Aside from the more apparent mentally unstable person on the streets, there are other sides to mental illness that run silently deeper and are more ominous.

Before 1993, no conceptual framework or support existed for mental health care in the Kingdom, leaving trauma-related disorders and other mental issues to go vastly untreated.

This was as reported by the only large-scale mental health survey ever conducted in Cambodia by the Royal University of Phnom Penh’s Department of Psychology in 2012.

In 1995, the Transcultural Psychosocial Organisation (TPO) Cambodia was inaugurated under the umbrella of Netherlands-based NGO TPO International. Five years later it underwent registration to become an independent local NGO, and TPO Cambodia is now operated and staffed by locals.

Dr Sotheara Chhim, senior consultant psychiatrist and executive director of TPO Cambodia, has been with the organisation for the past 14 years. He counts 22 years in the field of psychiatry as his experience, and here he gives Post Plus some updated insight on how the awareness of mental health has improved and is perceived by the Cambodian society.

Mental health remains largely a taboo in Cambodia - has the situation and awareness of mental illness improved in the last few years?

Yes, mental health is still a taboo in Cambodia, especially in rural areas. However, during the last 20 years I can say that this has been improved on a lot because there are increasingly more people who are willing to talk about mental health, and even discuss about their mental health problems and seek help. I can see that young people are more open to talk about mental health than their parents. This is because young people may have access to information, [such as] being exposed to social media in this age compared to their parents’ generation.

What are the biggest factors contributing to mental illness here? 

The contributing factors to the current mental health problems in Cambodia are mostly due to the daily hassle faced by many people. These include issues like poverty, domestic violence, alcoholism, substance abuse, social change (which further include migration, urban growth, and unemployment), human rights abuse, and land grabbing. The lack of sufficiently trained mental health professionals, and the unavailability of mental health services that can reach out to the people at the grassroots level hamper the people’s ability to get early treatment and quick recovery or support.

Which governmental body is responsible for the mental health system in the country, and does TPO work with these authorities? 

The Department of Mental Health and Substance Abuse (DMHSA) of the Ministry of Health (MoH) is responsible. This department may have a coordinating role to play among mental health providers in Cambodia. 

What is the most common way for Cambodians to deal with a mentally ill person and why is there still a stigma surrounding mentally unstable people? 

There are many reasons for this stigma. Many people in rural areas still believe that mental illnesses are caused by sorceries which may be treated by mediums like traditional healers and monks who can communicate with supernatural sources in order to get rid of the evil spirit. Sometimes, people believe that someone is mentally ill because of having low Reasey (Khmer for a kind of luck or fortune), and when they have low Reasey, they are more prone to suffer from mental illness. They would then seek help from monks or mediums to raise their Reasey so that they can be more immune to mental illness.

People also believe that mental illness is inherited from their parents, and this brings shame to the family. When their children have this problem, it is kept a secret because then no one would want to marry them or be associated with their family members. This, of course, delays or worsens the problem. There is also discrimination toward mental illness among employers too as they won’t employ someone who is mentally unstable.

When do you foresee mental health awareness in Cambodia becoming more accepted and understood by society? 

It is difficult to say! I think it needs a concerted effort from all levels of society. I believe that if politicians and public figures are more receptive and willing to talk about mental illness, then I am sure that the awareness of mental health in the country will increase. Thus, people will gradually accept the fact that they have some form of mental illness or other, and they will seek help on time.

Has the World Health Organisation or UN initiatives worked together with TPO in this regard? What are some of the action plans to tackle this issue? 

No, so far these global agencies only support the MoH and the DMHSA, not NGOs like us.