By: Dr Farhana Sabri

Recently, there were a few criminal cases involving OKU card holders.

For instance, a seven-year-old schoolboy was walking home when a man suddenly approached him and attempted to get him on his motorcycle. The man, in his mid-20s, was not only mentally ill – holding an “Orang Kurang Upaya” (OKU) card – but also tested positive for methamphetamine, a highly addictive stimulant drug. That incident occurred in Pasir Gudang, Johor.

In another case, in Klang, Selangor, a woman was brutally assaulted by a man who appeared to be homeless. Several people interviewed by the media disclosed that the assault was not his first, yet he got away with it because he was mentally ill.

The two incidents are similar in that both suspects are mentally ill with substance use history and are OKU card holders.

Three types of disability

According to the registration guideline for OKU people by the Department of Social Welfare (JKM), disability is categorised into three types:

i. learning disability for those with Down syndrome, attention deficit hyperactivity disorder (ADHD), autistic spectrum disorder (ASD), etc.,

ii. mental disorders (organic mental disorder, mood disorders, schizophrenia, etc.), and

iii. multiple disabilities.

For individuals suffering from substance abuse problems, particularly methamphetamine, mental disorders like psychotic disorders are a common co-occurring disorder.

Psychotic disorders are a group of severe mental disorders that affect the mind, with psychosis being characterised by an impaired relationship with reality. Individuals suffering from psychotic episodes, particularly drug-induced psychosis, commonly experience confusion, hallucinations, and delusions as a direct result of methamphetamine drug.

Methamphetamine-induced psychotic symptoms are difficult to diagnose because they can be confused with primary psychotic disorders such as schizophrenia.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or DSM-5 asserts that psychotic symptoms lasting more than a month following substance cessation may be related to another primary mental disorder and should not be attributed to substance abuse. However, some Japanese researchers argued the applicability of the diagnosis to methamphetamine-induced psychosis since the symptoms become chronic and can remain for months to years after cessation of substance.

Even after receiving psychiatric treatment for over two years, chronic symptoms reportedly can last for years due to the fast-growing nature of methamphetamine. Furthermore, the prolonged use of methamphetamine may result in late onset of chronic symptoms, making it more difficult to distinguish between methamphetamine-induced psychosis and schizophrenia.

There are a few questions raised here. The first is whether the disability is attributed by substance abuse issues, given the increase in crime cases involving OKU card holders with a history of substance use. Exposure to methamphetamines is indeed associated with increased aggression, violence, and criminal behaviours. These are related to delusional capacity to incite anger, raise a person’s perception of threat in their environment, and increase their tendency to misinterpret events.

Is addiction a disability?

The bigger and more obvious question is whether addiction is a disability. Countries like Canada and the United States have adopted the disability framework to protect people with drug dependence but specify that qualification for benefits subject to addiction being a material or secondary factor in disability application. Meaning, if addiction is the element that directly causes disability, and if the addiction element is removed, so does the disability.

This further raises the question whether OKU card holders, whose drug addiction affects their disability, qualify for benefits. The fundamental criterion for disability should consider those with functional impairments such as decision-making or limitations from performing work-related tasks such as walking, lifting, and typing that prevent gainful employment.

Therefore, there is a need for JKM to conduct a thorough review on OKU card holders whose primary impairment is caused by drug addiction and/or alcoholism. The process application should be rigorous and the diagnosis process by psychiatrist should be scrutinised for those applying for a card.

It is also about time for JKM to share statistics on mentally ill individuals with OKU cards who are involved in addiction-related cases. The public should be made aware that the OKU card is not a green card to commit crime. Police reports should be made accordingly towards crimes committed by anyone, and the police enforcement should treat the case as such.

-- BERNAMA

Dr Farhana Sabri is a lecturer with the Faculty of Leadership and Management at Universiti Sains Islam Malaysia (USIM).