SINGAPORE - It was the second time in two months that the elderly woman had locked herself in her rental flat and threatened to harm herself or jump out the window.

But following a stand-off which lasted under five hours, police officers were able to get into her flat without damaging property and secure her psychiatric help at the Institute of Mental Health (IMH).

Both incidents happened in 2018, said the Commander of the Central Police Division, Assistant Commissioner of Police Gregory Tan Siew Hin.

He was asked about memorable stand-offs he had been involved in.

AC Tan was speaking at the Home Team Tactical Centre on Tuesday (April 27) during a media event in which the police demonstrated how negotiations and forced entries are used in a stand-off.

He said stand-off incidents where people display symptoms of mental health conditions are the most unpredictable.

"In some cases, officers managed to break the door quickly enough, or find a way to crawl through windows to stop the person and save a life.

"There were also incidents where officers were not able to reach the person in time to stop them from ending their lives," he said, noting that stand-offs usually arise from people evading police arrests or contemplating suicide.

There were also incidents involving those who may be of unsound mind.

In the woman's case, officers visited her after she returned from her time in IMH and won her trust. She is also better now with treatment.

The demonstrations on Tuesday came after a number of incidents this year made the headlines.

In February, officers had to force their way into a Toa Payoh flat after a 64-year-old man locked himself in his room and threatened to commit suicide.

In the room, the man was seen holding a canister of butane fuel and a lighter in his hands before he is said to have charged towards the officers.

The man was arrested after he allegedly stabbed a police officer in the thigh. The police officer is no longer in hospital.

Another incident in March involved a 38-year-old Caucasian man who had locked himself inside a residential unit.

Officers entered the unit nearly four hours after the initial call for help. They had assessed that he posed a danger to himself.

The man was arrested under the Mental Health (Care and Treatment) Act. He was also investigated for consumption of controlled drugs.

The longest stand-off was 17 hours. It involved a drug abuser who took his girlfriend's toddler hostage in a Sembawang flat in 2016.

Such stand-off situations can be difficult to handle, especially since the approach is to minimise harm and uncertainty, said AC Tan.

"This is why we need so many resources," he added.

Their resources include the Crisis Negotiation Unit (CNU) and Special Operations Command.

The CNU includes police officers and psychologists who are trained in negotiation tactics.

One of the tools of their trade is active listening, said principal psychologist Ho Hui Fen.

"We will reflect certain contents and certain words that a person may be saying. We may try to reflect feelings, try to mirror what they are feeling," she said.

But handling these incidents can take an emotional toll on psychologists, added Ms Ho.

"It can be heart-wrenching to see some family members having to cope with the struggles they are having with the person, especially those with chronic mental health issues who can be violent or suicidal. The psychologists do check in, talk and share with one another as a form of coping mechanism," she said.

Mental Health (Care & Treatment) Act

Individuals can be detained by the authorities under the Mental Health (Care & Treatment) Act if they refuse treatment and are assessed to pose a risk to themselves or others.

Between January and March this year, 723 patients were admitted to Institute of Mental Health (IMH) under the Act.

Total admissions under the Act in 2019 was 2,768, and 2,510 patients last year.

Responding to queries from The Straits Times, a senior consultant of emergency services at IMH, Dr Jared Ng, said that the patients taken to the institute under the Act are usually either suicidal or are suspected to be of unsound mind.

"All reports of possible suicidality are taken seriously as one life lost to suicide is one too many," said Dr Ng.

Those who need emergency medical treatment are first taken to the nearest Ministry of Health-designated hospital. They are then taken to the IMH emergency services (ES) for psychiatric assessment.

"At IMH ES, the doctor would perform a thorough psychiatric assessment and determine if the patient requires inpatient treatment, or whether he or she can be discharged from the hospital and followed-up either as an outpatient or by care agencies in the community," explained Dr Ng.

The assessment includes a psychiatric interview, physical examination and medical investigations.

For patients diagnosed with a psychiatric disorder, treatment includes medication and psychological treatment.

Under the Act, a person may first be admitted to IMH for 72 hours, during which he or she is assessed and treated for any mental health conditions.

The period of the mandatory admission can be increased if the patient requires continued treatment in IMH due to his psychiatric condition, and if this is in the best interest for the health and safety of the patient or others around him.

The team will also work with caregivers and community partners to address other psycho-social issues and concerns and ensure that safe, holistic and quality care continues beyond the admission, said Dr Ng.

He added: "Patients will not be kept in the hospital beyond what is necessary. We believe that care can be delivered in the community and once it is safe for patients to be discharged, we will do so."

Police stand-offs: Notable cases

Toa Payoh, 2021

A man was arrested after he locked himself in the bedroom of a Toa Payoh flat and stabbed a police officer in the thigh on Feb 8.

The incident happened at Block 124 Lorong 1 Toa Payoh. The man, 64, had locked himself in his room and threatened to commit suicide.

He refused to heed officers' repeated calls to open the door and the police had to use forced entry to get into the room. They found him holding a canister of butane fuel and a lighter in his hands.

One of the police officers, 28, was stabbed in the left thigh with a knife, allegedly by the man.

Sembawang, 2016

A drug abuser who held his girlfriend's two-year-old son hostage caused a 17-hour stand-off with police. It remains the longest stand-off the authorities here have dealt with.

Muhammad Iskandah Suhaimi, then 40, had locked himself and the boy in a flat after he told his girlfriend to buy him cigarettes.

Officers from the Special Operations Command forced their way into the flat by breaking a window and removing the front gate when Iskandah was in the toilet. They arrested him and rescued the boy.

In March 2018, he was sentenced to five years' jail and six strokes of the cane for kidnapping the toddler, possessing and consuming methamphetamine, and for illegally possessing a knuckleduster.

Bukit Merah, 2005

Lim Ah Seng, then 37, was arrested following a four-hour stand-off.

Lim was armed with two knives and had slammed the front door shut, refusing to let the police officers in. With the help of the man's children, the police eventually persuaded him to open the door.

Lim's wife - Madam Riana Agustina, 26, an Indonesian permanent resident - was found dead in the flat.

In court it emerged that Lim and his children had been physically and mentally abused by Madam Riana for years. He had strangled her during a quarrel.

Lim was sentenced to 2½ years' jail in 2007 for culpable homicide not amounting to murder.