At the age of 18, Lim Visal* was chained to a post by his parents, who were anxious about his undiagnosed schizophrenia and too poor to refer him to a hospital. The couple feared their son might be dangerous, so they left him like that – alone and restrained most of the time – in a single room for two years.
That was his home until the day he escaped and, confirming his parent’s worst fears, killed a young girl in his village. The crime earned him 10 years of a different sort of confinement, this one not much better than the first.
Visal is one of more than 100 known convicts suffering from mental health problems in Cambodia’s prisons, where the cramped, unhygienic conditions and scarcity of food and water breed psychological torment. Sometimes prisoners live within as little as 0.7 square metres of floor space, according to rights organisation Licadho. Punishments include solitary confinement for those who break the rules.
At first, Visal refused to undergo any kind of psychological treatment or take medicine offered by the Transcultural Psychosocial Organisation (TPO), an NGO supporting the mentally ill, insisting that he didn’t have any problems. Eventually, he began to cooperate, and he now takes regular doses and receives counselling from professionals.
Depression, schizophrenia, anxiety and trauma are among the mental health conditions most prevalent in Cambodia’s prison system, said Long Borom, who coordinates TPO’s prison project, launched in 2012 to combat the problem of mental illness behind bars. Many inmates didn’t even have a history of these problems before being sentenced, he added.
“Some prisoners are given long sentences, so it makes them depressed,” he explained, speaking at TPO’s Phnom Penh office in June. “They don’t have an opportunity to learn, and sometimes they find it difficult to adapt, to control their anger or to manage themselves.”
A report published by Licadho in June revealed as many as 500 allegations of physical and psychological abuse in Cambodia’s prisons and police stations since 2008. Nail extraction, electric shocks, beatings and sleep deprivation as well as the threat of rape or death were among the torture techniques cited.
Inmates with mental health conditions are targets and are at particular risk of abuse. In a warped kind of downward spiral, this is bound to have psychological effects, according to the report.
Clients who cited abuse reported a wide range of symptoms, from disturbed sleeping patterns to hearing voices to depression. Some attempted suicide. Others had suicidal thoughts.
“Mental and physical health problems can be exacerbated by poor conditions of detention which, in Cambodia, are characterised by overcrowding and limited access to basic needs such as food, water, ventilation and natural sunlight,” said Sharon Critoph, prison consultant at Licadho.
Working in just four of Cambodia’s 28 prisons – Kampong Chhang Provincial Prison, Kandal Provincial Prison and Correctional Centres 1 and 2 – TPO’s prison project provides three mental health professionals to offer psychiatric treatment in the form of medication, psychological counselling, meditation, life skills and self-help groups. Prison staff are trained to identify inmates who might be mentally ill and to refer them to TPO specialists for assessment. A total of 112 people have been helped through the program, though there are likely many more in prisons where TPO cannot work because of funding shortages.
While some develop illness inside, many have pre-existing conditions. “Through our assessments, we always check their history, and we find that some prisoners committed a crime because of a psychotic disorder,” Borom said.
In some cases, it is those closest to the mentally ill who may in fact make the situation worse. Mental health is taboo in Cambodia, little understood and rarely spoken about. Phnom Penh’s Khmer-Soviet Friendship Hospital is the only facility of its kind in the country to house a mental health department. For many, like Visal’s family, tying up a relative is the most viable option.
Because of limited understanding, the mentally ill are generally unable to access the treatment they need and their conditions worsen. Some even self-medicate with drugs or alcohol, exacerbating the situation, Borom said.
He cited an example of a man who, like Visal, had undiagnosed schizophrenia. Suffering from delusions and hallucinations, he thought he saw his father trying to kill him. Terrified for his life, he eventually murdered his father.
While the program supports inmates, aftercare once they are discharged remains a concern. Former inmates find it difficult to regain people’s trust, and finding employment can be hard.
TPO does what it can to maintain contact, but with a large number moving around regularly for work, it’s not easy. However, if former inmates are in trouble, TPO has a hotline they can call, and upon leaving prison, they are given brochures about adapting to regular life.
For Visal, at least, processing information from the brochures won’t be a problem. Since acknowledging his condition and receiving treatment, he has learned to read and write in Khmer, and can even speak some English, Borom said.
It’s not clear if he is aware of the grief he caused, but letting his health deteriorate further is not an option for mental health advocates. If nothing else, he knows he is not alone.
*Name has been changed in line with confidentiality requirements.