have the data somewhere but I do not carry it at the top of my head.

16. Ms Sylvia Lim asked the Minister for Health how many persons are on the waiting list for places in subsidised nursing homes particularly those offering dementia care and what is the affordability of such care in Singapore.

Sir, there are around 8,600 nursing home beds in Singapore, of which about 4,800 or 56% are subsidised beds. Most nursing homes can take in patients with dementia. Dementia covers a wide range of disabilities and differs in different degrees of complexities.

The number of patients on the waiting list for subsidised nursing home fluctuates. For example, during the past year, it ranged from 68 to 193. But at any one point in time there were about 100 vacant beds available in subsidised

nursing homes for placement during the same period. Some mismatch occurs as some patients have specific preferences such as location, operator and sometimes even diet. Some waiting is perhaps also sensible to minimise nursing home admission becoming too convenient a substitute for taking care of the elderly within the family. The majority of patients on the waiting list are placed within a month.

Care is generally affordable as my Ministry provides the nursing homes with an operating subvention to help the lower income patients pay for their bills. For those who are more needy, Medifund is also available to assist.

That said, the demand for long-term care is growing with the ageing of our population, and this will pose a continuing challenge for us. We are investing more resources, including manpower, to expand the nursing home sector to meet the rising demand. We will also help upgrade the skills of the nursing home staff so that they can provide a higher service level and be more competent to care for patients with greater severity, particularly those with dementia.

Singaporeans can also help to play a part. First, stay active to delay or avoid the onset of long-term disability. That is why the Ministerial Committee chaired by Mr Lim Boon Heng actively promotes active ageing and there will be a series of wellness programmes being implemented at the community level. I hope the elderly Singaporeans will come and join in. It is for your own good. Second, subscribe to ElderShield and its supplements to ensure that we are better able to pay for any long-term care. Third, care for our elderly at home for as long as possible, so that they can be in the company of their families and friends.

Sir, I wonder if the Government

would be reviewing the means test criteria for Government subsidies because, currently, I understand that it is quite common for the average monthly bill of a nursing home patient to reach around $2,000 a month. And the current means test actually looks at per capita income of the household not exceeding $1,000 in order to qualify for the subsidy and this takes into account gross pay, which actually the CPF portion cannot be used to pay for the nursing home fees. So I wonder if the Government would consider perhaps relaxing the means test criteria so that more people can get some of the Government subsidies for the nursing home stay.

Sir, we do review means test criteria not just for nursing home but generally, because with wage adjustments and cost inflation, it is necessary to do so. The key point is what is the subvention for. In the case of Medifund, we are aiming at assisting the bottom 20%-30% of the population. So, a short answer is "yes", we do review and adjust them as necessary. I think, on compassion, you cannot find a more compassionate Health Minister.

17. Er Lee Bee Wah asked the Minister for Health whether the Ministry will review its current policy on Government's co-funding scheme for Assisted Reproduction Technology treatment to include patients at private hospitals.

Sir, the patients in Singapore can choose between public and private hospitals for their treatment. Both provide a high standard of clinical care, but at different prices because public hospitals are heavily subsidised.

For infertility treatment, the expertise is available in both sectors. Just to give

an example, last year, 2,100 patients sought infertility treatment. Public hospitals treated more than half of them. Success rates of the treatment are also comparable, with public hospitals averaging 27%, and private hospitals, 24%. The cost of treatment is generally lower in the public hospitals.

My Ministry’s decision to subsidise infertility treatment in public hospitals is within the context of our policy towards healthcare subsidies. Patients are not subsidised in private hospitals, as comparable services are available in public hospitals. Our approach for infertility treatment is the same. This way, Government subsidy will focus help on those couples who find it difficult to afford treatment in private clinics.

Yes, Ms Lee. One minute left.

Two supplementary questions: first, can the Ministry consider giving a subsidy but putting a cap for those patients in the private hospitals? And the second question – this is a feedback from my resident – is it true that for those couples who have two live births in the current marriage, then they are not entitled to the subsidy?

On the first question, the answer is "no" because, as I have explained, we do not subsidise care in private hospitals unless there are specific circumstances. I am ideologically not against having subsidies in private hospitals where, for example, we are not able to cope with the volume or we lack such expertise. For example, there was once when we subsidised a liver transplant in the private hospital. So, I have no problem subsidising private hospitals but there must be a purpose for it. In this case, there is no need as such capabilities and capacity are available in the public hospitals.

For the second question, the answer is "yes".

3.00 pm

Order. End of Question time.

[Pursuant to Standing Order No. 22(3), Written Answers to Question Nos. 22, 27 and 29-30 on the Order Paper are reproduced in the Appendix*. Question Nos. 18-21, 23-26, 28 and 31-40 have been postponed to the sitting of Parliament on 16th September 2008.]

*Cols. 161-168.

"to amend the Financial Advisers Act (Chapter 110 of the 2007 Revised Edition)",

presented by the Minister for Trade and Industry (Mr Lim Hng Kiang); read the First time; to be read a

Second time on the next available sitting of Parliament, and to be printed.

"to amend the Securities and Futures Act (Chapter 289 of the 2006 Revised Edition) and to make related and consequential amendments to the Business Trusts Act (Chapter 31A of the 2005 Revised Edition) and the Companies Act (Chapter 50 of the 2006 Revised Edition)",

presented by Mr Lim Hng Kiang; read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed.

"to amend the Administration of Muslim Law Act (Chapter 3 of the 1999 Revised

Edition) and to make a related amendment to the Supreme Court of Judicature Act (Chapter 322 of the 2007 Revised Edition)",

presented by the Minister for the Environment and Water Resources and Minister-in-charge of Muslim Affairs (Assoc. Prof. Dr Yaacob Ibrahim); read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed.

"to amend the Constitution of the Republic of Singapore (1999 Reprint)",

presented by the Minister for Finance (Mr Tharman Shanmugaratnam); read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed.

"to amend the Children Development Co-Savings Act (Chapter 38A of the 2002 Revised Edition) and to make related amendments to the Employment Act (Chapter 91 of the 1996 Revised Edition)",

recommendation of President signified; presented by the Minister for Community Development, Youth and Sports (Dr Vivian Balakrishnan); read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed.

"to amend certain statutes of the Republic of Singapore",

presented by the Senior Minister of State for Law (Assoc. Prof. Ho Peng Kee); read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed.

Order for Second Reading read.

3.02 pm

Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

This Bill is prompted by the Mental Capacity Bill which the Minister for Community Development, Youth and Sports will shortly take the House through. The Mental Capacity Bill aims to empower individuals to voluntarily plan in advance and appoint a proxy decision-maker for a time when they may lack mental capacity. It will also allow parents to apply to the court for the appointment of a proxy decision-maker for their intellectually disabled children. The Mental Capacity Bill will replace and update Part I of the existing Mental Disorders and Treatment Act.

The Mental Health (Care and Treatment) Bill will in turn replace Parts II and III of the Mental Disorders and Treatment Act. It aims to regulate the involuntary detention of a person in a psychiatric institution for treatment if:

he is suffering from a mental disorder which warrants the detention for treatment; and

it is necessary in the interests of the health or safety of the person or for the protection of other persons that the person be detained.

Many other countries, including the United Kingdom and Australia, have similar provisions for involuntary treatment for persons suffering from mental disorders whose ability to make decisions about medical treatment is significantly

impaired and who are likely to suffer mental, behavioural or physical deterioration without prompt and adequate treatment. Our Bill will maintain parity with modern best practices to strengthen the safeguards to protect the patients who are involuntarily detained for treatment. For example, regular inspections have to be conducted by visitors appointed by the Minister and a Magistrate's order is required for the detention of a patient beyond a certain period. The improper detention of a person, or wilful neglect or ill-treatment of a patient, will be an offence under the Bill.

Mr Speaker, Sir, let me elaborate on each of the proposed amendments.

Definitions

First, we will replace the term 'mental hospitals' with 'psychiatric institutions'. A part of a hospital (for example, a ward or a department) may now be designated as a 'psychiatric institution' for the reception and treatment of the mentally ill, instead of an entire hospital. This will give us greater flexibility to alter the capacity to meet changing demand in the future.

Procedures

Second, a patient who has voluntarily admitted himself to a psychiatric institution may now be detained pursuant to an order of a designated medical practitioner, if he is assessed to be a danger to himself or others. This is to facilitate prompt treatment. Currently, a detention order may only be made in respect of a person who has not yet been admitted into the mental hospital.

Third, we are reducing the minimum frequency of inspections by visitors appointed by the Minister for Health from once a month to once every three months. This will enable us to set the

frequency in accordance with needs. For example, where a psychiatric institution has not had adverse reports for a long period, a reduced frequency may be justified. This is a practical step to reduce the load on the visitors. The visitors are, however, required to submit a report to the Director of Medical Services after every inspection. Based on these reports, the Director of Medical Services may then direct the visitors to conduct further inspections as necessary.

Strengthening safeguards

Fourth, after the first month of detention, any further detention, if ordered by two designated doctors, will be capped at a maximum of six months. This is half of the current provision. For detention beyond six months, a Magistrate's order will be required. These safeguards are to ensure that patients are not detained beyond what is medically required.

Fifth, a detained patient who requires treatment for an acute medical condition other than his mental disorder may now be transferred to another hospital, and be temporarily detained there. This arrangement is necessary, as psychiatric institutions may not have the necessary facilities for managing these acute medical conditions. There is currently no such provision in the Mental Disorders and Treatment Act.

Penalties

Finally, we are updating the penalties for certain offences to ensure that they have a deterrent effect and to be on par with equivalent legislation. We are increasing the maximum penalties of fines and imprisonment for offences committed against patients who have to be detained for treatment. These patients are in a vulnerable situation and we need to send

a clear message that abuse of such patients will not be tolerated.

First, the maximum penalties for ill treating a patient will be raised. Ill-treatment includes physical or sexual abuse, as well as wilful or unreasonable endangerment or neglect of a patient. Currently, the maximum penalty is a fine not exceeding $500 or imprisonment for up to two years or both. The Bill increases this to a maximum fine of $5,000 or imprisonment for up to four years or both. If death is caused to the patient, the penalty will be a maximum fine of $20,000 or imprisonment for up to seven years or both.

Second, the penalty for having sexual intercourse with a patient will be increased from a fine of up to $1,000 or imprisonment for up to two years or both, to a maximum fine of $20,000 or imprisonment for up to 10 years or both.

Third, the penalty for improperly receiving or detaining a patient will be increased from a maximum fine of $2,000 or imprisonment for up to two years or both, to a maximum fine of $5,000 or imprisonment for up to three years or both.

Fourth, a police officer is empowered to visit and inspect a mentally disordered person under the care of a person to ascertain whether or not that mentally disordered person is under proper care and control or is ill-treated or neglected. The Bill enhances the maximum fine for refusing to produce the mentally disordered person for inspection from $1,000 to $4,000.

Lastly, the maximum amount for which a minor offence under the Bill may be compounded will be raised from $500 to $2,000.

Mr Speaker, Sir, the care and treatment of the mentally ill has evolved

over the years and it will continue to evolve, in the light of experience and medical knowledge. Increasingly, care and treatment for most mentally ill is best done in the community setting. But it is sometimes necessary to detain some mentally disordered persons in a psychiatric institution, to safeguard the health and safety of the patients and to protect the others in the community. In such cases, we have to ensure that the power to detain is not abused.

This Bill updates and strengthens the safeguards for the detained patients under such circumstances. I hope to get the support of all Members for this Bill.

Sir, I beg to move.

Question proposed.

3.15 pm

Mr Speaker, Sir, I rise in support of this Bill.

The World Health Organisation (WHO) has classified mental illness as a major health issue that will drain the coffers of many countries. In Singapore, too, we see a steady increase in the number of people suffering from mental illness. In 2006 alone, IMH treated close to 33,000 patients for mental illness in its outpatient clinics. A rapidly ageing population has added to the complexity as there are now more dementia cases. It is, therefore, in our interest to ensure that we have a proper legislation in place before the situation worsens.

I, therefore, welcome this new Bill. It is indeed timely for us to review the existing law to ensure that it is up to date and relevant. The Mental Disorders and Treatment Act that this Bill seeks to replace was passed in 1952 and seriously needs updating. According to the WHO, "progressive legislation can be an effective tool to promote access to mental

health care as well as to promote and protect the rights of persons with mental disorders". However, according to the WHO, "in some countries where legislation has not been updated for many years, mental health legislation has resulted in the violation, rather than the promotion, of human rights of persons with mental disorders. This is because much of the mental health legislation initially drafted was aimed at safeguarding members of the public from "dangerous" patients and isolating them from the public, rather than promoting the rights of persons with mental disorders as people and citizens. Other legislation permitted long-term custodial care of persons with mental disorders who posed no danger to society but were unable to care for themselves, and this too resulted in a violation of human rights".

So, Sir, I was hoping to see a different approach being taken in our legislation in the treatment and care of mentally disordered persons. But I find that the Bill has fundamentally kept the same approach which can be summed up as one that is based on institutional care and is rules based. Quite a large portion of the Bill dealt with giving powers to the Police to arrest mentally disordered persons and powers to the Magistrate and the psychiatric institution to admit or further detain a mentally disordered person for treatment. The Bill also now seeks to increase the fine for family members who fail to provide for the proper care and control of a mentally disordered person.

I am also concerned that while this Bill has strengthened the provisions to protect the public interest through a longer period of detention of a mentally disordered person, there is very little mentioned about protecting the rights of the mentally disordered persons. While I understand the need to protect the public, there is also a need to protect the rights of the mentally disordered persons from unnecessary and prolonged detention that

will deprive him of his freedom. I note that there is greater clarity now under section 22 on punishments for those who ill treat a patient in a psychiatric institution but more can be done.

While the Bill, Sir, wants caregivers to assume greater legal responsibility for the care and maintenance of mentally disordered persons, there is little support for caregivers in the community to perform their role. Caregivers need greater support as they often suffer as much as if not more than the mentally disordered person whom they are taking care of. While the Bill makes it an offence for caregivers to ill-treat or neglect persons who are mentally disordered, it ignores the fact that the mentally disordered persons are at times the perpetrators of harassment and violence against their caregivers. With the rising cost of medical care, it is certainly not cheap for caregivers to provide for the medical needs of mentally disordered family members when medical care is often needed over a long term period. Caregivers too have a life of their own. They need to work and have other family members to take care of. Often, when there is a mentally disordered family member, caregivers face financial, mental and emotional burnouts.

I have a young man, Sir, in my constituency who suffers from severe mental illness. He lives in a 3-room flat with his mother who works as a cleaner to support him. They are on financial assistance as the young man is unable to work due to the side effects from the medication that he is taking, sometimes a problem particularly with the older, cheaper variety that is commonly prescribed. His mother worries about who will take care of him when she is no longer around. I have another family with a son in his 30s also suffering from severe mental illness. Once he jumped down

from a four-storey building and on another occasion he slided down the rubbish chute, on both occasions after hearing voices. He miraculously survived both episodes. His elderly parents now do not leave home without him. I wonder whether they could be charged for neglect under this Bill as on one of the occasions when the incident occurred, he was left alone at home when one parent was working and the other went to do some errands.

Another gap, Sir, in the treatment and care of mentally disordered people is after a person is discharged from hospital. He gets very little support from the community because there are just not enough step-down care facilities and services. Home care services and support for families taking care of mentally disordered family members at home are also limited. There are not enough community-based programmes to help in the continued rehabilitation of people with mental disorders. The few that exist run by VWOs like the Singapore Association of Mental Health (SAMH), the Hougang Care Centre and the Silver Ribbon, are under funded and under resourced. They need more funding support especially as some of them run residential programmes and the cost of living has gone up. We all know that lack of support to help people with serious mental disorders after their discharge from hospitals often leads to relapses. With every relapse and re-admission into hospital, there is a terrible cost to the Government and society as most mentally disordered people cannot afford private rates.

Sir, the need for accommodation is another pressing issue for those who are mentally disordered. Three-quarters of the 1,600 patients in IMH have been there for at least three months. About 300 have been there for 10 years or more. Even VWOs are finding it hard to cope with the demand. In the Simei Care Centre, which was set up in 2005 to provide short-term

rehabilitative care to the mentally ill, a number of their patients have stayed on for at least three years. At the Sunlove Home, 70 of the 207 patients have been abandoned by their families. I hope that the Ministry could re-examine the basis of its current funding to some of these shelters for the mentally disordered which is inadequate.

Sir, let me share with this House the Australian example. In 2006, the Australian federal government allocated A$1.8 billion for the expansion of mental services over a period of five years. With this budget, the Australian government will fund 900 personal helpers and mentors to support those with serious mental illness live at home after their discharge from hospital. Carers will help those in need cope with everyday problems such as taking medicines and arranging accommodation. The funding will also expand support for accommodation provided to those with long-term mental illness. There is also funding for respite services for up to 15,000 families who care for relatives with severe mental illness or intellectual disability, with priority given to the elderly. So, Sir, the Australian example shows that they have adopted a much more community based, holistic approach towards treatment and care of mentally disordered persons.

Now, Sir, I would now like to seek some clarifications from the Minister on matters related to the Bill.

Under section 2, mental disorder will now cover not only mental illness but also "any other disorder or disability of the mind". This is very wide as it would also cover mental retardation (also known as mental handicap and intellectual disability) and personality disorders. In most countries, these categories are usually separated. Could the Minister clarify whether it is in the best interest of a person suffering from mental retardation

or autism, for instance, to be subject to the same regulatory regime as a mentally ill person and be detained for a prolonged period in a psychiatric institution?

Sir, under section 10, a mentally disordered person can be involuntarily admitted into hospital for treatment or even if he admits himself voluntarily, the hospital is given the power to detain him longer. Section 10(5) provides that the hospital can detain him for an extended period of six months, which has been reduced from 12 months – I agree with the Minister – but section 13(3) provides for the mentally disordered person to be detained for up to 12 months if ordered by the Magistrate and this could be further extended. Involuntary detention in a psychiatric institution for a prolonged period has come under scrutiny in many jurisdictions as it restricts a person’s rights and there is also potential for abuse. The WHO recommended that where involuntary treatment is necessary, the patients and their families and/or personal representatives must have a right to appeal to a review body, tribunal and or court against the imposition of involuntary treatment. The UK is one example which followed the WHO's advice as it provides for a Mental Health Review Tribunal to review the appeals of a person detained in a psychiatric institution under the UK Mental Health Act. The Tribunal has the power to order the discharge of any patient who is involuntarily admitted if it feels that there is no need to do so. Could the Minister explain what recourse does a mentally disordered person have under this Bill to ask for earlier release from involuntary detention in a psychiatric institution? Has the balance in the new Bill been tilted too much in favour of protecting the public but which may in fact affect the rights of those with mental disorders? How are the rights of a mentally disordered person protected from arbitrary exercise of power now that the powers of detention have been increased? Would the Minister consider establishing a

Mental Health Review Tribunal, akin to the UK situation, to provide recourse to persons detained under this Act if they are unhappy with their long detention period?

Sir, as an alternative to the involuntary detention and treatment of mentally disordered persons, could the Minister consider compulsory community supervision or treatment orders which are already commonly found in many developed countries? Such orders decrease hospitalisation and total hospital days when they are accompanied by intensive community-based treatment, which requires substantial commitment of manpower and financial resources, and I admit that. But these are less restrictive and would generally include outpatient treatment, day hospital treatment, partial hospitalisation programmes and home-based treatment. New Zealand, for example, has revised its mental health legislation to accord with the least restrictive principle. Under the New Zealand Mental Health (Compulsory Assessment and Treatment) Act, when a court has ruled that the certification criteria (for involuntary treatment) have been met, “the court shall make a community treatment order unless the court considers that the patient cannot be treated adequately as an outpatient, in which case the court shall make an inpatient order”. The new Bill, Sir, does not provide for supervised community treatments at all as it focuses primarily on institutionalised care which is not the best alternative as prolonged detention infringes on personal liberty whilst not necessarily ensuring the desired outcomes in the treatment of the mentally disordered. Compulsory community supervision and treatment are not only more humane but also provide a more holistic approach in the treatment of the mentally disordered as it complements the other

treatment methods and provides the much needed community support for those released from institutional care. Could I, therefore, ask the Minister to study the feasibility of introducing compulsory community supervision and treatment?

Sir, under section 5, visitors are now required to inspect a psychiatric institution only once in three months and not once a month as is required under the existing Act. Could the Minister explain how less number of visits would benefit the mentally disordered patients and ensure better protection for them? Also, under the new section 5, the visitors need not inspect every part of the psychiatric institution and see and examine every patient as is required under the existing law. Instead, under the Bill, visitors need to visit only any part of the psychiatric institution or see and examine any patients. Could the Minister clarify how this can be considered as an improvement since visitors are now needed to visit perhaps only a few patients and only some parts of the psychiatric institution?

Sir, under section 7, a police officer is authorised to apprehend any mentally disordered person who “is believed to be dangerous” to himself or to others. Could the Minister clarify what constitutes dangerous behaviour? Could the Minister also clarify what procedures and protocols are in place for the Police to ensure that there are proper safeguards so that the Police can play a constructive and helpful role with respect to people with mental disorders during arrest? Are police officers trained to handle people with mental disorders and how do they assess that a mentally disordered person is indeed dangerous to himself or others?

Under section 8(4), the fine for a caregiver to produce a mentally disordered person for inspection by a police officer has been increased four times, from $1,000 to $4,000. Could the Minister explain the rationale for this four-fold

increase in fines which would cause tremendous hardship to the caregivers, most of whom are already struggling to provide for their mentally disordered family members? So the question is: would increasing the fine help to address the problem or are we only trying to deal with the symptoms?

Sir, could the Minister enlighten this House on what measures will be taken to increase the number of psychiatrists to put this Bill into effect? There are about 115 psychiatrists in Singapore, giving a psychiatrist-to-population ratio of about 2.6 per 100,000, which is low compared to other developed countries like the USA, which has a ratio of 13.7 per 100,000, the UK (11 per 100,000), and Australia (14 per 100,000). There is also a shortage across the whole range of mental health professionals: psychiatric nurses, clinical psychologists, psychiatric case managers, medical social workers and occupational therapists? Can I ask the Minister what measures are being taken to recruit and train more of these staff as well?

Sir, could the Ministry of Health also focus more on early intervention programmes as early treatment certainly makes a difference? The Early Psychosis Intervention Programme (EPIP) is a good start but more can be done, particularly in schools and at the workplace. In the labour market, one big problem faced by mentally disordered people is the difficulty of getting a job as employers are not willing to employ them. Could they be provided with stronger support and more assistance?

Sir, could the Minister also review the current situation where mentally disordered persons are excluded from MediShield coverage causing them hardship as their illness requires long-term treatment, particularly long-term hospitalisation?

Sir, could the Minister give an update to this House on the progress made by the Inter-Ministerial Committee which was appointed last year with the task of rolling out a roadmap to tackle mental illness? What are the measurables and how have the lives of mentally disordered persons improved? Could the Minister also enlighten this House as to how much of the $88 million that has been set aside to implement this mental roadmap is allocated to funding the various VWOs that are running shelters and programmes for the mentally disordered as they are under-funded and under-resourced?

Sir, in conclusion, this new Bill is but one of the measures that will help to provide for the better care and treatment of mentally disordered persons. However, nothing contained in this Bill can overcome the prejudice, stigma and discrimination that mentally disordered persons face everyday of their lives. It is this stigma that often prevents individuals from seeking treatment early when the chances of recovery are better. It is this stigma that prevents them from landing a job, renting a room or integrating with the rest of society. It is this stigma that often makes them feel like lesser human beings and affects their recovery. To remove this stigma and prejudice requires more than the law. It requires the effort of everyone. For a start, we should start an education campaign to raise awareness and stamp out prejudice and narrow mindedness. I think we owe it to our mentally disordered Singaporeans.

I support the Bill, Sir.

3.30 pm

Mr Speaker, Sir, allow me to begin by quoting Dr Johann Christian Reil, one of the most progressive psychiatrists of his era, in the late 18th century. He said:

"It is difficult to understand the incredible inhumanity with which mentally-sick citizens

were treated. We incarcerate these miserable creatures as if they were criminals in abandoned jails, near to the lairs of owls in barren canyons beyond the city gates, or in damp dungeons of prisons, where never a pitying look of a humanitarian penetrates; and we let them, in chains, rot in their own excrement. Their fetters have eaten off the flesh of their bones, and their emaciated pale faces look expectantly toward the graves which will end their misery and cover up our shamefulness. Excited patients were locked naked into narrow closets and fed through holes from copperware attached to chains. Beatings were common and defended by shallow rationalisations. Strait jackets and chains attached to walls or beds were used to restrain patients, since the theory was that the more painful the restraint, the better the results, particularly with obstinate psychotics. The unsanitary conditions, lack of nourishment, wounds inflicted by the chains, and application of drastic skin irritants to increase the torment killed a large number of these patients."

Mr Speaker, Sir, what I just recounted were not just fictional stories that could possibly be made into box-office movies, such as the likes of Hannibals or the Silence of the Lambs. Such stories still exist in this day and age, though not to such horrific extent all over the world in mental institutions and homes, whose raison d'etre is to provide the very refuge, protection and care for these vulnerable human beings suffering from mental illnesses.

In a highly stressful urban society like Singapore, we do expect to see more people suffering from some form of mental illnesses. In addition, as more people are living longer, the incidence of the elderly developing age-related degenerative diseases of the brain, such as Parkinson's, Alzheimer and senile dementia, is expected to rise as well. By the year 2050, Singapore would have the

world's fourth oldest population. The introduction of the Mental Health (Care and Treatment) Bill is not only timely but also an important step in the right direction.

Mental illnesses, such as depression, anxiety, schizophrenia or dementia, are growing problems plaguing many developed countries. In the United States, the Alzheimer's Association estimated that the direct and indirect cost of Alzheimer's disease and other forms of dementia amounts to about US$145 billion annually. A study on Singapore in 2004 estimated that about 5.6% of our adult population suffers from some form of depression. This figure works out to more than 200,000 based on our current population size of four million. This is indeed an alarming figure for our healthcare delivery system to tackle. If not managed properly, the cost overrun could be catastrophic to our national health budget.

Notwithstanding the estimated number of 200,000 people suffering from depression, our Institute of Mental Health only treated a total of 33,000 patients last year, as alluded to by Mdm Halimah. This disparity in number of afflicted and those who sought treatment can be attributed to our Asians' perception of mental illness. Because of the stigma attached to mental illnesses, Asians are reluctant to seek treatment early when confronted with mental illnesses. Asians also have a tendency of somaticising psychological distress as physical pain. Experts in the field are in general agreement that early treatment of mental illnesses is crucial. Hence, I would like to urge the Ministry to engage and train primary healthcare givers, such as GPs, to help identify and provide early treatment, and to refer them to a specialist before the illness deteriorates.

In Hong Kong, mental healthcare faces critical manpower shortage problem

resulting in compromised quality of care, as well as physical and mental burnout of the caregivers. The situation in Hong Kong is likened to having five lids for 10 boiling teapots. Comparatively, in Singapore, as our population grows, the number of mental healthcare givers needs to correspondingly grow with it. The question to ask thus is, "Do we have an adequate number of mental healthcare professionals?" In the US and Canada, the ratio of professional psychiatric caregiver to the population is about 1:8,000. Whereas WHO recommends that the ratio should be about 1:19,000. According to the Singapore Medical Council's annual report, there are currently about 114 psychiatrists practising in Singapore. Based on WHO's recommendation, we should, therefore, have 210 doctors specialising in psychiatry. We need to act now, given the length of time needed to train the necessary medical professionals to meet these rising demands.

Sir, it is a fact that mental patients are more vulnerable to abuse than their perceived image of "danger". Mental patients, because of the nature of their ailments, are prone to abuse with possibly little recourse. In that respect, I support the harsher penalty imposed for the ill-treatment of patients by healthcare givers as it serves as an effective deterrent against such acts.

Having said that, Sir, let me declare my interest as a member of the healthcare profession. I am a little concerned over the possibility of wrongful prosecution of mental healthcare givers. Mental healthcare providers are exposed to a wide range of patients with mental illnesses, many of whom are of the violent type. For instance, healthcare providers taking care of patients suffering from paranoid schizophrenia are susceptible to violent manipulation. In addition, given their mental state, the injury and ill-treatment

may be self-inflicted, leading to the wrongful prosecution of healthcare givers. I hope the Ministry can recognise this possibility, no matter how remote, when investigating alleged claims of abuse by mental patients.

Similarly, in the prosecution of ill-treatment, the same predicament faced by family caregivers needs to be taken into consideration, and judicious enforcement necessary.

Usually, seemingly innocent problems are quite common for the elderly with mental illness. Hence, the issue of ill-treatment to people with mental illness, especially family members who are caregivers, needs to be enforced with greater care and sensitivity. For instance, the demented person may complain to others for being ill-treated by not being fed, while in actual fact they had been fed but could not recall recent events because of the nature of their sickness. Family members are already quite stressed out taking care of one of their members with mental disturbances, and may just keel over when confronted with unnecessary investigations into allegations of ill-treatment.

I would like to clarify with the Minister the reason for not stating the penalty for family members guilty of ill-treating mental patients in clause 8 of the Bill. Perhaps, family members who ill-treat mental patients, like Mr Sujit Kumar from Fiji, known to millions around the world as the Chicken Boy, who was confined in a chicken-coop by his family for almost 20 years. It is equally culpable. I understand the need to be sensitive and not to over-burden family members who are caregivers, but it is imperative to send the right signals that we do not condone any ill-treatment of mental patients by anyone. And the Bill needs to be fair in prosecuting any wrong-doers, whether they are healthcare givers, family members or anyone else.

Sir, I would also like to seek clarifications from the Minister on the following issues:

The Bill amends the maximum detention period of mental patients from 12 to six months, with further extensions requiring Magistrate approval. However, the Bill does not state if there is maximum period for this Magistrate's imposition. I would think that the maximum period is necessary as it mandates a thorough review of the patient's status before a further extension is allowed. Thus, preventing unnecessary prolonged detention of any mental patients.

Clause 15(5) allows a transfer to another hospital for treatment of non mental-related illness. This initiative is good as it allows prompt treatment of the non-medical condition in a better equipped facility. However, one concern is that when deciding on the medical facility for such a transfer, it should ideally be equipped in terms of physical infrastructure to handle such mental patients, especially if they are violent or suicidal.

In clause 10 of the Bill, what is the definition of the designated medical practitioner? Must they be specialists, ie, psychiatrists? If not, can the designated medical practitioner who has the power to sign the order to detain up to one month be a non-specialist and potentially a trainee or junior doctor?

Sir, in closing, let me quote from an American writer, Renata Adler, best known for articles in The New Yorker magazine:

"Nothing defines the quality of life in a community more clearly than people who regard themselves, or whom the consensus chooses to regard, as mentally unwell."

Sir, with that, I support the Bill.

3.41 pm

Sir, allow me to tell a story from a popular movie from Hong Kong some 20 years ago. The title of the movie was "tian cai yu bai chi ". Literally translated into English, it reads "The Genius and A Fool". The scene that I remember revolved around a mental hospital and the dialogue between a mental patient and one of the main actors.

This patient was squatting and holding a fishing rod over a bucket of water. He was asked what he was doing and replied that he was fishing. The protagonist then asked him how many fish he had caught that day. The patient replied, "Are you crazy? This is just a bucket. How to get any fish? I may be mental, but I am not stupid!"

Although this episode is fictitious and culled from a movie, it does illustrate the difficult task of defining what mental illness is. It also highlights one thing, ie, all mental patients – or the more politically-correct term is patients suffering from mental illness – are human beings too, like you and me. They have their feelings, wits and ability to think. Although they may be deluded and hearing voices when they become unwell, they can be treated and become rational. Certainly, they are not stupid.

Sir, I would like to declare my interest as a practising psychiatrist. Mental illnesses cover a broad area of human ailments. It is a problem that can afflict the young, the old and the not-so-old. A child going to school for the first time might suffer from school refusal, which is considered a form of mental illness. A person hearing imaginary voices is suffering from mental illness. So is an elder person who has degenerative brain diseases presenting behavioural problems

and/or deteriorating memories. Another person not being able to sleep without an increasing dosage of medication may also suffer from some form of mental illness. In such instances, medication may worsen the patient's condition when the patient actually needs ultimately to be weaned off the medication to be on the road to recovery. So it is a thin line after that between a medical problem and a psychological problem.

Sir, the Bill seeks to protect the mentally ill but fails to be clear about the definition of the area of mental illness to be covered. This point was also brought up by Mdm Halimah. In fact, the onus appears to be lop-sided, weighing on the psychiatrist to set out the parameters of what mental illness is. Therefore, given the many varied types, it would be overly onerous. I hope the Ministry can be clearer in its definition of the type of mental illness that the Bill seeks to address. Moreover, the proposed Bill involves only doctors in the decision-making of applying this detention order or order for involuntary treatment in the hospital. In the UK, Australia and a number of other developed countries, these detention orders are often made

jointly by a psychiatrist and a social worker. I urge the Ministry to consider adopting a similar approach. Having such an approach will allow a more rounded and informed decision when an application is made. The social worker will balance the views of the psychiatrist and they will have to ensure that the patient's social and family backgrounds have been investigated and considered before any order can be applied

Next, I would like to touch on the problems of patient-therapist relationship. Confidential relationship between patient and therapist or psychiatrist is different when it concerns people with mental illness. Unlike the usual patient-doctor relationship – where patient confiden-

tiality overrides most other considerations – when it concerns mental patients, we are on a slippery ground. In this Bill, I hope we can be clear where we stand. Do we make a clear stand now and debate in this House, or do we wait until something similar to the Tatiana Tarasoff's case before we act?

Allow me to narrate briefly what happened to this Tarasoff's case. This is a case of Tarasoff vs the Regents of the University of California. The family of Tatiana Tarasoff sued the Regents of the University of California for failing to act after Mr Poddar confided to his psychiatrist, Dr Moore, that he intended to kill Ms Tarasoff. Dr Moore diagnosed Mr Poddar as suffering from paranoid schizophrenia, then ordered Mr Poddar's detention, but was overruled by his supervisor. Mr Poddar plotted, waited and when the opportunity arose, he ended up killing Ms Tarasoff.

The California Supreme Court made the landmark ruling that a professional mental health body has an obligation not only to the patient, but also to the individual whom the patient specifically wanted to harm. The California Supreme Court ruling has not been accepted all over the United States, but has influenced many other judiciaries as well. In our case, since the Bill is being presented in this House, it might be in our favour to deliberate and debate it to reach a consensus. It would not be fair to leave it to our judiciary to second guess our intent. Do we take the majority stand that the communication between patient and therapist must yield to the extent where disclosure could avert essential danger to others? Or do we take the stand that the protection privileges of the patients rule supreme? This is an important issue which unfortunately the Bill does not seem to address. I would like to see the Health Minister present his learned views and then let the House debate on this issue on the sacrosanct rights of a patient.

While we are still on this subject, I am concerned, on the other hand, about the lack of security of mental patients' rights and welfare. I echo the call by Mdm Halimah. To protect the rights of the patients, we must adopt a balanced approach between protecting public interest and maintaining the dignity of and respect for the patient. Just as while bacteria are not visible to the naked eye it does not mean that it is not present. Similarly, the absence of abuse of mental patients does not mean that it does not happen either. Given the inability of mental patients when they are unwell to control over their mind, and as an extension, ability to protect themselves, mental patients' right has to be clearly safeguarded. For example, when a patient is involuntarily institutionalised, patients should retain the right to be visited by the family, the right to legal counsel and the right to appeal against involuntary institutionalisation. The recourse to appeal needs to be immediate and not allowed to drag on.

Sir, mental illness is unique from other physical illnesses. Hence, if a patient has an acute mental illness, and especially since he is still lucid or during his lucid moment, his appeal against institutionalisation ought to be heard and considered immediately. To this end, the United Kingdom's Mental Health provision for a Tribunal could be exemplary for us.

I would like to relate another story, Sir. It was told to me that a cheerful young boy working as an office assistant had an acute stress-induced nervous breakdown when he was travelling with his office colleagues to New Zealand. He ran away from his hotel room in the middle of the night, ostensibly waiting for his flight to take him home. While waiting all alone in the airport, he started to display his clothing all over the floor. The police found him, brought him back to the

hotel and the next day, he was brought to the psychiatric hospital where he spent the night. The boy related later that when he was in the hospital, he begun to regain his own composure and was calmer after the hospital had given him some medication. He was normal but they insisted on retaining him overnight in the hospital, together with other more seriously-ill mental patients. He went through a terrible time and no one would listen to him that he was well.

Sir, not all mental patients are alike and most mental patients are not a threat to society at large. Therefore, there must be a recourse to appeal and communications with the mental patient must always be maintained and established. I recognise that the Bill does attempt to provide some form of external audit. But if someone has been detained on a six-monthly order, waiting for six months is cold comfort to cases like the boy I have just mentioned. It might be too late for the boy. He would have been frightened by the terrible experience of living in a mental hospital and "gone mad" literally. The law must guarantee that immediate appeals and communications are allowed. Both England and Scotland made amendments to their Mental Health Act that, amongst other things, weigh heavily on protecting the rights of mental patients. In particular, both England and Scotland allow for the formation of a Mental Health Tribunal as the forum to hear cases to decide on compulsory treatment order.

Sir, there is another role of the Mental Health Tribunal. It is important in determining the type of treatment, the rights of the patient as well as when the patient can be taken into a hospital against his will. Let us talk about the treatment. In light of the different possible treatments that a psychiatric patient can be subjected to, for example, electro-convulsive treatment (ECT) or neurosurgery for mental disorder (NMD), it is all

the more important for the rights of the patient to be safeguarded. I think the Bill is not clear on this count. These provisions are not new and they are easily available. I rather not second guess the Ministry of Health's intention to deliberately leave this out but look forward to hearing from the Minister in his explanation. I also urge the Minister to consider taking the same approach of having a Mental Health Tribunal.

Another major obstacle faced by mental patients is stigmatisation. To quote our distinguished Minister for Health, Mr Khaw Boon Wan, he said that it is as bad as the undesirable label given to ex-convicts. Like ex-convicts, mental patients may recover from their illness. Like any medical illness, they are mostly treatable with medicines or different types of psychotherapy. However, social stigmatisation has no cure. They tend to stem from ignorance, and sadly, there is a lot of ignorance surrounding mental illnesses. The findings of a recent survey support this generally accepted misnomer that mental patients are "dangerous".

Sir, this is further from the truth. The mentally ill are no more violent than those who suffer no mental illness. If you look at those persons who have committed the violent crimes, in fact, many of them are otherwise normal people with no mental illness. But Singaporeans are no different from many people all over the world in thinking that the mentally ill are dangerous people. We generally think that they are dangerous to normal people and, hence, need to be segregated. The myth that mental patients are prone to violence is probably perpetuated by the media. So this results in stigmatisation which is worse than the disease itself. Unfortunately, this Bill does not even attempt to deal with the terrible stigmatisation that mental patients have to bear.

Let me give you another survey. In a recent survey in the United Kingdom

Parliament, published in July 2008 by the Royal College of Psychiatrist, the survey covered 94 MPs, 100 Lords and 151 parliamentary staff in the UK. It is very telling of the downside of stigmatisation. The report conducted by the All-Party Parliamentary Group on Mental Health showed that 27% of those surveyed had reported some form of personal experience of mental health problem. However, it is not surprising also to learn that one in three of them feared hostile public reaction which prevented them from being open about their mental health problems. British Members of Parliament stand to lose their seat for life if they are sectioned under the Mental Health Act for six months or more. While there is understandable reason for the British MPs to hide their mental health problems for obvious reasons, I think what is more important is that the social stigmatisation is also stopping them from seeking treatment. This is a big problem, if left unattended and will cost our society even more. So, therefore, we need to have public education.

Sir, I acknowledge that it would be an uphill task to try and address the social stigmatisation issue but given the terrible cost we would have to bear, we need to deal with them head on. For starters, we could begin with greater public education on the ignorance surrounding mental illness. We need to inform the general public that mental illnesses are treatable. It is estimated that 1% of any given population may suffer from schizophrenia. Just now, Dr Lam also quoted a report in 2004 which estimated that about 5.6% of our population suffers from depression and this will work out to about 240,000 of our population.

One of the common problems among people with mental health problems is when it comes to applying for jobs. Usually, there is a column requiring them to declare whether they have any mental

health problems. In dealing with my patients in a psychiatric clinic, I see that this is a constant struggle for many of them because I suspect that if they truthfully declare that they have some form of mental health problems, it is very likely that the prospective employers would not even consider shortlisting them for interview. This may mean that a quarter million people may lose their job or become unemployed. And also because of this stigmatisation, many people are not seeking the necessary treatment because if I go and see a doctor and I have been diagnosed as suffering from depression or schizophrenia, the label will stay with me. If I never see a doctor, I never know that I have this illness, I would never have to declare it. So it compounded the problem even more. I think we should educate our people to let them know that delayed treatment is not to our advantage. Early detection and treatment, like Mdm Halimah suggested, will help recovery and prevent illness from developing into a crisis. So I support the Government's efforts to engage a primary health provider for early identification and treatment of mental illness, and nipping it in the bud before it becomes more serious. It would go a long way to help us from engaging a bigger medical bill.

One common problem of people with mental illness is that mental illness is a chronic condition. Besides the right dose and right type of medication, the patient needs to be followed up regularly by the psychiatrist and be given support by a network of social workers and many other agencies. However, our experience shows that a significant proportion of the patients defaulted on the treatment for a variety of reasons after they are discharged. And what will happen is that they will relapse and often result in re-admissions. This is what we call a revolving-door syndrome. I think there is one way that we can avoid the revolving-

door syndrome by introducing a community treatment order, as proposed by Mdm Halimah.

I therefore, also urge the Ministry to ensure that patients get their regular follow-up and continue with their treatment after they are discharged from the hospital, and to provide for a Community Treatment Order to ensure continual treatment after they return back to the community. Both caregiver as well as immediate families have the responsibility to ensure that mental health patients continue with their treatment. The community support services also need to be beefed up as well. If the law fails to safeguard continual treatment and medication of the patient, the patient will be released soon after they show some sign of recovery, staying away from medication and, especially when the money is tight, they would relapse and revolve back, this time probably more serious than the last, to the hospital.

In the Community Treatment Order, we must also ensure that there is a clear involvement of social workers and all the community support services. This is because many of our patients with mental illness also face a whole range of social problems when they attempt to reintegrate back into the society. Not only discrimination of jobs, they may also have problems of housing, family relationship and financial difficulties. Therefore, this multi-agency and multi-disciplinary approach is crucial in the long-term care of the patients.

Finally, I would like to urge the Ministry to consider free continuous treatments for psychiatric patients. Because a recurring mental patient, is of little economic value to the State. It is of even little significance to his immediate family. In preparation for the play "Off Centre", Mr Alvin Tan of the Necessary Stage, interviewed some recovering mental patients, and reported that all did

not want to reveal to him their occupation. They fear that if the truth comes out, they might lose their job. It is a fact that most employers are reluctant to employ people with mental illness. Mental patients would be even more resented by their family members if, in addition to losing their economic value, they are a financial burden to their family and that may prevent the family from wanting to support them for treatment. In this regard, I think we may be better off providing free treatment to these patients so that we can maintain them well in the communities, so that whether they can work or they cannot work, they have a more meaningful life without having to be re-admitted repeatedly – it is like a revolving-door syndrome.

Sir, with these comments, I support the Bill.

Order. I propose to take the break now. I suspend the Sitting and will take the Chair again at 4.30 pm.

Sitting accordingly suspended

at 4.07 pm until 4.30 pm.

Sitting resumed at 4.30 pm

Debate resumed.

Mr Speaker, Sir, I would like to begin by commending our Health Minister Mr Khaw Boon Wan for introducing the Mental Health (Care and Treatment) Bill, which is timely especially when mental dementia may be more prevalent with an ageing population. With an increasing number of people being afflicted by psychological problems, concerns about legal implications and

social issues with the regard to mental illness have been surfacing. The Bill is a farsighted move in drawing up a framework to provide clarity in the event of any legal disputes involving those who may be mentally ill, and in ensuring such patients are identified and given appropriate health care and attention.

However, to effectively provide support for the mentally ill, much more can be done. Although mental patients are able to turn to medical care from local hospitals and health institutions, they receive little in terms of social support. On the other hand, those who are suffering from physical health problems, such as cancer victims and the physically disabled, have the options of seeking medical and social assistance from welfare organisations that are established to take care of their ailments. This is a situation of disparity that needs to be addressed.

Few welfare organisations cater to the needs of the mentally ill. I believe there are sub-specialties in counselling and that one who is trained in psychological counselling may not be suitable to handle cases that require someone trained in psychotherapy. Hence, though some volunteers are trained in counselling skills, this does not equip them to deal with a whole spectrum of cases including involving those who are mentally ill. We must be able to train our psychological counsellors in the community to identify mental health patients and refer them to trained mental health professionals. Presently, in the community, there are very few trained mental health professionals. We need to speed up the effort to encourage this pool of professionals.

We need to increase the awareness that mental health can improve with prompt treatment, as in the case of cancer. More often than not, mental patients find themselves in the dilemma of

whether to seek medical treatment or not. Some may find medical fees unaffordable. Some do not recognise the severity of their symptoms. Yet others keep mum about their predicament and avoid the hospital for fear of negative labels. Worse will be those who turn to pseudo counsellors who mislead them, and strip them off their life savings.

Once they are receiving treatment, they also require support to get their life back on track. So we need to organise strong support groups in the community to give post-treatment support. This is where I urge the Government to look into training a talent pool of perhaps volunteers by giving them opportunities to undergo basic training in areas that are pertinent to understanding and supporting mental illnesses. I think this is especially so for family members because they are caring for the patients day and night. Personally, when I was young, I was living, for a short period, with a mental patient and it was really very torturing and very hard on the family to care for the patient day and night. At times, when there is no medication, either because there is no financial support or the patient refuses to take the medication, the patient goes on a cyclical mood. And that is where aggressiveness comes in, there is a real need for community support in terms of even police intervention, and this is where I feel that even the Police could be involved in certain areas as well.

In Singapore, special attention needs to be given to the elderly, who constitute a large group among those with psychological problems. Last year, suicide rates among those aged 65 years and above took a leap from 69 in 2006 to 87. A large number of these suicide cases may be attributed to psychological issues. Training for counsellors to handle this group should also include lessons in local dialects so that they can communicate

with the elderly, most of whom do not speak Mandarin, for example. This will also enable volunteers to become confidant to the elderly and alleviate their loneliness.

Lastly, I urge the Minister to look into how we can prevent people from abandoning the mentally-ill at the hospitals or institutions. Given modern technology, we should impose a system whereby the next-of-kin, guardian or family members must be tracked so that they look after these patients. Without family support, their chances of recovery and returning to society would be worse.

4.36 pm

Thank you, Mr Speaker, Sir for granting me permission to speak on this Bill.

To illustrate, allow me to describe an empirical study conducted in Singapore by a Master's level Social Work student from

National University of Singapore. He found that schizophrenic patients were so afraid of being identified by their employers as being mentally ill that they religiously kept their appointments with their doctor, and were conscious of taking their medicines as prescribed. Hence, they lived in fear of being disclosed, and instead of advocating for better treatment by society, they kept their shroud of secrecy to hold on to their jobs. A similar study using similar research instruments, found that in contrast to the Singaporean patients, their American counterparts were more active in advocating for themselves, and did not live in fear of being identified as mentally ill. One positive outcome identified by the researcher was that Singapore patients tended to be more compliant as far as medication is concerned as compared to their American counterparts! The study made me wonder whether we could work towards a situation when schizophrenic sufferers would feel accepted by society and have a positive rather than a negative motivation to comply to medication.

In the last 10 years, the legal sector has made some progress in their recognition of the needs of the mentally ill when they appear in court. Chief Justice Chan Sek Keong, who introduced the Community Court in June 2006, introduced relevant policies as to how the mentally ill and disabled should be tried in court. His progressive thoughts in this arena are commendable.

The Mental Health (Care and Treatment) Bill is comprehensive in that it deals with the apprehension, treatment, removal and transfer from a psychiatric institution; maintenance and liability, punishment for offences against mentally disordered persons as well as for improper detention of them. It is more reactive and protective of the physical well being of the mentally ill.

Mr Speaker, Sir, I have the following concerns about the Bill.

Firstly, not enough attention is paid to the psychosocial treatment of the abuser after he or she has been fined and punished for ill-treatment and/or neglect of the mentally disordered person. Just as we have mandated counselling for the domestic violence abuser, similarly, informal and formal caregivers may also need counselling and support to improve themselves or even show remorse for their past deeds. Caregivers, who have intentionally or unintentionally neglected or ill-treated the mentally disordered person, usually have been burnt out by the stress of caregiving which could have been for lengthy periods, eg, 20 or even 30 years. They need help too. In order not to overstretch the manpower of the Medical Social Services Departments, such abusive caregivers could be referred for counselling at the Family Service Centre nearer their homes.

My second concern is that mentally ill persons may be detained or institutionalised against their will. The reasons for detention have to be the health and safety of the mentally disordered person as well as the safety of other persons. The period of detention should not exceed six months. I would like to ask the Minister for Health whether there will be a channel for review of detention. Are there plans to develop a Code of Practice to guide any family members who may wish to seek a review of the detention order? To whom should such a request for review be directed? For comparison purposes, the British have developed a document titled "Deprivation of Liberty Safeguards" or DOLS in June 2008, which provides such information. It is reasonable for concerned family members to seek a review and they should be entitled to a full explanation, as mentioned earlier by my honourable colleague, Mdm Halimah.

Another related third concern is that of inadequate manpower to cope with the

additional clientele in psychiatric institutions. With the broader powers assigned to police officers for the removal of mentally disordered persons, it is to be expected that the numbers admitted to the psychiatric institutions will increase dramatically. If the population of allied health workers such as counsellors, medical social workers and psychologists does not commensurate with the expansion of services, we could face insurmountable problems. I would like to ask the Minister for his plans on the rapid expansion of the sector of allied health professionals such as nurses, psychologists, medical social workers, counsellors, and the like. If our local expertise is inadequate, will our dependence on foreign labour be accelerated as a result?

It is a well-thought-out strategy to introduce the Mental Health (Care and Treatment) Bill and the Mental Capacity Bill together as they deal with connected issues. The Singapore Government is to be applauded for taking the issues of the mentally ill and disabled very seriously. It is not only imperative politically, but also morally and philosophically, for a government to support its marginalised populations and facilitate their growth and protection. By example, our Government is giving the message that the mentally disordered persons deserve a better deal in life, and better services, which they may have been deprived of either by choice or circumstance. The inspection of psychiatric facilities by a Board of Visitors every three months is also necessary to maintain the institutions' high level of quality of care.

On a broader level, we need more evidence-based research to identify the causes for the rise in mental illness in our population. Does the Ministry have any plans for conducting such research? If yes, can the Minister please elaborate? Prevention is the better route, both

economically as well as in terms of productivity; some forms of mental disorders are hereditary and it is hoped that our Singapore Genome Project may help in future to curb such sources of mental illness. Alzheimer’s disease is one such mentally debilitating disease.

On this note, I support the Bill.

In Singapore, one in six persons suffers from some form of mental health problem. While the current percentage of 16%-18% is lower than many developed societies like USA, where the corollary is 26%, the finding from the National Mental Health Survey has propelled the Ministry of Health to carry out a Blueprint or Master plan for the next five years. The introduction of this new Bill which replaces the earlier Mental Disorders and Treatment Act 1985 has been long overdue. For far too long we have devalued people with mental illness, and there has not been proper protection, whether medical or legal, of mentally ill persons. Stigmatisation of people who belong to this category was prevalent in the past as seen in the derogatory reference to Woodbridge Hospital as the 'mad persons' hospital. Even today, a person with a history of mental ill health would have difficulty in seeking employment.

(In Mandarin): [For vernacular speech, please refer to Appendix A*.] Mr Speaker, Sir, mental disorder is one that is not easily detectable. According to my understanding, even the doctor and psychiatrist agree that two doctors will never get the same diagnosis for a psychotic patient.

I would like to ask the Minister how does MOH define mental disorder. For instance, making gestures in public, making indiscreet remarks, sloppily dressed, or scolding people for no reason – is this considered a case of a mentally deranged person? The person might not have vandalised, or hurt anyone. However, a mentally deranged person can vandalise public property, he cannot refrain from dangerous behaviour, and can inflict harm on another person. But according to the proposed amendment, the police officers will only transport the mentally deranged person to the hospital for treatment in the event a member of the public lodges a complaint. But members of the public are usually not proactive and they will not call the police. If these psychotic patients are not treated in time, their illness will get worse.

Therefore, I propose that we empower our police officers with the authority that in the event they encounter mentally deranged persons, they can "invite" them to the hospital for examination. If the patients’ condition is not too serious, the family members can take care of them, make sure that they receive treatment periodically, so as to prevent it from worsening. For those with a critical

condition, the Government should make it mandatory for them to receive treatment.

Singapore is facing a greying population, and we know that dementia is one very common case of mental disorder. If you have watched Jack Neo’s movie "Money No Enough II", in one part of the movie, the elderly mother has dementia and she repeatedly asked her son, "Have you eaten?". This has caused misunderstanding between the mother and son, and we can see that dementia has similar symptoms as that of mental disorder.

Therefore, I would like to ask the Minister, under the proposed changes, will there be any negative impact on the elderly who have dementia? My worry is that some parents might abuse the system and they get the police officers to send their old folks for examination, or compulsorily admit them into psychiatric institutions. This may cause family discord and could be detrimental to our Government’s family policy. In this regard, how can the Ministry ensure that all these dementia elderly are not treated as psychotic patients?

*Cols. 173-174.

4.48 pm

Mr Speaker, Sir, let me thank Members for rendering their support to this Bill. Members have spoken very passionately on this subject and I have noted all their feedback and suggestions.

As noted by Members, mental disorder covers a very wide range of mental illnesses, and that is why most legislation, including ours, have to define "mental disorder" very widely. Mdm Halimah, Dr Ong Seh Hong and, just a while ago, Mr Ang Mong Seng seem to prefer a clearer, presumably, tighter definition. But the objective of this Bill is to ensure that those mentally ill patients who require

institutionalised psychiatric care are accorded prompt treatment. Not all mentally ill need to be institutionalised. In fact, only a small minority do. Mdm Halimah and Dr Lam highlighted this point a while ago. So all patients have to be assessed and a medical judgement made. We think this is best achieved by allowing the attending doctor to make such an assessment rather than trying to hard-wire the various possible mental disabilities into the legal definition. But because mental disorder covers a wide range of mental illnesses, the stereotype image of the mentally ill is most unfortunate, incorrect, unfair and unhelpful. A senior doctor once commented, probably half in jest, that to different degrees, we are all mentally ill. In fact, he probably meant it quite seriously.

The fact is that most mentally ill patients can carry on a productive life, especially if they comply with the doctor's medical prescription. They do not need to be institutionalised. Even for the small minority who require institutionalisation, extended institutionalisation is now the exception rather than the rule. This is the result of better medical knowledge and advancement in mental healthcare. Unfortunately, society's perception of the mentally ill remains largely archaic.

As noted by Dr Ong Seh Hong, a recent study by IMH found that more than one in three Singaporeans believed mentally ill patients to be dangerous. About half of the respondents felt that the public should be better protected from people with mental health problems. The stigma runs deep, as noted by several Members. The majority of the respondents believed that mental health problems could afflict anyone, including themselves. But about half would not want anyone to know about it, if they were to suffer mental health problems, and that is why many continue to delay treatment to the detriment of their own health. And this is not unique to Singapore. Dr Ong quoted a

similar study in the United Kingdom. So, clearly, we have much to do. We have to work harder to correct the misperceptions, destigmatise mental illness, promote mental health and ensure that the patients receive prompt care in the appropriate setting, whether it is in a hospital or in a community.

Mdm Halimah, Mdm Cynthia Phua and Dr Ong highlighted the benefits of educating the public about mental health. I totally agree. Early treatment and detection aid recovery and prevent the illness from getting worse. These are the issues we need to address through community-based mental healthcare programmes. Medical experts agree that community-based care is the way forward in improving the standards of care for the mentally ill by focusing on rehabilitation and integration of the patient into society as far as possible. There is evidence to suggest that aggressive community management of persons with mental illness can result in improvements in the quality of life, greater acceptance of treatment and reduction in hospital readmissions.

Last year, my Ministry launched a five-year programme to help enhanced mental health. So we are now into year two. There are four key thrusts – improve public education on mental health, develop community-based mental healthcare services, increase manpower and enhance research capabilities in mental health. I think we are all on the same wavelength here, based on what Members have spoken.

Two-thirds of the fund would seek to expand the community's resources for persons with mental illness. This includes developing partnership with GPs, community mental health teams and integrated medical psychological teams. The community mental health teams

target four significant groups - school-going children, adolescents, adults and the elderly. They provide clinical services which include diagnosis, treatment and support to persons with mental health conditions in the community. They also provide training to front-line staff in a community agency as well as carers, a point raised by Mdm Cynthia Phua. The targeted agencies include eldercare services, VWOs, grassroots organisations and schools to teach them to detect possible mental health problems in their clients and educate them on the follow-up steps that they should take.

Early detection and intervention programmes ensure that persons who have just developed mental disorder can reintegrate into the community as soon as possible. With good clinical care and strong support in the community to ensure good compliance with follow-up treatment and rehabilitation, the mentally ill in the community can be managed much more effectively. About $18 million is set aside for public education to increase awareness of Singaporeans about the importance of mental wellness and what they can do to maintain it. Like all things, a preventive approach is best. If we wait until it is too late, it is really too late. We can try to remedy and rectify, but it is never satisfactory and full recovery is almost impossible. The Health Promotion Board will implement its health promotion activities across a variety of settings, such as schools and workplaces, targeting Singaporeans at various stages of life.

I agree with Mdm Halimah and Dr Ong that society needs to help the mentally ill in many areas, including trying to secure employment. IMH has a job club programme to facilitate the employment of persons whose mental disorders have stabilised by providing rehabilitation and skills training. I believe strongly in this, but I know how uphill the task is. I have looked at the "Yellow Ribbon" programme

which tries to help the ex-convicts secure jobs. It started off difficult, as usual. But after 10 years, it had achieved quite good results. I challenged our people in IMH and the Ministry of Health to try to do something similar, though knowing that getting employers to accept ex-convicts is probably easier than the ex-mentally ill; a lot has to do with social stigma, which many Members have talked about. Society tends to generalise that all mentally ill are identically of the extreme, when in fact these are the small minority. Many can be stabilised and rehabilitated and can function like you and me. So we need the support of many to make this work, ie, employers, fellow employees, family members, community rehabilitation organisations as well as agencies like the Workforce Development Agency (WDA) and CDCs. Through these initiatives, we seek to train more GPs to better manage their mentally ill patients, avoid hospitalisation, reduce length of hospital stay, increase public awareness of the importance of public mental health and knowledge of coping strategies as well as improve the level of functioning of the mentally ill patients.

I agree with Mdm Halimah and Prof. Mehta that we need to ramp up our manpower in a big way to support mental healthcare. We need many more trained professionals who can manage persons with mental illness effectively. Mental health or psychiatry has now been incorporated into the basic training of medical doctors, nurses and therapists. We support post-graduate training and specialisation in mental health for healthcare professionals through training awards and scholarships.

As Members noted, there are now 116 registered psychiatrists in Singapore. Too few! We have to ramp up the number. I am quite glad to note, just before coming here, that right now, we have 50 trainees in the pipeline. We are definitely going to increase the number to at least 200 by

2015. It can be done. If we need to augment with foreign recruits, we would do so. This would raise the psychiatric population ratio to about 4:100,000 – still low compared to many other countries, but a significant improvement compared to today. But we have to take a multi-disciplinary team approach, relying not merely on psychiatrists. $15 million has been set aside to develop mental health manpower through the training of nurses, clinical psychologists, occupational therapists, medical social workers and many more, as noted by Mdm Cynthia Phua.

Mental health scholarships, awards and other skills development opportunities are also being offered. GPs can do more, as our key partners in managing patients with more stable and less severe mental illness in the community. Hospitals are training our GPs and engaging them in close working partnership to deliver continuing mental healthcare in the community. A new graduate diploma in psychiatry for GPs will also be launched. The family medicine training programme which prepares our young doctors to become GPs now includes a core posting in psychiatry. That probably helps explain the big increase in the number of trainees in psychiatry.

There are nearly 500 nurses who have specialised training in mental health today. We will support more nurses for skills upgrading. This year, 35 nurses have been awarded scholarships to do so. And from this year, 15 new fellowships will be offered annually for allied health professionals to pursue skills upgrading or postgraduate training in clinical psychology, occupational therapy, medical social work and other mental health areas.

Prof. Kalyani Mehta asked about clinical research. Yes, this is also an area of emphasis. Out of the five-year programme funding, a small though significant sum is set aside for research,

to particularly pay attention to applied research; how we can reduce hospitalisation stay, how we can avoid re-admissions to hospitals, and other related areas. Over all, my Ministry will continue to review these measures, study the experience elsewhere, whether it is Australia or New Zealand, and improve ours so as to enhance the care and treatment of the mentally ill here.

Let me now address some specific queries on the Bill. Dr Lam asked whether non-psychiatrists, including potentially untrained junior doctors, may sign the orders to detain patients for care and treatment. The answer is no. Clause 2 of the Bill states that only a doctor working in a psychiatric institution and who is designated in writing by my Ministry may sign such an order. And, obviously, we would only authorise doctors who are competent and have been properly trained.

Several Members were concerned about patients being subjected to unnecessary or prolonged detention. This is a valid concern. Mdm Halimah and Dr Ong called for a Mental Health Review Tribunal to hear appeals by patients and their families. Mdm Halimah asked for stronger protection of a patient from the arbitrary exercise of the power of detention, now that it has been increased. Dr Lam asked if there is a maximum period of which a Magistrate may order a patient's detention. Let me clarify that, as compared to the current Act, this Bill does not increase the power of detention or the length of time for which a patient may be detained. On the contrary, this Bill is to reduce the power of detention. The maximum period of detention, for example, is now halved. Let me stress that not all mentally ill patients can be detained by us. We must fulfil two conditions:

That his condition requires in-patient treatment. If he does not require in-patient treatment, there is no reason to exercise this Act; and

That detention is necessary in the interest of his own health and safety or for the protection of other persons.

So, both criteria must be valid before we can exercise this power. And there are checks and balances in place to ensure there is no abuse. For instance, the need for detention is reviewed regularly by a multi-disciplinary team treating the patient, as well as by the Visitors Board. The Visitors Board comprises lay persons and doctors who are not working at a psychiatric institution. As an added safeguard, applications for detention of up to 12 months at a time can only be made by these external visitors, after reviewing the institution's report and personally inspecting the patient. The visitors' application is then carefully scrutinised by the Magistrate who then decides whether to make such a detention order. Apart from these safeguards, applications may be made to the High Court for a review of any detention to challenge the lawfulness of a detention. Once a patient is assessed as no longer posing a danger, he will be discharged from detention immediately.

As this is not a new power, let us see what has been our actual experience. Last year, for example, IMH had more than 3,000 admissions under the Mental Disorders and Treatment Act. But of these, only five cases required further detention beyond one month. In fact, only 5% of these cases require detention beyond three days. So, the bulk of the detentions are for less than 72 hours. A Magistrate's Order for extended detention is also rare.

I believe the current measures are adequate, based on actual experience. We will study best practices overseas to

see whether additional safety nets, such as the tribunal that Members mentioned about, should also be put in place. I will keep an open mind on this particular issue.

Mdm Halimah expressed concern that a reduction in the minimum frequency of visitor inspections might affect the protection of patients. Let me assure this House that the protection for detained patients will not be compromised. The amendment refers to the minimum frequency of visits. So it does not prevent visitors from conducting more frequent checks. We have added a provision which allows the Director of Medical Services to order additional visits if he deems necessary. The visitors can also make surprise random checks at any time. The visitors have a comprehensive list of tasks to perform whenever they conduct an inspection. Besides inspecting the institution, they also have to carefully review the overall well-being of the detained patients through observations and interviews. In addition, they need to evaluate patients detained by court order under the Criminal Procedure Code, make recommendations on patients' fitness for discharge from detention or from a remand to an open ward.

Mdm Halimah and Mdm Cynthia Phua spoke on continuing care for psychiatric patients after their discharge from hospitals, and this is clearly necessary. Last year, my Ministry provided about $7 million of subsidies to support such long-term care for psychiatric patients. This will not be sufficient, going forward. Our approach is to ensure that a wide range of community-based services are available to help these patients. We will invest more resources to expand the sector as demand increases.

Mdm Halimah and Dr Ong have asked us to study the feasibility of supervised community treatments. Mdm Phua also called on MOH to support the

management of these patients in a much more aggressive way in the community, and we will try to be aggressive. Mdm Halimah referred this House to the New Zealand Mental Health Compulsory Assessment and Treatment Act. If a patient can be treated in a community and does not pose a danger, then he cannot be detained. Detention is a major step and that is why we set the threshold high. But countries, such as New Zealand, have gone further. Under the New Zealand scheme, two kinds of compulsory orders may be made.

The first is an in-patient order which is similar to our Bill, when detention and in-patient treatment are considered absolutely necessary.

The second is community treatment order, where a patient can be adequately and safely treated on an outpatient basis and he is ordered to undergo treatment in the community. Mandatory community treatment is therefore a complement to compulsory in-patient treatment and an extension of legal coverage. It is not an alternative.

My Ministry is committed to ensuring that patients with mental disorders are treated in the least restrictive way possible. Like any other illnesses, such patients and their families should be encouraged to seek help, whether in the community or in a hospital. Detention is really a last resort, when a patient poses a risk to himself or to others. Even when detention is necessary, there is a provision in the Bill to grant the patient leave from the institution. This is one mechanism to transit patients back to the community even before formal discharge, when the risk to themselves or the community is reduced.

Our intent is clear. It is to shift the focus of caring for the mentally ill from the institution to the community. If a patient does not need to be detained, then

we think it is best to emphasise voluntary treatment and community self-help, rather than resort to legal compulsion. That is why we promote voluntary community mental health treatment programmes rather than extend the law to make community treatment compulsory.

Nevertheless, I keep an open mind. We will closely monitor the progress, outcomes and the effectiveness of our own programmes and compare them with the experience in New Zealand and elsewhere. We can then decide if we need to extend the law to provide for community treatment orders. But, meanwhile, we step up and strengthen the community services. There is a gap and let us plug the gap first. We will think about the law later.

Mdm Halimah asked for MediShield to cover mental illness, while Dr Ong suggested that treatment be free. With Medifund, some mentally ill do not pay anything. So, it is free for them. But they have to be properly means-tested to avoid any abuse. MediShield does not cover mental illness because its premiums have not factored in such a liability. If MediShield is to cover mental illness, these premiums will have to be raised. But I have mentioned before that I keep an open mind on this particular idea. At some stage, when we are going to revise MediShield again, we can think about this particular idea.

Mdm Halimah was concerned that increasing the maximum penalty in clause 8 of the Bill will cause hardship for caregivers. Under clause 8(3), a police officer is empowered to visit and inspect a mentally disordered person to ascertain whether or not he is properly cared for or whether he is being ill-treated or neglected. A caregiver commits an offence only if he refuses to allow the police officer access. I believe it is

necessary to enhance the penalty for such an offence so as to protect the patients in the community.

Mr Ang Mong Seng was worried that family members may abuse the elderly with dementia by complaining to the police so that these elderly persons can be arrested and removed from their homes. If so, this will indeed be a very sad development for our society. The police will not detain any person indiscriminately based solely on complaints. They will conduct a thorough investigation and assessment of the situation. On the other hand, if the investigation turns out that the family members have ill-treated their mentally ill relatives – a scenario painted by Dr Lam just now – they would have committed an offence, not under this Bill but under the Penal Code, and will be taken to task. In any case, each case will have to be looked at individually and we should not jump to any hasty conclusion or moral judgment. It is easy for outsiders to criticise a family member living with a mentally ill 24 hours a day, seven days a week. As Mdm Halimah, Mdm Cynthia Phua and Prof. Kalyani Mehta have noted, sometimes the family members will need strong support and treatment too.

Mdm Halimah asked what constitutes dangerous behaviour, whether police officers are trained to handle persons with mental disorders and how they assess that a mentally disordered person is indeed dangerous to himself or others. Dangerous behaviour may include arming oneself with a knife or other sharp object, threatening others, or putting oneself in a precarious position, for example, climbing out of the window to stand on the parapet. In dealing with such situations, the police will bring the mentally disordered person into safe custody first before referring them to medical assessment and treatment. The police have proper procedures in place to handle such persons. These procedures will guide

officers on the course of actions to take, to assure, to pacify and to persuade the person to go for medical treatment. Where force is required as a last resort, to disarm the person or to bring him into custody safely, these procedures further specify that such force shall only be sufficient to overcome the threat or resistance. In short, police officers do receive training in handling persons with mental disorders.

Mr Ang Mong Seng asked if the police can be more proactive in getting patients, behaving strangely before they become violent or dangerous, to seek treatment early. We certainly should try, whenever we come across such cases, to alert the medical officers and hospitals so that we can start early treatment or diagnosis. But I hope we can do it in a way which will not reinforce the flawed stereotyping of the mentally ill. Some of this social nuisance does not equate to dangerous behaviour. It simply means that the person is unwell

and we should find the root cause to it. Is he getting enough support and care from his family, compliant with his treatment or experiencing a relapse? Let us all, as family members, neighbours and fellow Singaporeans, lend a listening ear and a helping hand. Society can play a greater role in supporting the needs of the mentally ill. Police assistance can be sought, however, if the public thinks that the nuisance is persistent and it poses a danger to himself or others.

I thank Dr Lam for expressing concerns about the welfare of healthcare givers working in psychiatric institutions but we are used to dealing with such occupational hazards. The IMH has a framework in place to deal with cases of assault on staff.

Clause 15(5) of the Bill allows the transfer of detained patients to another hospital for treatment of non-mental related illness. Dr Lam was concerned

that the receiving hospital's facility might not be adequate. We will work with the hospitals to ensure that they have the necessary capacity and capability to manage these patients.

Dr Ong highlighted the 1976 California Supreme Court ruling of Tarasoff vs Regents of the University of California and asked for a debate on this issue. While I agree that the California case threw up an important issue, I doubt this is the occasion to debate it. I do not think it is appropriate to legislate on a psychiatrist's duty of care towards third parties in this Bill. Without detracting too much from the debate on this Bill, let me just say that the doctor-patient confidentiality is fundamentally important but it is not absolute. There may be very compelling situations where countervailing public interests may justify disclosure. This is also recognised in the Singapore Medical Council's ethical code and ethical guidelines.

Mr Speaker, Sir, my Ministry will continue to work with other ministries and agencies on this nation-wide mental healthcare programme. My Ministry cannot do this alone. Under this programme, we will pro-actively care for patients across a wide spectrum of mental health conditions. The focus is prevention, early treatment for those who suffer from mental health conditions, get them back on their feet with continuing care in the community wherever possible. While the Government will work hard on this, the society at large has to work even harder on changing mindset, ie, employers, fellow employees, fellow Singaporeans, family members, neighbours. The mentally ill need our help, our sympathy, our empathy. Try to put ourselves in their shoes. If you continue to stigmatise mental illness, treat all of them like psychopaths, we will only make their conditions worse and their recovery more difficult.

I, therefore, join Mdm Halimah, Dr Ong, Mdm Cynthia Phua and all the

Members who have spoken, to appeal to all Singaporeans to join us to help these unfortunate patients. But for a small minority of these mentally ill, their psychiatric problems necessitate their involuntary admission, care and treatment in a psychiatric institution. This is to ensure their personal safety, health and to protect other persons in the community. Hence, we need this Bill and, once again, I thank the House for their strong support.

Question put, and agreed to.

Bill accordingly read a Second time and committed to a Committee of the whole House.

The House immediately resolved itself into a Committee on the Bill. – [Mr Khaw Boon Wan].

Bill considered in Committee; reported without amendment; read a Third time and passed.

Order for Second Reading read.

5.21 pm

Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

Our population is ageing and with ageing, unfortunately, the rate of dementia will also increase. At the age of 65 years, one in twenty of us may have dementia. By the time we are 75 years old, the incidence could be as high as one in 10. Maybe I will use the numbers in the Chamber as an analogy. If this Chamber was full and all of us were past the age of

75, there could be as many as nine persons who would have some form of dementia. I think it is just a coincidence that there will be nine speakers on this Bill!

As we grow older and become frail, the fact is our dependence on other people will increase. In a

book entitled, "Tuesdays with Morrie", the author Morrie Schwartz described this need quite succinctly. He says, and I quote, "It's like going back to being a child again. Someone to bathe you. Someone to lift you. Someone to wipe you."

Morrie Schwartz graciously accepted his need for others as his body wasted away from Lou Gehrig's Disease and he was unable to take care of himself. But sometimes, instead of the body wasting away, our minds may waste away first. And we may be unable to make decisions on our own and ultimately be unable to fend for ourselves. If any of us, unfortunately, was to reach that point, I am sure that we will feel much safer if we knew that the person whom we were going to depend on at that point in time was someone whom we had chosen when we had the capacity to choose – someone whom we could trust and rely on and someone who was willing to undertake that burden. The best time to choose that someone is now, before we lose our minds, before we lose our capacity. The question therefore is: can we do so under the current legal system? The short answer to that question is "not quite".

Today, a Committee of Person or Estate may be appointed by the High Court to manage the personal welfare and financial matters of those with 'unsound mind' and who are deemed to be incapable of managing their affairs. This is provided for under the Mental Disorders and Treatment Act, an Act which Parliament has just agreed to repeal. However, the problem with this prevailing

legislation is that the appointment of the Committee of Person or Estate can only be done after an individual person has lost his mental capacity. In other words, you cannot plan in advance and, even worse, you cannot exercise a choice. I am therefore introducing the Mental Capacity Bill to address this lacuna. We have studied the legislative frameworks of various countries, including the United Kingdom, Germany, Australia, and other countries closer to us in Asia, including Japan and Hong Kong. We have found the England and Wales Mental Capacity Act to be a comprehensive example, and we have modelled our Bill along their lines.

The Mental Capacity Bill puts in place a framework for proxy decision making. This framework sets out who can make the decisions on behalf of those who are mentally incapacitated, which includes persons with dementia, intellectual disabilities or brain damage. It also specifies the processes for doing so. Family members and caregivers who make decisions on behalf of those lacking capacity will be guided by this overall framework. And recognising that persons who lack capacity are specially vulnerable, this Bill provides safeguards against abuse by proxy decision makers.

Public consultation

This Bill is one that has taken a long time in gestating and it has been considered by staff in the Ministry of Law, Ministry of Health and the MCYS for almost a decade. Personally, it has been on my desk for almost three years and we consulted the public through a consultation exercise which began two years ago. So, we have taken our time to carefully and deliberately craft this Bill and make sure it suits our local conditions.

The consultation exercise included, in particular, consultation with social welfare organisations, legal, banking and medical

sectors. I am very heartened that most Singaporeans and key stakeholders have welcomed the Bill as a timely measure in view of our ageing population and they have also provided useful feedback. We have evaluated all the feedback and we have also amended our original drafts so that we have come up with what I believe is a more appropriate Bill in its current form.

I would now like to draw the attention of the House to some of the main features of the Bill.

Lasting Power of Attorney

The Mental Capacity Bill will empower individuals to plan in advance. It creates a new statutory mechanism called the Lasting Power of Attorney (or LPA in short). With the LPA, individuals can choose, in advance, the person whom they would like to make decisions on their behalf, if and when they lose their capacity in the future. The designated proxy decision maker is known as the donee.

The LPA is a flexible instrument and individuals will be empowered to determine in advance the specific areas which their donee can make decisions for them. These areas may cover property and financial matters, as well as personal welfare matters, including healthcare matters. When the individual loses his mental capacity, his donee is sanctioned to make decisions on his behalf in the areas that have been pre-determined by the person. An individual can also appoint one or several donees who can act jointly or jointly and severally.

Under the Bill, we have provided that bankrupts will not be able to act as a donee for property and financial affairs. However, a person who is a bankrupt can act for personal welfare affairs. When we consulted the public on the exclusion

criteria for donees, we received mixed reactions - some wanted us to be very safe and have a long list of exclusion criteria, yet, others said that these are personal decisions and we should let the individual decide who he or she wants to act as a donee, regardless of any previous convictions or financial embarrassment which an individual may be exposed to.

In the end, we decided to take what we believe is the right balance between protection and choice and we decided that we would draw the line only on bankrupts insofar as property and financial affairs are concerned. We do not want to be overly prescriptive and we want to allow Singaporeans the maximum choice to choose someone whom they trust to be their donee. But I would emphasise that you should consider very carefully the overall circumstances of the person whom you are intending to make your donee and to confer a lasting power of attorney to.

When individuals plan in advance, they may actually alleviate their loved ones of much stress later when they lose capacity. I will cite an example of one Madam Adeline Ang who is married with two sons. Some time ago, her husband was diagnosed with brain cancer, subsequently lost his ability to make decisions, and Madam Ang found that she then could not gain access to his bank account in order to even pay his medical bills. She was told she had to make an application to Court but she discovered that this process would be costly and sometimes cumbersome.

In the end, she chose not to go to court but that meant she had to struggle even more, to look after the husband, to get the necessary resources and also to look after the children. We believe having a Bill like this which allows pre-planning and pre-designation will lighten the burden in a significant way for future families in such

circumstances. But having said that, I also want to say that we will not mandate that everyone must make such a directive and conferring a lasting Power of Attorney to someone else. This will be entirely voluntary. We are merely providing individuals with the means to do so if they wish to and this, therefore, is the attraction of the Bill. It is empowering, it is giving you a choice, and it allows you to plan in advance.

Court decisions

Sometimes, there will be people who did not plan or deliberately did not want to plan and to appoint someone as a donee. In such a case, there is an option of applying to the High Court when that person loses capacity, for a court decision on the person’s personal welfare or property and affairs.

The High Court will have powers which are listed in the Bill to make decisions on the control and management of the mentally incapacitated person’s property, carrying on the profession or business of the mentally incapacitated person and the execution, amendment or revocation of a will on behalf of that person.

Court made wills

Sir, allowing the High Court to make wills on behalf of a person who lacks capacity was a recommendation put up by the Law Society and one which I hesitated on initially. However, after consulting the experts involved in this field, I think this is something which we should provide for. Why? When a person who has not made his will and then subsequently loses his capacity, and if he has got a fair bit of assets that need to be distributed, and where it is apparent from his circumstances that the distribution of the assets according to the laws of intestacy – that means according to circumstances where no will is made –

would lead to inappropriate, unfair or unjust outcomes, then there is an advantage in allowing an application to the High Court for the court to step in and decide in an objective and fair manner as to how these assets should be distributed in the person’s best interests, not necessarily in the best interest of the beneficiaries This, I believe, will clarify misapprehensions and prevent possible future disputes or tensions among family members. Family members can then focus on looking after the well-being of the mentally incapacitated person.

Deputies

For those who have not planned in advance, and where there is a need for ongoing decisions to be undertaken, the High Court can also sometimes appoint a deputy for the person who lacks capacity. This system is not unlike the current Committee of Estate or Person which we have in today's legislative framework.

This provision would be particularly useful for parents of children with intellectual disabilities. Let me explain this in greater detail. Very often, parents who have children with disability, mental or physical, have expressed to me that their greatest anxiety is what happens after they pass on. Who will look after their child? Who will look after him when he reaches adulthood? Who will take care? Who will make decisions? As a parent myself and, I think, as all of us here are parents, we can empathise with this great anxiety or fear of the future in such circumstances. This Bill would not be a panacea for their worries but it provides a framework which I believe will assuage some of their fears.

Let me explain how this will operate. Parents can apply to the High Court to appoint a deputy for their child. In the case where the child has reached the age of 21, the court may make the appointment if at that point in time the

child is deemed to lack the capacity within the meaning of this Bill. In the case where the child is not yet 21, the court may still make the appointment if it considers likely that the child will continue to lack capacity when he reaches 21 years of age. In appointing a deputy for the child who has not reached the age of 21, the court must have regard to the principle that the appointment of his parents or guardian is to be preferred. The court also has the power to appoint successor deputies in the event that the parents pass away. When considering who should be the successor deputy for a child who has not reached the age of 21 years, the court shall have regard to the parents’ wishes. In other words, the parents can indicate who they want to act as their successor deputy and the court will have regard to their wishes. This, therefore, establishes a succession pathway for the care of the child with intellectual disability and we will work to make this process as efficient and simple and as affordable as possible to all parents in such circumstances.

Safeguards and protection

Sir, I have shared with the House the avenues provided under this Bill to appoint a proxy decision maker, either a donee or a deputy. In addition to providing these avenues, the Bill also guides proxy decision makers in the discharge of their duties. Let me, therefore, elaborate on some of these provisions.

Key principles

At the heart of the Bill is a set of key principles whose core tenet is that every individual must be presumed to have capacity unless shown otherwise. The Bill provides a two-stage test that must be applied in order to determine whether a person has the capacity to carry out an act or make a particular decision. It focuses on the particular time that the decision has to be made and on the

particular matter to which the decision relates. This, therefore, allows the calibration of powers to be granted to appointed proxy decision-makers so that they will take into account, at all times, the extent of the person’s mental capacity.

As for those that lack capacity, decisions that have been taken on their behalf must be taken in their best interests. The Bill offers guidance on what constitutes best interests. One example would be in the case of making a decision with respect to the incapacitated person’s property. The Bill states that where there is a need to dispose of or settle a person’s property, the decision-maker must be motivated by a desire to ensure that the incapacitated person’s property is preserved as far as possible to maintain the incapacitated person during his life. This is to avoid some of the conflicts of interest which inevitably arise in such circumstances.

Statutory protection for informal caregivers

We also have provided for statutory protection for informal caregivers. These are people who are looking after people who are incapacitated but have not been designated formally as donees or deputies. As long as these informal caregivers perform acts in connection with the care and treatment of people with incapacity, in their best interests, and without negligence, then clause 7 of the Bill will provide these informal caregivers with protection against civil and criminal liability.

This requirement, and I want to emphasise this requirement, to act in the best interests of the mentally incapacitated person and without negligence, is based on existing common law principles. Caregivers should be assuaged that they

would not be ‘criminalised’ nor face civil suits in their course of caring for the mentally incapacitated insofar that they were performing these acts of care and treatment in the best interests of the mentally incapacitated in good faith.

Excluded decisions

Having said that, Sir, there are some issues which we believe should be excluded and some decisions which proxy decision makers should not have a right to make. For instance, there are some decisions which are so sensitive, for example, the consent to marriage; consent to divorce; consent to sexual relations; sterilisation; adoption; renunciation of religion or change of gender. This Bill will also not affect the existing operation of the Human Organ and Transplant Act or the Advance Medical Directive (AMD) and where a person has already made an AMD, the AMD will prevail.

Criminalisation of ill-treatment

I am certain that the majority of us, if we are called upon to perform the role of a proxy decision maker, will do so sincerely and to the best of our ability but we should also be realistic and understand the vagaries of human nature. Some of us may have read in the newspapers, I think in May this year, of a wife who was appointed to the Committee of Person for her husband by the court. Her husband was incapacitated due to a work-related incident. She was appointed to manage the sum of money that was awarded to her husband as a result of the accident. I believe this was the Workmen's Compensation. Many of us would have been appalled to read that not only had the wife pocketed the entire sum of money for herself, she also locked her husband up at home without care while she went on to live with another man.

We want to deter such flagrant cases of abuse as far as possible. As a bulwark

against abuse, this Bill will introduce a new criminalisation clause. Ill-treatment or wilful neglect of a mentally incapacitated person will be a criminal offence. Any caregiver, donee or deputy found guilty of such an offence shall be liable to imprisonment or a fine or both.

Office of Public Guardian

Sir, we will set up a new Office of Public Guardian. It will perform a range of functions that contribute to the protection of those that lack capacity. The Office will supervise and support court-appointed deputies. Families may approach the Office of Public Guardian for information on making the Lasting Power of Attorney as to what powers they could consider granting and what to consider when trying to choose who they want to act as a donee. We expect that the Office would be operational some time in the middle of next year.

Mdm Deputy Speaker, we cannot stop the ageing process and we cannot stop the fact that some of us will lose capacity in the future. But this Bill is to empower us to plan in advance, to try in some significant way to secure peace of mind even if we were to lose our minds in the future.

Mdm Deputy Speaker, I beg to move.

Question proposed.

5.42 pm

Mdm Deputy Speaker, I may be getting old but I assure the Minister that I am not yet suffering from dementia.

Madam, the Mental Capacity Bill is both timely and appropriate. Singapore is rapidly ageing. We are constantly reminded of the increasing number of elderly Singaporeans. With ageing, comes

the reality that our mental faculty may not be as capable as before. For a fair number within our society there will come a time where they are no longer capable of assuming the mental ability and responsibility for their decisions.

Presently, the Mental Disorders and Treatment Act (MDTA) is the only significant piece of legislation that deals with people who are mentally incapable of looking after themselves. And we have just only this afternoon repealed this Act but it will come back in a different form. Unfortunately, the MDTA was drafted more for those who are mentally unsound than for those who are mentally incapable, in law at least, of making proper decisions. Although the MDTA may be applied to those who lack mental capacity to look after themselves, to have decisions taken on behalf of those who lack the capacity under the prevailing legislation may not always be appropriate, as the application of the Act carries with it the potential stigma, as we have heard earlier, of being labelled as insane by the community.

The present Bill, therefore, fills a gap in the legislation. It also simplifies and makes it possible for us to plan ahead to prepare for the day we no longer are able to make sensible decisions. With the passing of the Bill, Singaporeans can now draw up instruments in the form of Lasting Power of Attorney, or can now take comfort in the prospect of a court appointed Deputy who can eventually make decisions in their best interests.

I, therefore, applaud and welcome such moves by the Government to attempt to bring back some dignity in the lives of those who cannot look after themselves. However, I do have a few concerns that I hope Minister can shed light on.

It would be ideal for one to plan ahead to draw up Lasting Power of Attorney but

I am not sure if the majority of Singaporeans will fully appreciate the benefits that this legislation seeks to bring to them. I suspect that as with wills and testamentary dispositions, most Singaporeans would either be ignorant of the matter, or will not appreciate it sufficiently to want to bother. Besides, even if they are prepared to draw up such an instrument, we may not have the right people who are sufficiently informed of their rights and obligations in duty to properly discharge their functions as guardians of such mentally incapacitated people.

In the absence of a Lasting Power of Attorney, concerned parties, as we understand, may still apply to court to get an order to appoint a Deputy to act on behalf of the person concerned. However, unless that person is a man of means, few would ordinarily want to take the trouble of making an application to court to get a Deputy appointed in the absence of a Lasting Power of Attorney.

Who will bear the cost of such application? The fact remains that a person who lacks the mental capacity to make decisions would have to rely on his family for his daily needs. What he may not be able to do, unless he has made prior arrangements, is to have contractual dealings with other parties. In many cases, families may just wait till the person passes away before dealing with his assets and properties. The prospect of going to court to make an application in most cases would just put many Singaporeans off. Unfortunately, unlike estate matters where properties of the deceased may be applied for the benefit of the beneficiaries, including the administrator, there may be fewer incentives for anyone to apply to court to act as a Deputy as there are added impositions on the person concerned without the obvious benefits. Sir, if the Act is to achieve the broader purpose for

which it was designed, it should be made more friendly and less costly to implement and has a wider reach to all and sundry rather than just be confined to a few. What we certainly do not want is a legislation that is confined to the middle class and the well-heeled Singaporeans.

Secondly, much authority has been given to the Attorney or the Deputy in a court appointed case. These powers are wide ranging. Potentially, these persons may make decisions that harm the person concerned although these decisions are ostensibly made in his best interest. The Bill presently disallows persons who are bankrupt from acting on behalf of the incapacitated person in certain matters. However, the Act is silent as to persons with past record of criminal convictions, particularly those who have been convicted of violent or sexual crimes, fraud or dishonesty. I note that the Public Guardian, together with the Board of Visitors, is supposed to provide supervisory guidance on the conduct of the Attorney, which, for the purpose of my speech, also includes the Deputy appointed by the court. The question really is, whether this is sufficient to safeguard the interest of the person concerned. The Bill seems to be saying that a bankrupt is more dangerous than a convicted fraudster or a violent criminal. This seems like an anomaly and is rather presumptions. A person could be bankrupt for various reasons. However, the law unfortunately makes the presupposition that all bankrupts cannot be trusted to act in the best financial interest or property interest of the person who is mentally incapacitated.

Thirdly, the Bill entrusts the Attorney to behave properly in discharging his duties under the appointment. Currently, otherwise determined by the authorities, the law allows the Attorney to deal with the property and affairs of the incapacitated person. Such acts will be binding on the person whom the Attorney

represents. While the Bill makes provisions for the oversight and supervision by the courts, the Board of Visitors and the Public Guardian, there should be rules to spell out the specific areas that these guardians should look out for. For instance, the Bill is silent on the question of whether or not, in the discharge of his duties, the Attorney ought not to be placed in a position where he is in breach of his fiduciary duty to the incapacitated person. As to what the nature of that fiduciary duty is, as I said earlier, or what is the nature of the conflict that the Attorney should not put himself into a position is very much dependent on the knowledge and maturity of the Attorney concerned. In this regard, I am not sure whether all who will be appointed Attorneys under a Lasting Power of Attorney will properly and fully appreciate the responsibilities that he now has to shoulder for his loved ones whom he is giving continuing care for. I do understand that under the present regime as proposed, there is a provision for the Code of Practice. I therefore would like to urge the Government that in drawing up a detailed Code of Practice, the Government would take into consideration a very detailed set of guidelines that will guide and supervise the Attorney or perhaps the Deputy in the discharge of his duties towards the incapacitated person.

Madam, in its implementation, much will have to depend on the public to have the good sense to know that delegating the authority to someone to make decisions on their behalf under certain circumstances is a very important and serious exercise. Much of his quality of life will depend on the Attorney to properly discharge his duties and to have the wherewithal to discharge it. Nonetheless, the introduction of the Bill is welcome as it provides a proper platform that is convenient and efficient in dealing with mental incapacity than that which is currently available. However, this is also one Bill that would require much public

education and training if it is to be effective. I do hope that in this regard, the Government will put in place resources to properly and adequately prepare the public for it.

With that, Madam, I support the Bill.

5.50 pm

Mdm Deputy Speaker, I will speak in Mandarin.

(In Mandarin): [For vernacular speech, please refer to Appendix A *. ] The introduction of the Mental Capacity Bill is indeed timely as we anticipate and prepare for the imminent challenges of an ageing population coupled with longer life expectancy.

When the draft Bill was circulated for discussion, many groups of people from various non-governmental organisations and self-help groups were consulted. I can see from this Bill that quite a number of the recommendations have been included and feedback considered. I applaud MCYS for this.

The Bill has attempted to elucidate the meaning of "mental incapacity" and what is in the "best interests" of the donor and the various instances where decisions can be made on behalf of them. In short, the Bill has attempted to encapsulate comprehensively and make express provisions to cover the various possibilities where a person who lacks mental capacity has to make a decision.

This Bill will only be useful for our populace in so far and as long as the common man in the street understands the provisions of this new law when passed. In addition, the various useful recourses provided in this Bill must not only be understood but utilised and executed effectively to give full justification for its existence.

As you can see from the recent front page newspaper reports, crimes against the older folks are on the rise. It is therefore imperative that this Bill provides security and has widespread use and reach amongst our people, especially the older folks, to truly prevent abuses and instances where their interests are not guarded due to them sustaining "mental incapacity". I therefore urge MCYS to take cognisance of the fact that communication and outreach are of paramount importance in the light of our greying population and the increasing trend of "mental incapacity" cases.

In short, I request MCYS, when embarking on issuing a Code or Codes of Practice for the implementation of this Bill when passed as law, to simplify the implementation processes so that the common folks would not find it too onerous.

*Cols. 175-176.

5.53 pm

Mdm Deputy Speaker, I rise in support of the Mental Capacity Bill and thank the Minister for this significant legislation. If executed well, this new Bill will make a real positive difference to many lives.

I will speak on three key points: (1) responses to the Bill; (2) its positive features; and (3) provide three suggestions for implementation.

The response to the Bill is mixed. One, professionals, especially the social service, legal and healthcare sectors, generally welcome the new Bill as it provides a comprehensive framework that reforms and updates the current Mental Disorders and Treatment Act (MDTA). The current Act is limiting in its scope and does not allow persons to plan in advance for a time when they may lose their

mental capacity. Two, parents of special needs or disabled children appreciate the new Bill and thank the Ministry for this. In a 2006 Parent Workgroup Report on enhancing the financial security of persons with special needs, close to 100 parents and disability experts were engaged. The families' key fears were grouped into two main areas, namely, (1) financial and (2) caregiving arrangements when they are unable or no longer around to look out for their special needs children. And, three, other Singaporeans who either do not have or do not want to rely on their children and wish to plan in advance for their old age, I believe, also embrace the new Bill.

However, for the man in the street, the content of the Bill does not appear to be their concern. At a recent dialogue with my residents and grassroots leaders, I learnt that there is even concern that planning too early will (1) disrupt harmony amongst their children, and (2) encourage the abdication of filial duties of adult children who are not "appointed" to make financial and personal welfare decisions when their elderly parents lose their capacity. Hence, for the typical Singaporeans, there is a need for the Ministry to educate them so they can make informed options, instead of relying on their potentially false confidence that things will fall into place when the time comes or as the Chinese call this attitude, "chuan dao qiao tou zi ran zhi", or as the song goes, "que sera sera, whatever will be will be".

As the new Bill is based on the British Mental Capacity Act passed in 2005 and came into force in 2007, Singapore is in a fortunate space to not have to reinvent the wheel. Positive new features were introduced in this new Bill. The Bill is comprehensive and protective of the person lacking capacity.

The new positive features of the Bill include the Lasting Power of Attorney

that the Minister spoke about, a new regime for the appointment of a Deputy and even Successor Deputies for the person lacking mental capacity and the creation of the new Office of Public Guardian and Board of Visitors with accountabilities to safeguard the persons lacking capacity.