By Dr. Ang Yong Guan
This write up first appeared as a status update on Dr. Ang’s facebook account. Updated on 9th April with additional notes.
Private Ganesh Pillay Magindren, aged 23, who suffered from schizophrenia (diagnosed and on treatment by Dr Paul Ngui, a senior consultant psychiatrist in private practice), was found dead at the bottom of his Sengkang condominium in July 2013. As the coroner’s inquiry is still on, I will avoid commenting on the specifics of the case.
However, some of my friends have asked me this general question: Should male Singaporeans suffering from Schizophrenia serve national service?
The answer is No if the person has been suffering from Schizophrenia for a period of time and still has got symptoms of the illness at the time of his medical check-up at the Medical Classification Centre (MCC) of Central Manpower Base (CMPB). Such a person is usually given PES F. (please note that PES A and B are for those who are combat fit; PES C and E are for those with medical or psychiatric illnesses and are considered non-combat fit; PES D is for those who are temporary unfit due to medical illnesses which are still being treated. PES F is for those medically unfit and is exempted from national service)
The answer is Yes if the Schizophrenia is diagnosed and treated and the person is free from symptoms at the time of his medical check-up at MCC. The person can be considered for enlistment as a non-combatant (most probably as a PES E personnel) to serve as a clerk or store-man.
This decision to enlist a male person suffering from Schizophrenia is on a case-by-case basis; there is certainly no one size-fits-all policy. Sometimes, the SAF psychiatrist may consider the person with Schizophrenia fit for PES E enlistment but because of the risk of relapse whilst serving NS, the psychiatrist may decide to exempt the person by giving him PES F instead. Sometimes, family members may request the SAF psychiatrist to enlist their son with Schizophrenia for a trial of PES E because they feel that a stint of NS may be useful for their son to get mentally stronger. If the person fails to adapt after a period of time, the SAF psychiatrist will then medically discharge him by giving him PES F.
What is important is that when the person with well-controlled Schizophrenia is enlisted, the camp Medical Officer and Manpower Officer must be notified so that they would make sure that the person is well supervised and taken care of. The work allocated to such a person and his stress level should be monitored closely.
The moment there is evidence of abnormal behavior or change of behavior because he is unable to handle the stress of even PES E type of work, the person’s immediate family members must be notified so that preventive steps (e.g. bringing the person to see his psychiatrist earlier than his scheduled appointment etc) can be taken. And if the person continues to have difficulties adjusting to the military environment, the Manpower Officer must notify the unit Medical Officer who will then inform the SAF psychiatrist. A medical board can be convened to medically discharge (PES F) the person so that he can continue to receive treatment without the additional stress of having to serve national service.
Some of you feel that male Singaporeans with mental illness (especially Schizophrenia) should NOT be enlisted to do NS at all.
My view is as follows:
Pre-enlistees with psychiatric conditions (or for that matter, any medical conditions) should be treated on a case-by-case basis at the Medical Classification Centre (MCC) when they come for their medical check-up.
In the final analysis, whether they are enlisted as PES C or E (non-combat vocations such as clerk or storeman) or PES F (exemption from NS based on medical / psychiatric grounds) depends on a confluence of factors:
- The severity of their conditions,
- The likelihood of a relapse when subject to stress of NS,
- The pre-enlistees’ attitude towards NS,
- Parents’ attitude and view about NS (some parents would prefer their sons to serve a stint of NS even though they are aware of their sons’ medical problems and risks involved and / or
- The parents and the pre-enlistees must be aware that the moment they cannot take the stress once enlisted, they will be medically boarded out.
It is therefore NOT a one-size-fit-all approach. We must NOT forget that SAF is a microcosm of Singapore. We cannot avoid encountering people with mental illness whether in the SAF or Singapore. The earlier we learn how about their illnesses and how to get along with them, the better.
[spacer style=”1″ icon=”none”] Dr Ang Yong Guan graduated from the University of Singapore in 1979 with a medical degree. He did his post-graduate training in psychiatry at the University of Edinburgh from 1984 to 1986. Upon his return from Edinburgh, he served as a psychiatrist with the Singapore Armed Forces for 17 years from 1986 to 2003 before retiring as a Colonel in 2003 as Head, Psychological Care Centre at the SAF’s Military Medicine Institute.
Dr Ang is currently in private practice as a Consultant Psychiatrist at Paragon Medical, Singapore.
He was the President of the Singapore Psychiatric Association for two consecutive terms in 1997 and 1998 and Chairman of the Chapter of Psychiatrists, Academy of Medicine from 2001 to 2003. He was also a member of National Council on Problem Gambling (NCPG), set up by Ministry of Community Development, Youth & Sports (MCYS), from its formation in 2005 till 2011. He also served as a Special Visitor, Board of Visitors of the Mental Capacity Act under the Ministry for Community Development, Youth and Sports (MCYS) from 2010 to 2012.
He is the founding and current Chairman of the Action Group for Mental Illness (AGMI), a non-profit advocacy group formed in October 2004 to champion for persons with mental illness.
He is a current member of the Ministry of Health’s Clinical Advisory Committee for Chronic Disease Management Programme on Mental Illness and the Visitor’s Board under the Mental Health (Care & Treatment) Act. He is also a member of the Medifund Committee, Institute of Mental Health.
He is also on the Panel of Medical Experts appointed by Subordinate Courts of Singapore since 1 March 2013.
He was awarded the Public Service Medal (PBM) in 1995 for his contribution in community work and the Public Administration Medal (PPA) in 1996 for his service in the Singapore Armed Forces.