Cambodia has some of the world’s worst mental health statistics – largely due to the effects of Pol Pot’s murderous Khmer Rouge regime. Yet mental health services remain underfunded and – in the words of the World Health Organization – “critically neglected." There’s little sign of that changing in the near future, in part because few Cambodian students are interested in psychiatry as a career.
The psychiatric clinic at the government’s Khmer-Soviet Hospital in Phnom Penh is one of Cambodia’s busiest.
Fifteen years ago, said clinic director Yem Sobotra, it saw between 70 and 150 patients a day. When VOA visited in April, the daily average was 400.
With few mental health services in rural areas, where most Cambodians live, patients have to come to centers like this for treatment.
But with just 10 psychiatrists and as many nurses, most get just a few minutes before leaving with a bottle of pills.
Dr. Yem Sobotra said they could do better with more resources.
“So we [have] not much time to give good service for them – especially for psychotherapy. We just only [offer] some short [term] counseling, short [term] psychotherapy for the patient. That is my idea – not enough for service, not enough for human resources,” he said.
The challenges do not end there: Cambodia lacks the advanced drugs used in neighboring Vietnam and Thailand – a particular problem when prescribing for patients with heart conditions.
It also needs more psychiatrists – yet few youngsters seem interested.
Nationwide just six students are taking the three-year course. Experts blame low salaries and the challenges of studying psychiatry.
TPO-Cambodia is a respected mental health non-profit.
Dr. Chhim Sotheara, who heads TPO, said Cambodia had many needs, few resources – particularly in rural areas – and a government that was not doing enough.
A skills-transfer program would help, he said.
“We don’t have anyone enrolling in the psychiatry training program, so that’s not going to happen. So I think the transferring skills from the specialist psychiatrist to GP, GP to nurse, to village health support groups, traditional healers, the monks, the nuns – and all this would be good,” he said.
At the government’s newly formed Department of Mental Health and Substance Abuse, Deputy Director Dr. Muny Sothara said matters have improved in recent years, but acknowledged more was needed.
“For the coming future we need to improve the quality of the existing trained staff instead, and also additional mobilize new general practitioners and nurses in order to operate more mental health units in other sectors down,” he said.
Yet despite repeated requests, officials were unable to tell VOA how many doctors and nurses it has trained in mental health basics.
And with limited funds allocated – perhaps $1 million a year – it is unlikely that those in need of better mental health services will see improvements soon.