Nurse Ong Ny talks to the father of a child who could not speak before he came to the center.
Som was six months old when he fell ill with a high fever. The sickness changed
"He acted differently and because of his irregular behavior, such as cursing
at teachers, he did not go to school," says Som's mother when her son's behavioral
problems became more noticeable some years later.
When he turned 18, Som started experiencing convulsions and went to a hospital in
Kampong Speu. It was there that his mother learned about a program that helps children
with mental illnesses and disabilities. Social Services of Cambodia (SSC) referred
him to the Center for Child Mental Health (CCMH) at Chey Chum-neas Hospital in Takhmau,
"Normally, our clients know our center by word of mouth," says Dr Lor Vann
Thary, who has worked at CCMH for three years. "One client tells another client
or we get referrals from organizations."
CCMH was founded in 1995 with a grant from the Dr Marcel Charles Roy Foundation.
It is housed in three buildings at the Chey Chumneas Hospital. Before the Pol Pot
era the hospital was run by French staff who treated mental health patients. The
Khmer Rouge used it as a prison instead.
Staff at CCMH help Som with basic recognition skills, among other things. For example,
Som will be shown a cat and asked to identify the parts of its body. He has therapy
sessions every three weeks and his mother is hopeful he will improve.
Som's case is not unusual. Projected figures show that approximately one in five
children in Cambodia need help from a mental health professional. As 40 percent of
Cambodia's population is under 18, it is likely that around one million children
experience psychiatric problems. CCMH is the only mental health facility in Cambodia
focusing on children.
The first step for a child coming to CCMH is registration. The hospital assigns a
case worker -a psychiatrist nurse or doctor - who will be the child's partner throughout
"We do this to build a relationship between the patient and the doctor and also
[to ensure] confidentiality," says Dr Thary. Children waiting for their one-on-one
counseling session to begin are encouraged to draw and play with toys.
"Allowing the child to draw is a self-esteem building measure," says Dr
J. Bhoomi Kumar, standing next to a bulletin board filled with crayon drawnings.
"The way a child relates to toys gives us clues. The idea is to have a child-frien-dly
atmos-phere. We sit like a family and talk."
Involving the child's family is an important part of therapy at CCMH.
"The family is involved in every step," says Dr Kumar, who has worked
at the center since 1996. "We see the family as a system that the child is a
Since families and children come to sessions together, CCMH is an out-patient facility
only. This means that no child stays overnight or for any long period of time.
As the mental health system in Cambodia is relatively new, there are challenges in
providing services for children. For example, parents need to be educated about mental
illness and disabilities, and also about appropriate treatments. Dr Kumar says that
many people have preconceptions about which treatments will work.
"[Treatment] is all the more complicated if families come from rural areas,
because of their belief in magic and injections," he explains.
"They go to the wat and [a monk performs] a religious or magic cure. People
come with expectations that we then need to refocus. They expect a quick cure from
the modern system."
CCMH staff listen to Dr Lor Vann Thary, right, at a daily briefing.
Before taking Som to the hospital, his mother took him to seven Khmer traditional
doctors. Their cures ranged from splashing water on him to chanting sermons.
"The [traditional] doctors told me that my son's disease was from his mother
in a previous life," she says.
In addition to educating about treatment, Dr Kumar says it is important for parents
to learn the normal developmental stages of children and general parenting skills.
During the Pol Pot regime, many children were separated from their families and thus
had no model for parenthood.
"The child might not have a problem but the parents perceive a problem,"
he says. "Parents need information about child-rearing practices. We give information
because education is our approach."
CCMH and OXFAM, a community-development NGO, also conduct weekend educational sessions
for teachers, students and community members to disseminate information. The community-based
Child Mental Health Program trains volunteers, who come to the clinic once a month.
"They share the information with their community and talk to children who have
problems," says Dr Kumar. "Teachers who come can identify basic problems
and see the connection [between] the importance of mental health and learning."
Another challenge besides education is maintaining the facilities and resources.
"The government needs to put in more money," he says. "Chil-dren's
needs are not highlighted."
At the end of last year UN volunteers worked for three weeks to renovate a daycare
center for CCMH. Staff meet in the renovated daycare center to discuss their cases
for the day. Other than Dr Kumar, the staff includes Khmer psychiatrists, psychiatric
nurses and students.
Wearing pink and red pants and a camouflage shirt with a button missing, seven-year-old
Srey waits in the daycare center for his turn to talk with the psychiatrist.
"Before coming here my son could not speak," says Srey's father. "Now
he has gotten better and can help himself."
Som's mother is also grateful to the hospital staff, and has become more optimistic
about her son's progress.
"My son's health is better now because the doctors provide a good service,"
says Som's mother. "They have educated my son very well through his therapy."
Editor's note: The names of the children and their families have been changed to
protect their confidentiality.