Implementation of the Mental Capacity Act in Singapore

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Juliana Charles
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Implementation of the Mental Capacity Act in Singapore 3 rd World Congress on Adult Guardianship 30 May 2014 1 Singapore New York City (786 sq km) is slightly larger than Singapore Tokyo (2,187 sq

1 Implementation of the Mental Capacity Act in Singapore 3 rd World Congress on Adult Guardianship 30 May Singapore New York City (786 sq km) is slightly larger than Singapore Tokyo (2,187 sq km) is three times bigger. Sources: (1) (2) 2 Demographic Trends: Singapore 1,000, , , , , , , , ,000 Resident Elderly Rise in No. of Resident Elderly 65+ with Dementia Resident Elderly Source: MOH, DOS, NPTD (2011) Source: DOS, NPTD (2011) Observation: increasing number of individuals would need deputies and donees 3 1

2 Singapore law Mental Disorder Ordinance 38 of 1952 Mental Disorders and Treatment Act 1970 ( MDTA ) Mental Capacity Act ( MCA ) 4 Government s role enhanced by MCA MDTA: Judicial arm confined to archaic concept of unsound mind MCA framework adequate to deal with the problems suffered by the mentally incapacitated 5 Framework of Mental Capacity Act Person who Lacks Mental Capacity ardian Office of the Public Gua Lasting Power of Attorney The 5 Principles Court Appointed Deputies Excluded Decisions Code of Practice Ill-Treatment Care Givers 6 2

3 Functions of the Office of Public Guardian 7 4 Functions of OPG Registry Supervision Public Guardian Public Education Investigation 8 4 Functions of OPG at a glance Registry Establish and maintain a registry of: Lasting Power of Attorney (LPAs) Court orders appointing deputies Investigation Investigate into alleged illtreatment of a person without mental capacity Supervision Supervise deputies Manage & direct Board of Visitors Reporting to court Public Education Create awareness of MCA / LPA Stakeholder outreach and education Public information 9 3

4 Key Components of Registry Functions LPA Establish and maintain a register of LPAs Verify information on LPAs before registration Review draft LPAs for ineffective clauses Update list of revoked LPAs for third parties verification Deputy Establish and maintain a register of Court orders Facilitate 3 rd parties searches on OPG s register 10 Key Components of Supervision Functions Supervise deputies Allocate appropriate level of monitoring to new cases Write to deputies to request for due reports Manage & direct Board of Visitors to conduct home visits Reporting to court where directed to do so 11 Key Components of Investigation Functions Receive complaints of alleged illtreatment of a person without mental capacity Investigate into complaints by exercising statutory powers Take follow up action to protect P s personal welfare or property 12 4

5 Key Components of Public Education Functions Create awareness Publish information about MCA and LPA Reach out to target audience through booths at exhibitions Stakeholder Hold lddialogues with hkey stakeholders regularly Meetings with individual stakeholders Engagement Public Information Give talks on LPA and deputyship Publish guides for donees, deputies and caregivers 13 Registry of LPAs and court orders FY2010 (March 2010 March 2011) FY2011 (April 2011 March 2012) FY2012 (April 2012 March 2013) FY2013 (April 2013 till date) No of LPA applications received No of court orders appointing deputies , , NB: Persons appointed as Committee of Persons and/or Estate under repealed Mental Disorder and Treatment Act are considered deemed deputies. 4,528 deemed deputies from 3,195 court orders were absorbed by OPG on 1 March Public Education s key messages and target audience Positioning LPA as pre-planning instrument to protect one s interests. LPA as key component of holistic planning for life s eventualities. LPA provides for personal autonomy & upholds one s dignity. Key Messages Target Audience Life unpredictable. One can lose mental capacity unexpectedly because of accidents even as dementia also rising ii in fast ageing population. LPA protects an individual in event he loses mental capacity and becomes vulnerable. Making LPA offers certainty and peace of mind to individual, his family and loved ones in life s uncertainties. Elderly Working/ Influencers Active lawyers, doctors, Heartlanders affluent Agers financial planners, adults social workers Youth 15 5

Varied tactics to reach out to the target audience

local media engagement, outdoor bus shelters, bus wrap

Tactics Talks Corporate lunch time talks Community

public talks like HDB s retirement seminars Industry

NNI s Neurocognitive Symposium Events outreach

CEL: LivEnabled roadshow NTUC U Live: U Live Symposium

related events Workshops Regular LPA & Deputy workshops

influencers Training social intermediaries (pro bono

6 Varied tactics to reach out to the target audience Public Awareness Campaign TV/radio campaign, print ads, local media engagement, outdoor bus shelters, bus wrap ads etc. Tactics Talks Corporate lunch time talks Community Centre/VWO/Healthcare institution talks Big scale public talks like HDB s retirement seminars Industry specific seminars e.g. NNI s Neurocognitive Symposium Events outreach participation C3A: 50Plus Expo, religious organisations CEL: LivEnabled roadshow NTUC U Live: U Live Symposium for the 50+ ADA, HPB, TTSH: World Alzheimer s Day related events Workshops Regular LPA & Deputy workshops Collaboration with partners POSB, C3A, PA Outreach to influencers Training social intermediaries (pro bono lawyers, social workers at FSCs) to conduct talks & assist elderly with form-filling 16 OPG s inaugural awareness campaign Out-of-home ads 17 OPG in the news 18 6

Public surveys conducted in 2010 and 2012

Review & refine ACCESSIBILIITY, EASE AND

7 Increasing awareness of LPA, MCA and increased uptake of LPA Almost 50% Source: Public surveys conducted in 2010 and year workplan (FY2013 FY2017) 20 Strategic Thrusts Next 5 years Theme : Staying Relevant; Review & Refine STRATEGIC THRUSTS Review & refine ACCESSIBILIITY, EASE AND CONVENIENCE PUBLIC SHARPEN PROTECTION Relevance Changing Mindsets 21 7

8 The Roadmap Next 5 years STRATEGIC THRUSTS Refine Review & R PUBLIC Review legislation Targeted donor / LPA Review Review Code of donee engagements Committee Practice Targeted third party Review modes of LPA submission engagements Online accreditation Promote & encourage Feasibility of tribunal system best practices Framework for professional deputies Develop risk-based supervision framework ce Relevan Changing Mindsets Continuing education and outreach Ongoing engagements Generate conversations Advocacy 22 Simplification of LPA form PUBLIC Mid-Jan 2014 Testing of revised forms Feb 2014 Comments by Chairman, PGB 7 th LPA Review Comm. mtg Mar - Apr 2014 Senior mgmt s clearance AGC clearance Minister s approval Apr May 2014 Public comms. Plan & training 1 Jun 2014 Launch of simplified forms See Appendix for full timeline 23 New initiatives to increase efficiency PUBLIC Additional manpower for LPA registry Pilot postal mode of LPA submissions Tapping on technology To reduce waiting time for public and staff pressure during processing of application Exploring with RSVP to tap on volunteers to carry out back-end processing of LPA applications Online search module Online LPA form maker Self-help kiosk 24 8

9 Continual public engagement PUBLIC Mar 13: Review of outreach, identification of issues and development of strategies Mar 14: OPG-Financial Sector Dialogue Session Apr 13: Proposed engagement plan to Sub Board Dec 14: Public confidence survey 25 Engaging financial sector through dialogue and exchange of ideas Objectives PUBLIC Ongoing engagement to achieve greater buy-in to MCA and its planning instrument, LPA Dialogue with banks to share and understand ground issues faced by banks as well as proxy decision makers to ensure public confidence in LPA Share and promote best practices in industry Desired Outcomes A good understanding and appreciation of MCA / LPA Buy-in and support from banks Consistent approaches in facilitating LPA transactions Awareness of best practices in industry in facilitating banking transactions on behalf of Ps See Appendix: OPG-Financial Sector Dialogue Session 26 Panel deputyship for Ps without NOK Proposal for appointment of Panel Deputies via service level agreement Accept cases referred by AIC Deputies lawyer and social worker to be jointly appointed Deputyship for limited duration and power PUBLIC D liquidates P s assets D submits report to PG & discharges himself D transfers P s money into SNTC trust D works out P s care plan with SNTC 27 9

1186 private clinics distributed across Singapore 183 285 205 256 257 Source: SingHealth, Find a

10 1186 private clinics distributed across Singapore Source: SingHealth, Find a GP or Family Clinic Near You, <

Policies, Procedures, Guidelines and Protocols

Policies, Procedures, Guidelines and Protocols Document Details Title Advanced Decision to Refuse Treatment Policy and Procedure (previously known as Living Wills) Trust Ref No 443-24903 Local Ref (optional)