KUALA LUMPUR, May 24 – The Dewan Rakyat yesterday passed the Mental Health (Amendment) Bill 2023, which is part of a set of legislative changes aimed at decriminalising attempted suicide in Malaysia.
The Mental Health (Amendment) Bill 2023 primarily seeks to give crisis intervention officers (CIOs) the power to apprehend individuals with or who may have mental disorder who pose a threat to themselves or others, or who is attempting to commit suicide.
This legislation is one of three bills that signify a significant shift in the country’s legal reforms to recognise suicide as a mental illness that needs treatment, not punishment.
On Monday, the Dewan Rakyat passed the landmark Penal Code (Amendment) (No. 2) Bill 2023, which removes Section 309 — a provision that punishes individuals who attempted suicide with up to one year in jail, or a fine, or both — from the Penal Code.
Legislators, although supportive of amendments to the Mental Health Act, raised concerns about the qualifications and abilities of CIOs to handle individuals with mental health issues. They also questioned the broad discretionary powers granted to CIOs, raising concerns about potential arbitrariness and subjectivity in addition to available recourse for individuals who experience property damage due to forced entry by CIOs.
Section 11(5) of the Mental Health Act 2001 (Act 615) defines CIOs as police officers, officers of the Malaysian Maritime Enforcement Agency, firefighters, auxiliary fire officers, appointed volunteer fire officers, members of the Malaysia Civil Defence Force, and community welfare officers.
The newly passed amendment allows any CIOs to apprehend whomsoever they believe to be mentally disordered who is dangerous to themselves or other people and property, or who tries to commit suicide.
For CIOs to intervene in a crisis, Section 11(2) grants them the power to enter any premises at any point in time to apprehend the mentally disordered person for the purpose of the act.
The amendment stipulates that CIOs are given the power to break down any door or window in any premise to enter, or forcibly enter, or forcibly remove any obstruction to the entrance.
Bentong MP Young Syefura Othman, who is a nurse by training, raised concerns about the persuasion, negotiation, and psychotherapy skills of the CIOs and proposed that these officers undergo continuous special training focused on crisis management and intervention.
This continuous training would ensure that CIOs possess the necessary skills and expertise to effectively handle the intervention process.
“I feel that there is a need for CIOs to be given special training on how to deal with a crisis and how to intervene. Intervention cannot be performed aggressively, and necessarily, it requires persuasion and negotiation skills to [converse] with the victim.
“The victim’s emotion is the priority in the intervention process, and we can refer to this as a mission to save lives,” said the first-term DAP parliamentarian.
Kapar MP Halimah Ali echoed the concerns raised by Young Syefura regarding the qualifications of CIOs in effectively handling situations involving individuals with mental instability.
Halimah, a member of the PAS party, cautioned about potential unintended practical scenarios that could arise after the bill’s passage and questioned whether the government is prepared to provide adequate training to CIOs before granting them the authority.
In addition, Halimah proposed that medical officers (MOs) and assistant medical officers, who possess a better understanding of the psychological aspects of such situations, should be considered eligible to serve as CIOs, as they understand the psychology of the situation better than CIOs from other sectors.
“So I would like to ask the government: Is the government prepared to ensure that the individuals we refer to as crisis intervention officers receive thorough briefings and sufficient training before being entrusted with such a weighty mandate?
“I agree with the statement made by Kuala Langat, where medical officers and medical assistant officers should also be considered qualified individuals since this pertains to a mental health issue. After all, the name of the act itself is ‘mental health.’ Naturally, those who are directly involved and possess a better understanding of the psychological aspects and mental disorders should be involved.”
In response to the aforementioned concerns raised by MPs and similar concerns, Deputy Minister in the Prime Minister’s Department (Law and Institutional Reform) Ramkarpal Singh highlighted a suicide prevention training programme developed by the Ministry of Health (MOH) to train frontline officers.
Ramkarpal shared that in 2022, over fifty national-level police officers and firefighters underwent training based on this model, which encompassed essential skills such as communication and negotiation.
“The MOH has developed a suicide prevention training model for frontline officers, and training at a national level has been carried out in the year 2022 that involved more than 50 police officers and firefighters.
“This training model also includes communication skills and also negotiation skills. So, training that is continuous and regular needs to be implemented to improve the skills of the crisis intervention officers to manage the crisis [that is] attempted suicide situations,” said Ramkarpal.
Regarding the proposal put forth by Halimah and Kuala Langat MP Dr Ahmad Yunus Hairi to include MOs and assistant medical officers as CIOs, Ramkarpal opposed the idea by highlighting that involving doctors in such roles exceeds their professional responsibilities and breaches the fiduciary relationship established between doctors and patients.
The fiduciary relationship between doctor and patient means that the doctor has a duty to act in the patient’s best interests and to refrain from exploiting the patient. Upholding this fiduciary relationship and preserving the trust of patients are fundamental principles in the ethical practice of medicine.
According to the Confidentiality Guidelines of the Malaysian Medical Council (MMC), patients have the right to expect that any personal information obtained by a health care practitioner during the course of their professional duties will remain confidential unless explicit consent is given.
Therefore, if medical practitioners were to be included as CIOs, it could potentially place them in a precarious situation where they may be required to disclose patient records. If it is subsequently determined that the patient was not at risk of suicide, doctors could face severe consequences, including the potential loss of their medical license under Section 30 of the Medical Act 1971, among other disciplinary actions.
Furthermore, the image of medical practitioners involved in the apprehension process could serve to disrupt the doctor-patient relationship and prevent vulnerable patients from seeking help.
“To understand this issue, we need to take note that the medical officer in the hospital has been tasked with treatment and rehabilitation in hospitals, not the task of arrest or rescue. That is the duty of the agency or other bodies.
“We need to remember here that it needs to be emphasised that there is a doctor-patient relationship, including medical officers, and if a medical officer is also appointed [as] a crisis intervention officer and also involved in the apprehension process, this can disrupt the patient and doctor relationship, [and] in one fell swoop, increase the stigma of patients getting treatment.
“More patients might not come for treatment and cause this problem to be more difficult to overcome. Other than that, medical officers are also tied with the duty of care and also [the] duty to protect. If the medical officer is also involved in the apprehension efforts, it will definitely disturb the therapeutic relationship — the basis of trust between the medical officer and patient.”
Ramkarpal added that medical practitioners will not accompany apprehended individuals to the medical facilities and that their duty will only begin once they receive the victim from the CIO.
In response to concerns raised about the extensive powers of entry granted to CIOs, Ramkarpal emphasised that the intention behind Section 11 is unequivocal. CIOs are bestowed with these powers to forcefully enter premises in critical moments of crisis when an individual’s life is at stake.
“This Section 11, the intention is clear, it is to save a person that might have a mental disorder, but also subsection (b) states that a person who needs to be saved is a person that wants to commit suicide.
“In that situation, it is obvious when we see a person wanting to jump from a building, we know, whether or not we suspect he is mentally ill or not, we know he is about to commit suicide.
“That is the purpose or the spirit under Section 11. In that situation, it is when a person is given power under Section 11 to save the victim before they commit suicide.”
Therefore, the mode of entry is left to the discretion of the officer involved, Ramkarpal said. He reminded lawmakers that CIOs are in emergency situations which require officers to act swiftly, making it impossible for them to consult anyone at that point in time.
In cases of property damage as a result of forced entry, the Mental Health (Amendment) Bill 2023 does not prohibit affected parties from bringing a civil action suit to recuperate losses. However, Ramkarpal clarified that the success of such a lawsuit hinges on a matter of factual inquiry.
Ultimately, it is within the jurisdiction of the courts to determine whether compensation should be granted and the specific amount to be awarded.
