World Mental Health Day, which falls tomorrow, is a stark reminder that at least 450 million people around the world suffer from mental disorders.
The World Health Organization (WHO) forecasts that by 2030, depression will be the largest contributor to the burden of disease. Because of this, the theme for this year’s campaign is Depression: A Global Crisis.
Cambodia faces a heavy mental burden as a result of past trauma from the genocidal Khmer Rouge regime and nearly two decades of war.
This burden is exacerbated by the poverty that remains widespread in the Kingdom.
The WHO has documented a “very strong relationship” between indicators of poverty and mental disability in developing countries. Common mental disorders are about twice as frequent among the poor as among the rich.
Evidence indicates that depression is at least one and a half times more prevalent among the low-income groups of a population. Moreover, having a mental disorder increases the likelihood of descending into poverty.
Poverty and other psycho-social problems cause many Cambodians to suffer from minor to severe psychiatric problems such as depression and anxiety.
Some individuals turn to alcohol and violence as they seek to lessen the mental anguish and stress in their lives and to deal with problems within the family as well as in the community.
The combination of poverty, youth unemployment, lack of youth services, the trauma of the Pol Pot era and the subsequent two decades of civil strife has also had a significant impact on young Cambodians.
There is increasing evidence that the offspring of the survivors of the Khmer Rouge show signs of secondary traumatisation or indirect psychological effects of trauma from growing up with parents who lived through the Pol Pot era.
The impact of parents’ Khmer Rouge-related trauma on their parenting ability, and the resultant effect of neglect and abuse of their children, are among the known risk factors for suicide among young Cambodians.
A comprehensive understanding of the long-standing effects of the Khmer Rouge and the mental health of present-day second generation Cambodians, including the interpretation of socio-economic, political, anthropological and historical factors, is needed.
Prioritising mental health is in Cambodia’s interests. Improved mental health will contribute to meeting the nation’s Millennium Development Goals, which include a reduction in extreme poverty.
The Royal Government is to be congratulated for the steps it has taken to date.
The Ministry of Health, with technical support from the WHO and other partners and donor support from the Norwegian Agency for Development Co-operation, has declared mental health a priority.
It has created sub-departments specifically for mental health, incorporated the delivery of mental-health services within the general public-health system, and adopted the Mental Health and Substance Misuse Strategic Plan.
But Cambodia’s human resources in mental health are still limited.
A small but growing group of dedicated professionals and universities offer an increasing range of specialised training programs, and efforts continue to make mental-health services more accessible.
At least 50 of the nation’s 82 referral hospitals and 18 of its 1004 health centres offer outpatient mental-health services.
Two psychiatric inpatient units, with a total of 14 acute care psychiatric beds, have been established at referral hospitals, and child mental-health services are available at one hospital in Kandal province.
Cambodia’s main psychiatric facility, in Phnom Penh, offers clinical services to about 200 patients a day in its outpatient department and 30 patients a month at its crisis unit.
But it is clear that more needs to be done to meet the mental-health needs of Cambodians.
Financial resources from the national budget allocated to mental health must be increased beyond their present low levels. This would allow for an expansion of services, including the integration of mental health in primary health care.
Community-based mental health services are badly needed in rural Cambodia to curb cruel practices such as chaining the mentally ill to posts or keeping them in cages. Establishing support services at the community level for those with mental disabilities will help prevent stigma and discrimination.
The public health system must work with civil-society groups, NGOs and the private sector in a broad mental-health coalition.
Such a coalition can be a significant step towards ending marginalisation of mental health. In addition, the cross-sectoral nature of mental-health issues calls for the involvement of multiple ministries.
The time to act is now.
World Mental Health Day is a great opportunity for Cambodia to put mental-health services high on the agenda.
Cambodians face multiple risk factors for developing poor mental health, but strong, effective action can, and should, make a big difference to the outlook.
Dr Pieter JM Van Maaren is the World Health Organization's representative in Cambodia