In a country with one of the world’s highest rates of psychological stress, Cambodia has a remarkably low number of psychologists, and is struggling to retain those who go to work on the front-lines of the field.
A new program at the Royal University of Phnom Penh (RUPP) is hoping to change that.
The sheer numbers of Cambodians coping with war-related post-traumatic stress disorder—estimated at up to a third of the adult population—and other mental illnesses, as well as abuse, exploitation and domestic violence, has created oversized workloads for the country’s trained professionals.
The potential for burnout among providers of psychiatric care is of such a concern that the university is offering a course in clinical supervision that aims to train psychologists to provide professional support to their peers treating patients across the country.
Lim Bouyheak, a 31-year-old psychologist, and 10 other students are in the first supervision class. Over six months, the students will receive classroom training and opportunities to put their skills into practice in the field.
Ms. Bouyheak knows firsthand how difficult it can be to handle an unmanageable caseload. In her first job after receiving a bachelor’s degree in psychology, she worked at the Maddox Chivan Children’s Center, a facility that actress Angelina Jolie opened for children and teenagers with HIV and AIDS.
“I felt like I was not competent to do my work because I didn’t see improvement in my children,” Ms. Bouyheak said. “Every time I went to work, I just felt exhausted and I felt like I didn’t want to do that job anymore.”
After a year, she was close to quitting, but her colleagues intervened, advising her on the importance of setting boundaries between her life and her young clients’ needs. Following their advice, Ms. Bouyheak sought professional counseling and found a better balance.
That type of intercession is just what German psychologist Bernhild Pfautsch had in mind when she proposed the training course and a program to offer a certificate in clinical supervision at RUPP.
After working as an adviser to the university’s master’s program in psychology for more than a year, she realized the students were graduating without the professional guidance that would help them succeed in their first jobs.
“Here it is so hard because they have five semesters and their internship, and they are expected to be this specialist,” Ms. Pfautsch said.
With funding from her employer, GIZ, a German development organization, Ms. Pfautsch collaborated with foreign and local psychologists in Phnom Penh to create a four-part curriculum that is the first of its kind in Cambodia. The course started in August.
During the first module, the students are learning how a supervisor should educate, evaluate and provide psychological support to those they are supervising. The remaining modules will also focus on the development of skills to help young psychologists thrive.
Retention of qualified mental health providers in Cambodia is critical for two reasons: There are far too few of them for the population’s needs, and the number of newly trained psychologists and counselors entering the field has slowed in recent years.
Studies have found that PTSD rates among Khmer Rouge survivors range from 14.2 percent to 33.4 percent—significantly higher than the 0.4 percent global prevalence, according to a mental health survey conducted in 2012 by RUPP and Transcultural Psychological Organizations, a mental health services NGO.
Seventy percent of the country’s population was born after the war, but the study still found high rates of psychological stress in that demographic. It reported that 70.2 percent of the post-war generation has experienced at least one traumatic event, such as natural disasters, life threatening accidents or witnessing someone physically attacked.
The study also found Cambodia’s suicide rate to be the second highest in the world at 42.35 per 100,000 people. In the same year, the World Health Organization reported Cambodia’s suicide rate to be 9 out of 100,000 people.
Yet the country’s budget for mental health care remains tiny. Less than 1 percent of the national health budget, or about $100,000, is allocated to the Health Ministry’s department of mental health and substance abuse excluding salaries, said Chhit Sophal, the department’s head.
According to the World Health Organization, Cambodia had 0.23 psychiatrists per 100,000 people in 2011, the last year for which such statistics are available. That compares to 1.01 psychiatrists per 100,000 people in neighboring Vietnam.
RUPP is the only university in Cambodia that offers psychology as a major. Since it began the program in 1994, it has graduated more than 1,000 psychologists. The government does not employ any of them, according to Dr. Sophal.
“We know that there are many psychologists trained from RUPP, but in the government every year we have limited budget to recruit new staff,” he said. “This is our constraint. It doesn’t mean that we don’t have a need. We need, but we don’t have budget for that.”
That leaves a majority of graduates looking for jobs at NGOs, where those in the sector say opportunities appear to be dwindling. The lack of employment prospects has resulted in a reduction in the number of students majoring in psychology at RUPP. Over the past five years, the number has dropped by nearly 80 percent, according to the university.
There are numerous factors affecting the department’s enrollment, said Sek Sisokhom, the chair of the psychology department, including the 40 percent reduction in the number of students passing the national high school exit exam, making them eligible for university.
Just a few years ago, the job market was more inviting. Ms. Bouyheak, who has since worked for a variety of NGOs, majored in psychology because of the post-graduation prospects. However, the thriving job market for such majors has dried up in the past 10 years, she said.
Low pay—about $200 a month for new graduates—also is a factor, she said. Of the 70 to 80 others majoring in psychology at RUPP when Ms. Bouyheak was a student, she only knows of a handful still working in the field.
A March survey by RUPP found that a third of the graduates from its master’s program in clinical psychology, which focuses on assessment and treatment, are currently working as counselors or therapists, while the rest are working as researchers, teachers in unrelated fields or have jobs in the sales and service sector.
Even though there are many challenges in the provision of mental health services in Cambodia, Ms. Bouyheak still has hope for the future, and her own ability to contribute with her newly acquired understanding of the profession.
“I want to be one person to support the other fresh graduates in psychology or fresh counselors,” Ms. Bouyheak said. “I just know how important it is and how much support they need. I used to be in their shoes.”