Mental health conditions are rapidly taking centre stage in the global burden of disease, especially in low- and middle-income countries. Currently, mental and substance-use disorders are the leading cause of disability worldwide, and the World Health Organization estimates that by 2030, depression will be the leading contributor to the global burden of disease.
Adolescence is regarded as a healthy period of a person’s life compared with other ages, but we often overlook the associated risks of those going through this stage. The contribution of mental disorders to the nonfatal burden of disease rises sharply throughout adolescence and is the largest contributor to the burden of disease in young people aged 10-24 years (45 per cent), ahead of unintentional injuries (12 per cent) and infectious and parasitic diseases (10 per cent).
Cambodia is a country where a large proportion of the population is under the age of 25. Young people, especially those who are poor, vulnerable or marginalised, including young gay, lesbian, bisexual and transgender Cambodians, are particularly affected and afflicted by mental health conditions and lack access to services and support.
Substance abuse, suicide, stress, depression and anxiety are some of the consequences Cambodian youth experience as a result of being exposed to a combination of risk factors, including poverty, unemployment, inadequate youth services, violence, self-stigma and discrimination, especially against women as well as individuals based on their health status (such as HIV-positive), profession or sexual orientation.
The Royal University of Phnom Penh conducted the first-ever large-scale mental health survey in 2011, through which Cambodia’s suicide rate was found to be 42.5 per 100,000 people, a much higher rate than the worldwide average of 16. Rates of anxiety, depression and post-traumatic stress disorder were also found to be high. The study showed that women were predominantly affected by mental health disorders, but it also recognised that adolescent mental health was ignored here.
To draw attention to the importance of acknowledging young people’s mental health as a crucial part in their development, the United Nations in Cambodia is organising a panel discussion with national experts for International Youth Day. Young people, including those who are marginalised, will be given the opportunity to interact with experts and share their concerns.
The United Nations recognises that risk factors for mental health problems are well established and include childhood abuse and neglect, exposure to violence, poverty, social exclusion, stigma and discrimination, and educational disadvantage. Unassisted mental health problems among teens are linked with unemployment, substance abuse, risk-taking behaviours, crime, poor sexual and reproductive health, and self-harm, all of which increase the risk of premature death.
Mental health conditions among youth carry high social and economic costs, as they often develop into more disabling conditions later in life. The stigma directed towards young people with mental health conditions and the human rights violations to which they are subjected amplify the adverse consequences.
There is an urgent need to improve access to quality treatment and care by trained psychiatrists and psychologists for those with mental health conditions, including young people. A Leitner Center report stated that in 2010 there were only 35 trained psychiatrists and 45 trained psychiatric nurses to provide services for the country’s entire population. Often those with mental health conditions are left alone or cared for by family or community members who have little knowledge or understanding of mental health, which results in harmful treatments such as “tying up”, stigmatisation, neglect and abuse.
Improving mental health literacy and awareness is vital to reducing the stigma and discrimination associated with mental health conditions and increasing the utilisation of mental health services. At a national level, there is a need for greater data and reporting on adolescent health, including mental health, and a need for the inclusion of adolescent health information in global health initiatives. A more holistic approach to addressing Cambodia’s mental health crisis, including prevention, especially as it affects youth, must be taken.
Cambodia has already made some progress towards ensuring that mental health problems, including those of young people, are addressed. The Mental Health and Substance Misuse Strategic Plan 2011-2015, the establishment of the Department of Mental Health and Substance Abuse in the Ministry of Health, and the important work of the Transcultural Psychosocial Organization and other NGOs are important steps; however, mental health remains critically neglected. More efforts and resources are required to provide an effective response for young people growing up in Cambodia. A greater understanding of and attention to mental health are also important for how we plan for the post-2015 development agenda.
Claire Van der Vaeren is the United Nations’ resident coordinator for Cambodia.