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Few resources for the mentally ill

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Chea Dy, 20, lies on her hospital bed in the Cambodian-Russian Friendship Hospital. Doctors have been unable to diagnose her mental disorder.

Mental health professionals say little funding has been directed towards programmes for the Kingdom's mentally ill, meaning shortages of doctors and medicine will likely persist.

TIED down with red-and-white kramas to a bed in the Cambodian-Russian Friendship Hospital, Chea Dy, 20, writhes and moans all day, unable to communicate with her doctors or even her own mother.

"I have to tie my daughter's hands to the bed because she is dangerous," Chea Dy's mother, En Seng, said. "My daughter became a crazy person."

The 55-year-old mother has tried everything to cure her daughter, who suffers from a mental condition that doctors have yet to identify. Even after spending two months with a traditional healer, Chea Dy's condition only worsened.

"I don't know what I will do if my daughter cannot get better. I don't have any more money to help her," she said.

But the nation's mental health infrastructure has yet to recover from decades of conflict.

Ka Sunbaunat, a psychiatrist on the faculty at the University of Health Sciences, said Cambodia is rebuilding its mental health infrastructure from nothing. In 1994, when the first psychiatric outpatient clinic since 1975 opened at the Cambodian-Russian Friendship Hospital, there were no Cambodian psychiatrists.

Yet mental health professionals said in recent interviews that mental health services were grossly underfunded, with several suggesting that patients such as Chea Dy are lucky to receive any form of treatment in a modern hospital.

Sotheara Chhim, a psychiatrist and executive director of the mental health NGO Trans-cultural Psychosocial Organisation (TPO), said many families were unable to afford treatment for mentally ill patients, and that many resorted to forcibly restraining them instead.

"There are still many patients who are locked up in their houses alone," he said. He added that he has even heard of people being caged in remote areas.

If those same patients were taken to a well-stocked hospital, they could be sedated and stabilised with medicine. But Cambodia has only 32 psychiatrists and eight psychiatric specialists, according to Kim Savuon, head of the mental health department at the Ministry of Health and president of the Mental Health Association in Cambodia.

Ka Sunbaunat said Cambodia needs "hundreds of psychiatrists" to deal with its mentally ill patients, but he noted that students do not want to enter the psychiatric field.

"Psychiatrists are not well-considered in society," he said. "Colleagues will call you 'mad doctor'."

Other shortages
Along with the doctor shortage, Cambodia must also cope with an inconsistent supply of medicine, Sotheara Chhim said.

Orders placed by Cambodia's public mental health clinics are not always filled, he said, and even when they are, the clinics might only receive enough medicine to last for three to six months of each year.

"Chronically mentally ill patients need to continue treatment, even if they are symptom-free," he said. "When they don't get the medication, their symptoms come back."

Kim Savuon said the ministry's lack of funds prevented it from purchasing enough medication and following up with patients to make sure the medicine was being taken properly.

People still call patients crazy, but many know that it is a treatable disease.

"The Ministry of Health lacked money in 2008, and I want to send a message to NGOs to help us buy tablets," he said.
As Cambodians learn more about mental illness, they are increasingly seeking medical help, taxing a system that is already overwhelmed, experts said.

"The number of cases of mental illness increases every year," said Kim Savuon, noting that the number of total cases had increased by 20 percent from 2007 to 2008.

Sotheara Chhim said the quality of care drops dramatically as doctors see more patients. Unlike their colleagues in other medical fields, mental health physicians need to make diagnoses based solely on conversations, a process that can be time-consuming.

"Mentally ill patients need to talk to doctors so doctors can understand their problem.... There is no machine that tests whether this is schizophrenia or not," he said.

Though mental health education in Cambodia still has a long way to go, experts said the public had become more aware that mental health problems could be treated.

"People still call patients crazy, but many know that it is a treatable disease and bring people to the hospital," Sotheara Chhim said.

The biggest obstacle to improving mental health services in Cambodia is money, said Ka Sunbaunat.

Despite government promises, he said, he does not expect to see a sufficient funding increase.

"Financing mental health is not a priority ... even though the policy says that mental health is one of the top health priorities," he said.

Sotheara Chhim said mental health issues are being ignored even by foreign donors.

"There are fewer donors interested, and there are smaller amounts of money available," he said. "But if we can start early prevention and early treatment, we'll reduce a lot of harm and the high costs of caring for those people."

ADDITIONAL REPORTING BY ELEANOR AINGE ROY

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