Mental Health in Cambodia

Abstract

Mental health in Cambodia has been largely influenced by the genocidal history of the Khmer Rouge regime that virtually destroyed the entire country between 1975 and 1979. After the first United Nations sponsored election in 1993, international sanctions were lifted and Cambodia was allowed to receive international assistance. Many international organizations established mental health programs and services including Oslo University's Cambodian Mental Health Training Program (CMHTP), Social Services of Cambodia, Transcultural Psychosocial Organization, Harvard Program in Refugee Trauma and Caritas Cambodia's Center for Child and Adolescent Mental Health. Many stakeholders recommended the Praek Thnoat Mental Health Hospital, which had been destroyed by the Khmer Rouge, should not be reopened and community services developed. Over the past 20 years, significant advances have been made due in large part to the collaborative efforts between the Ministry of Health of Cambodia and the aforementioned international organizations. Currently, the University of Health Sciences is responsible for providing specialist training in psychiatry. There are now 56 psychiatrists and 44 psychiatric nurses (0.33 and 0.26 per 100,000 people, respectively). There are also services available in many of the larger provincial hospitals as well as in some health centers in rural areas. However, the number of psychiatric beds in Cambodian hospital remains critically low: only 0.10 beds per 100,000 people. Despite the increasing availability of mental health services, many Cambodians living in rural areas still adhere to traditional beliefs to explain and cope with their mental health problems. They generally attribute their problems to ruptured relationships with the spirits of their ancestors. In addition, the Buddhist concept of karma is widely seen as a way of justifying current living conditions. To complicate matters further, culturally specific syndromes are also common. For these reasons, mental health services in Cambodia need to be culturally sensitive and contextually appropriate. Regardless of the progress in-service delivery, much more needs to be done to develop and improve care. Given the lack of resources, Cambodia should take the approach of the World Health Organization and shift the task of providing mental health services from highly qualified practitioners to less qualified, but adequately trained, individuals. This can add greater value and create a more integrated mental health care system. Finally, due to the complex needs of mentally ill persons, mental health workers should integrate aspects from other disciplines including community development, human rights, gender equality, social justice and vocational training. This will serve to enable and empower mental health patients to recover and lead more productive lives within their communities.