Why Was the Mental Capacity Act Introduced in Singapore?

old woman speaking with a young female lawyer

Medically Reviewed by Dr Ho Ying Jie, M.B.B.S (Singapore)

Mental capacity is defined as an individual’s ability to make a specific decision at a specific time. An individual must be assumed to have mental capacity unless it has been established otherwise. It is assessed on a case-by-case basis and, following the principles of the Mental Capacity Act 2008, cannot be purely based on age, physical appearance, health condition or aspects of their behaviour. 

This is because these characteristics may cause others to make a biased or unjustified assumption about an individual’s mental capacity. Officially, a person is deemed as lacking mental capacity when they are unable to do one or more of the below when making a specific decision at the particular time it needs to be made:

  1. Understand the information presented to them
  2. Remember the information presented to them
  3. Weigh the information presented to them
  4. Communicate their decision

What is the Mental Capacity Act?

In 2012, Singapore had 28,000 individuals (aged 60 and above) diagnosed with dementia.  The number is expected to escalate to 80,000 by 2030. Considering additional groups with potential mental capacity challenges, including those born with intellectual disabilities and accident victims, the actual count is likely higher. 

Consequently, mental capacity emerges as a significant concern in Singapore, and its relevance is anticipated to persist in the coming years. The Mental Capacity Act was introduced to address the rising prominence of mental illnesses in Singapore and came into effect in 2010. It was created with the intention to make new provisions relating to people who lack mental capacity and to provide for matters concerning them. 

The Mental Capacity Act states the parameters of lacking capacity, the inability to make decisions and best interests. It includes a code of practice that provides guidance to how the Mental Capacity Act works in practice. All in all, it tries to strike a balance between respecting the rights of an individual in making their own decisions and protecting individuals who lack the mental capacity to make their own decisions.

Why is the Mental Capacity Act Important?

The Mental Capacity Act enables people to plan ahead and empowers them to make choices for their future before they lose their mental capacity. It also allows parents to appoint a trusted person as a deputy to assist in making decisions for their children with intellectual disabilities when they pass away. The Mental Capacity Act has been revised multiple times to better meet the changing needs related to mental capacity in Singapore. 

There has been an increasing trend in the creation of a Lasting Power of Attorney (LPA) because the Mental Capacity Act enables individuals above 21 years of age to voluntarily appoint one or more persons, also known as donee(s), to make decisions and act on their behalf in the event that they lose their mental capacity in the future. 

Why is an LPA and Why Is It Important?

An LPA is a legal document that allows us to appoint someone we trust to make decisions on our behalf if we become unable to do so. When it comes to planning for our future, an LPA is an important document to have in place as it allows you to ensure that your wishes are respected and your best interests are taken into account, regardless of your physical or mental capabilities. 

It also allows you to give someone you trust the power to make decisions on your behalf, so that you don’t have to worry about these matters if you become unable to do so. Aside from these, appointing a donee earlier alleviates the stress and difficulties of your loved ones should there come a day you lose mental capacity as they are required to apply for a deputyship order instead because an LPA was not set in place. 

This process can be strenuous, time-consuming as well as expensive, thus potentially adding on the burden on your family. The person you appoint as your donee must act in accordance with the Mental Capacity Act which sets out the rules and regulations for decision-making on behalf of those who lack capacity. This ensures that your donee will make decisions with your best interests at heart. 

Furthermore, appointing a donee earlier enables him or her to arrange for your care quicker. In the event you fall sick one day, and lose the capacity to make decisions, the LPA that was set in place would allow quicker access for your donee to your bank accounts and insurance payouts to ensure timely payment of your medical care and maintenance.

Case Studies

Understandably, assessing mental capacity can be complex especially when there are many other factors to consider such as the patient having pre-existing mental conditions. In such cases, doctors may refer the patients to psychiatrists who are more qualified to make a judgement about the patient’s mental capacity. 

Dr. Barathi Balasundaram, a clinical assistant professor and senior consultant specializing in Old Age Psychiatry at the Department of Psychological Medicine, Changi General Hospital, encountered a few of such cases.

The first case is that of a 95-year-old woman residing alone with a domestic helper, and with limited involvement from her children in her care, underwent assessment. The evaluation revealed potential mild cognitive impairment (MCI), which, when considered alongside her psychosocial circumstances, raised concerns about her decision-making capacity. However, after a thorough assessment, Dr. Barathi affirmed that this woman possessed the necessary capacity and assisted her in establishing her Lasting Power of Attorney (LPA). 

This case exemplifies the intricate equilibrium between a vulnerable yet capacitated elderly individual and the imperative to both safeguard and promote autonomy.

Another case study involved a 68-year-old patient with chronic schizophrenia, aiming to include another family member’s name as a joint tenant in her HDB flat. At first glance, it might seem as if she would not be mentally competent given her medical condition. However, there were various other factors to consider, such as the stability of her mental health, her current level of functioning, and family dynamics. Upon assessment, Dr. Barathi identified Mild Cognitive Impairment (MCI) due to suggestive cognitive features. Yet, despite the coexistence of MCI and chronic schizophrenia, she was determined to retain decision-making capacity. 

This case underscores the crucial lesson that capacity should be presumed unless proven otherwise, emphasizing that the presence of conditions like schizophrenia or MCI does not automatically imply a lack of capacity.

Lastly, there was an elderly gentleman in the early stages of dementia, appearing capable of articulating his desires despite cognitive challenges. However, the family revealed that there were unusual withdrawals from his bank account, and the elderly man could not justify what happened to the money or what it was used for. This behavior indicated impaired judgment, and given his struggles in financial management, he was considered lacking mental capacity for financial decisions. In such instances, if assistance with managing his finances was necessary, obtaining a court-appointed deputy would be required as the elderly man did not have an LPA.

Hence, any clinician must strike a balance between the imperative to safeguard and the encouragement of personal choice. Making imprudent decisions should not be misconstrued as a lack of mental capacity. Moreover, an individual’s inability to make intricate decisions does not imply an absence of capability in making simpler ones.

How to Obtain LPA Certification?

Before obtaining an LPA certification, you need to first decide who you would like to appoint to be your donee. This is an important decision to make and one that should be considered carefully. Then, you must complete an online LPA form after your donee(s) have accepted their appointment. 

After which, you need to visit an approved doctor (who must not have a conflict of interest e.g. being related to the person creating an LPA) for them to certify your LPA. They will need to conduct a formal assessment before certifying the LPA. This is different from an informal assessment which can be done on a day-to-day basis by anyone who has not been specially trained to conduct mental capacity assessments.


The Mental Capacity Act strives to protect the needs of people who are mentally incompetent while also allowing for advanced planning given the rising emergence of mental illnesses related to an aging population. Having a Lasting Power of Attorney in place is an important step to take, as it ensures that your wishes will be respected and your best interests taken into account if you become unable to make decisions for yourself. 

It is important to ensure that the forms are completed correctly and certified by an appropriate individual, and that your donee understands their responsibilities. While this decision to apply for an LPA is not mandatory, it still remains a personal decision for you. Nevertheless, it would be a prudent decision to make, in order to protect the interests of not just yourself but your family as well should you become mentally incapacitated one day. 

All of our doctors at Keystone Clinic & Surgery are LPA-approved and are trained to conduct formal mental assessments. The Singapore government has acknowledged the importance of LPAs and waived all LPA application fees until 31 March 2026 to encourage more people to create their own LPAs. Filling up the online application can be done easily and you can quickly come down to any of our clinics to have your LPA certified by any of our doctors!


Lim, C. B and Charlene N. Guide to Mental Capacity Act in Singapore. PKWA Law Practice LLW. Accessed 2023, May 26. https://pkwalaw.com/mental-capacity-act/ 

Office of the Public Guardian. What is a Lasting Power of Attorney? Ministry of Social and Family Development. 2023. https://www.msf.gov.sg/what-we-do/opg/lasting-power-of-attorney/what-is-a-lasting-power-of-attorney 

Office of the Public Guardian. The Mental Capacity Act: A Caregiver’s Guide. Ministry of Social and Family Development. 2020. https://www.msf.gov.sg/docs/default-source/opg/lpa_caregiver_guidebooks_el.pdf 

Mohamed B. 6 Reasons to Make Your Lasting Power of Attorney While You Still Can. Singapore Legal Advice. 2019.

Government of Singapore. Mental Capacity Act 2008 (2020 Edition). Accessed 2023, May 26. https://sso.agc.gov.sg/Act/MCA2008

Papers.ssrn.com. 2020. The Deputyship Regime Under Singapore’s Mental Capacity Act: An Introduction. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3511833

Sma.org.sg. 2022. Revisiting Mental Capacity Assessments for Primary Care Doctors. https://www.sma.org.sg/news/2023/January/Revisiting-Mental-Capacity-Assessments-for-Primary-Care-Doctors

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