Although an estimated 40 percent of Cambodia’s 13.5 million people suffer some form of mental illness, the country has only 20 trained psychiatrists and just six more are expected to graduate in 2005, mental health experts said last week.
And after decades of warfare and the barbarity of the Khmer Rouge, helping Cambodians understand their psychological problems could have a major impact on social development and poverty alleviation, said Dr Chhim Sotheara, psychiatrist and managing director for Transcultural Psycho-social Organization.
Preah Bat Norodom Sihanouk Hospital in Phnom Penh is the only public hospital in Cambodia that caters to adults suffering from mental problems. Specialists there see 200 to 300 patients daily, said Dr Pauv Bunthoeun, one of the hospital’s 11 psychiatrists.
Since the hospital’s mental health section opened in 1994, the hospital has treated some 30,000 mentally ill patients and over 200,000 have received counseling. More than 60 percent of patients are women, who commonly complain of stress related to family life and home responsibilities that lead to anxiety attacks, depression and psychosis, said Ka Sunbaunat, director of the National Program of Mental Health within the Ministry of Health.
According to the hospital’s report, from September 1994 to January 2004, 34 percent of patients suffered anxiety, 25 percent from depression, 23 percent experienced psychosis, and 2 percent suffered from mental problems associated with drug abuse.
Sixty-two percent of patients came from rural areas. Some 80 percent of those who seek help are between the ages of 22 and 56, while just 10 percent are older than 57.
Pauv Bunthoeun said he sees more than 20 patients a day, including abused housewives, rape victims and patients who either to want kill themselves or someone else.
In treating mental problems, the first step is to help the patient recognize that his symptoms are not related to physical pain but rather emotional pain. Dr Ka Sunbaunat said that many people who suffer mental health problems lack the drive and ability to work hard, and are hesitant to take initiative or assume responsibilities.
“Depressed people lose their capacity for judgment, reasoning and decision making,” said Ka Sunbaunat. He added that symptoms of mental illness may be misinterpreted by society.
“The employer blames a mentally ill person for being lazy or weak and this often leads to firing,” he said.
Other behaviors associated with mental states such as depression may include headaches, lack of motivation, mood swings, an inability to concentrate, poor work performance and the appearance of lethargy and sadness.
Trauma resulting from the Khmer Rouge regime and the psycho-social consequences of the past may also be preventing people from moving forward and becoming productive citizens, Chhim Sotheara said.
An NGO that provides mental health services to communities all over Cambodia, Sotheara’s employer TPO has helped more than 50,000 Cambodians with mental health problems since 1995. According to the organization’s 2002-2003 report, 63 percent of patients were women and 37 percent were men.
At a cost of less than $14 for medication and counseling, TPO can help a mentally ill person reintegrate back into a community as a productive citizen, Chhim Sotheara said.
One of Chhim Sotheara’s patients in Kandal province was a former Khmer Rouge soldier who suffered from severe hallucinations and delusions that local people wanted to kill him.
After treating the patient for one year with two different medications, the man has recovered and is calm, well and working normally as a farmer, Chhim Sotheara said.
The Khmer Rouge problem is a trauma that many Cambodians suffered, and while some people cope well, others don’t, he said.
Many psychiatrists agree that prescribing medications and counseling patients is part of the treatment, but the rest must come from family support and understanding.
“It is important for the family to understand that mental illness is a disease and the patient needs special care, said Dr Chak Thida, coordinator for psycho-social rehabilitation at the National Mental Health Program.