Facing stigma and neglect

The problem of mental illness is not limited to any particular region in the world, but countries that have experienced conflicts like Cambodia tend to have comparatively higher rates of mental disorders.

As many as 300 patients queue everyday inside Cambodia's largest mental hospital in the capital Phnom Penh hoping to receive treatment; however, not everyone is lucky to get help.

Moreover, treatment is limited to offering medication, with little emphasis laid on providing services such as counseling and community support. Another issue relates to the over usage of drugs for treating the mentally ill and the resulting negative side-effects in the long run.

Compounding the problem are the meager resources the government allocates towards mental health services.

To combat mental illness, many Cambodians also turn to Buddhist monks or traditional healers rather than seek professional help. There is, however, considerable stigma attached to mental sickness, with many patients left abandoned and ostracized; some are even chained and caged like animals.

In an interview with DW, health expert Chhim Sotheara says while the demand for mental health treatment has increased in recent years, the number of treatment centers across the country has continued to remain low.

DW: How is mental illness viewed in Cambodia?

Chhim Sotheara: Many people in Cambodia consider the state of mentally ill as being crazy. They believe the patients are cursed or trapped by black magic or spirits. Such views are less prevalent in urbanized regions like Phnom Penh, but very widespread in rural provinces where people have no access to mental health services.

What types of mental disorders do people in Cambodia suffer most frequently?

Anxiety and depression are two noticeable mental problems in Cambodia. People become more overwhelmed and stressed in their daily lives, but many of them are unfortunately not aware of the issue.

How do mentally ill patients in Cambodia get the treatment?

The two most common treatments practiced in Cambodia are religious treatment and scientific treatment. Many rural people prefer going for the religious method where some of them are treated badly and cruelly - patients get beaten, caged or tied in one place.

But in the case of the scientific method, the treatment depends on the illness condition. If the condition is severe, the patients will be medicated and if it is light, proper counseling for the patients will have to be provided.

However, in Cambodian hospitals, counseling services are not offered at all and the treatment is narrowly limited to prescribing drugs or injections.

What in your view are the pros and cons of relying solely upon drugs to combat mental health problems?

The prescription of medication helps the patients relieve from common mental ill symptoms such as disturbed behavior and hallucination delusion. But some psychiatrists in Cambodia offer excessive drug dosage and many different types of medication at the same time, resulting in many severe side-effects for the patients.

Mentally ill patients are different from physically ill patients.

And in the treatment process, it is necessary to minimize the use of medication to as low as possible. Apart from drug dosage, the patients also need proper counseling and assistance from the psychologist as well as the social worker. Rehabilitation is therefore very much needed so that the treatment will be more comprehensive and less dependent upon the medication.

What are the main challenges facing Cambodia's mental health professionals?

The scant resources the government allocates to mental health services in the country make it quite challenging for health professionals to do their work effectively and efficiently.

First of all, the demand for mental health services in the country outweighs what the state has supplied. Also, there are very few different types of medication available for treating different patients and a lack of people who are willing to take the initiative to combat the challenges.

The numbers of psychiatry and psychology students in the country have been on the rise in recent years. Will this have any positive impact?

This is a positive development, although the numbers are still no where near the levels that are needed to meet the demand. We lack skilled mental health professionals across the country due to the inadequate quality of education and training offered by some universities.

I am also very concerned about the growing number of private medical schools that are reportedly failing to impart proper education and training to students. This, I am afraid, will lead to disappointing results.

What measures have to be taken to improve the mental health situation in Cambodia?

There will have to be increased public spending on mental health. This could lead to the training of more highly-qualified and skilled professionals who will be able to provide much better care and services to the patients.

Furthermore, there has to be more action at the community level to prevent the development of mental disorders as well as psycho-social problems such as domestic violence and alcoholism.

In addition, we should raise public awareness on mental health issues and unite all institutions involved, including the government and NGOs, to work together to develop effective solutions.

Chhim Sotheara is executive director and psychiatrist at Transcultural Psychosocial Organization (TPO) in Phnom Penh.