SCDF reviewed processes after NSF's suicide; coroner recommends appointing mental health experts in findings
SINGAPORE: A coroner found that an 18-year-old Singapore Civil Defence Force (SCDF) full-time national serviceman who was found dead at the foot of a block in Clementi last year had committed suicide, and recommended that the force review its structure and protocols including appointing trained mental health professionals to each camp.
In findings released on Wednesday (Nov 20), State Coroner Kamala Ponnampalam found that the death of Singaporean Muhammad Ahad Lone, who had returned to Singapore from Pakistan to complete his national service, was a deliberate act of suicide.
He was found dead at the foot of Block 1A Pine Grove on Apr 7, 2018 dressed in SCDF trousers, with the cause of death certified as multiple injuries consistent with a fall from height.
The coroner said the inquiry showed that "there are several dedicated commanders at SCDF's National Service Training Institute (NSTI), who regularly give up their personal time to interact with the recruits".
She found that Mr Ahad's commanding officers had taken appropriate steps to ensure his well-being within the constraints of their current framework, and found no lapse in the discharge of their duty to Mr Ahad.
"While the causal stressors were found to be related to camp, there was no evidence to suggest that Ahad was bullied at camp," she said.
"When he was identified to be a suicide risk, he was provided timely and appropriate treatment."
However, not all recruits may exhibit overt evidence of distress or disorders like depression, and it would take a trained professional to identify and diagnose the condition.
"It is therefore desirable to have professional counsellors present to support the recruits who face mental health issues," she said.
She recommended that "SCDF undertakes a review of its structure and protocols and implements evidence based measures, including, but not limited to, the appointment of trained mental health professionals to each SCDF camp".
MR AHAD WAS FREQUENTLY SICK, REPORTED PREVIOUS SUICIDAL THOUGHTS AT ENLISTMENT
In the coroner's 29-page findings, she listed his medical history - Mr Ahad had enlisted in SCDF on Feb 6, 2018, and saw a medical officer that same night complaining of various maladies including vomiting and runny nose and being "not used to the weather and food".
On the first day of enlistment, he filled out a questionnaire that has to be completed by all recruits, stating that he had tried to harm himself or attempted suicide, and that he had been thinking of harming himself or attempting suicide.
He was immediately interviewed by the platoon commander, but said he had overcome these issues prior to enlistment, declining to speak to the orientation officer.
In the days that followed, he reported insomnia, headaches, poor sleep and gastroenteritis.
Because of his frequent sickness, Mr Ahad did not manage to undergo most of the training curriculum and instead was either on light duty or on medical leave.
He also told a doctor that he had suicidal thoughts and thought of cutting his wrists to end his life, after which he was taken to the Institute of Mental Health (IMH) emergency department in late March 2018.
He also told the IMH doctor that he was unable to cope with the physical training in NS and frankly admitted that he was taking MCs to be excused from his duties. Because of his frequent sickness, he was worried that he would be charged for being absent without official leave.
He had been sleeping poorly for about four years and took Xanax in Pakistan, and when asked about life in camp, said he was not bullied there.
When asked if he had made any concrete suicidal plans, he said he had none, and said he had hoped to study economics and finance in an Ivy League university and was very close to his family, and would not do anything to hurt himself.
He denied being suicidal and displayed no indication of self-harm or having active suicidal ideation.
He was diagnosed with adjustment disorder with depressed mood - where an individual develops emotional and behavioural symptoms in response to stress - with no imminent risk of suicide, and prescribed pills to help him sleep.
Mr Ahad's buddy in camp testified during the hearings that Mr Ahad said he had no close friends in Singapore and felt lonely.
He also said he had financial issues and felt sad because he missed his mother and felt like a burden to his platoon as he had taken a lot of sick leave.
Mr Ahad had told his buddy a few days before his death that he was not feeling well and that there was a voice in his head telling him to kill himself. The buddy told him to fight it and not harm himself.
SON WANTED TO BE A FIREFIGHTER LIKE HIS BROTHER: MOTHER
Mr Ahad's mother, who lives in Pakistan, said her son had told her a few times that he was happy and enjoying his NS, wanting to be a firefighter like his brother.
However, she noticed during a phone call on Apr 6, 2018, that Mr Ahad sounded "hysterical and afraid" and later divulged to her that he was punished and had to do guard duty.
At noon on the day of his suicide, Mr Ahad called his mother sounding "very calm" and asked about his family.
Madam Lone stated that she did not believe that her son would commit suicide by jumping, and suspects instead that his actions could have been a reaction to the medication prescribed to him.
She was also concerned that SCDF had not notified her about Mr Ahad's condition during NS and his conveyance to IMH.
The court heard that the contact details of Mr Ahad's next-of-kin had been left blank in an SCDF system called the National Service Personnel Administration System (NSPAM).
Colonel Kadir Maideen from the NSTI testified that the information in the system is sometimes incomplete or outdated, and that recruits are given forms on the first day of enlistment to update their particulars.
Those who do not give the correct details are given up to three days to provide these updates, but there have been occasions when "in the flurry of activities", recruits forget to complete the forms, and this goes undetected.
In Mr Ahad's case, his next-of-kin's contact details were left blank in the system and he subsequently did not provide updates in his form.
SCDF REVIEWED PROCESSES AFTER MR AHAD'S DEATH
After Mr Ahad's death, SCDF reviewed its processes, said Colonel Kadir Maideen.
All incomplete next-of-kin fields within the NSPAM will now be identified by 2pm on enlistment day, and recruits have to provide the updates by that night.
They will also have to contact their next-of-kin, given a password to the NSPAM within a week of being enlisted, and can log in whenever they need to update their particulars.
Colonel Kadir Maideen said that after the review, all recruits declaring that they have no next-of-kin residing in Singapore would be met by an officer on enlistment day, who will try to get to know all the recruits and offer assistance.
He said officers and commanders would regularly have dialogue sessions with recruits to identify some of their common stressors and share examples of how other recruits overcame adversity during hard training.
However, Colonel Kadir Maideen agreed that "they do not have a dedicated treatment or response centre to cater to the recruits' psychological well-being".
There is only one in-camp orientation officer, who roves around the camp on enlistment day and on following days to identify recruits who might need intervention.
This officer has no specific clinical training but is supported by psychologists from the Behavioural Sciences Unit at the SCDF HQ for more complex cases.
The coroner said "it is not possible to predict suicide in an individual and clinicians can only try to identify the suicide risk factors and respond with appropriate care and intervention".
She found that Mr Ahad could have benefitted from a supervisory arrangement with a trained counsellor.
"Assessing suicide risk is an inexact science requiring a judgement call," said Ms Kamala.
"National Service recruits are known to encounter many stressors related to training. They have difficulty adjusting to a more regimented lifestyle and often suffer disappointments from a perceived underachievement when they fail to attain a desired rank or vocation."
She added: "Mental health literacy is generally not intuitive. It is a learnt skill. Often, good intentions alone is not sufficient to support those in crisis. They require support and intervention from trained professionals."
She conveyed her condolences to Mr Ahad's family for their sad loss.
Where to get help: Samaritans of Singapore operates a 24-hour hotline at 1800 221 4444, or you can email firstname.lastname@example.org. You can also find a list of international helplines here. If someone you know is at immediate risk, call 24-hour emergency medical services.