As mental health services continue to expand, many still need to travel to Phnom Penh to seek professional treatment
After years of enduring a violent, drunk husband, Chhab Rathana sought advice from friends and family as she could no longer sleep at night, lying awake worrying about her life and considering if it was worth living.
Ms Rathana, who lives in Ratanakkiri province, took the advice of her confidantes and made the trek to Phnom Penh to seek advice from a doctor, specifically at the Khmer Soviet Friendship Hospital’s psychiatric department where she learned she was suffering from depression.
“I was having a family crisis,” she says while standing in line to get her anti-depression medicine at the hospital. “My husband always blamed me and became violent after drinking. Because of that, I developed anxiety and then depression; at night, I could not sleep because I was always worrying too much.”
Ms Rathana, the mother of two young children, says she has been taking the medicine for ten years now and adds that her marriage has improved slightly.
“I cannot leave my husband,” she says, holding the hand of her daughter. “Even though my husband is violent, I still live with him because I don’t want to be a divorcee and I want my children to have a father, so I endure the mental health issues and take medicine every month.”
Ms Rathana says doctors at the hospital have helped her understand her mental health and take care of it, allowing her to move forward with her life. She makes the trek to Phnom Penh once per month.
“When I told my story to doctors, they told me I have a mental illness and it made me worry but they explained it to me,” she says. “I have to take medicine at the hospital every month to cure my illness and sometimes they consult with me to make me feel better.”
According to the Transcultural Psychosocial Organisation, an NGO which assists those suffering from mental illness, about 40 percent of Cambodians suffer from mental health and psychological problems, with many battling Post Traumatic Stress Disorder.
The NGO notes the high prevalence of PTSD in the country’s population can be attributed to its traumatic history, notably the murderous Khmer Rouge.
However, it also notes that domestic violence, like in Ms Rathana’s case, poverty and substance abuse lead to many mental health cases.
The organisation has been working to improve access to mental health services in the country, noting that many health centres and referral hospitals do not have mental health services.
A Ministry of Health 2017 mental health report notes that it has been expanding services, with outreach efforts in public health facilities rising from 177 in 2016 to 419 in 2017 throughout the country.
In addition to expanding coverage, the ministry has also focused on training doctors and nurses on mental health treatment and drug addiction.
However, services are still lacking as most are based in Phnom Penh, leaving thousands of villagers in provinces without access to treatment.
A 2017 annual report from TPO notes that it aided 555 new patients last year, with a total of 4,699 consultation sessions offered by social workers and nurses.
“In Cambodia, there are still many ill patients who have been locked up at home or chained to trees by desperate family members,” the report says. “This happened in communities around the country, because family members do not know how to deal with the patients, there are no mental health services available in their community and they lack the finances to seek help further or to even take care of the patients.”
This leaves people like Ms Rathana to her own devices when looking for treatment while back home in Ratanakkiri, where she often turns to listening to Buddhist dharmas online to calm down.
“Before sleeping at night, I always listen to dharmas online, and the monk helps me relax and understand my mental health,” she says. “It helps me a lot, as I don’t always have time to go to Phnom Penh or a pagoda.”
Dr Chak Thida, director of the Khmer Soviet Friendship Hospital psychiatric department, says that mental health services only started to appear in Cambodia in 1998 thanks to aid from Norway.
Before that, no one sought aid from doctors for mental health issues and were not even aware that they were suffering from treatable illnesses, she says.
“Before, they mostly went to traditional Khmer practitioners, who did not have the right standards” she says. “Now we can explain to them that doctors can help them, that medicine is available to treat them.”
She says services offered at the hospital have been growing, and more villagers from the provinces are coming to get treatment every year as they are educated about their situations.
Just five years ago, only about 30 people were aided per day, a number that has jumped from 400 to 500 this year, she says.
“We have only 20 specialist officials, but our officials try to cure them and consult with them,” she says. “It is hard sometimes to help them because they live far away in the provinces and often miss appointments, whether it’s because it’s too far or because they do not have money for transportation.”
Dr Thida says most of the mental health issues addressed at the hospital are caused by family and work problems. She adds that she supports patients turning to Buddhism for guidance.
“When monks post educational videos online, I think it is good because it helps people understand their mental health and also think about what would happen if they killed themselves,” she says. “They learn that if they kill themselves, they will not be re-born.”
Venerable Kou Sopheap, a famous monk well-known for posting educational mental health videos online, says that he tries to bring peace to people facing hardships.
“When people watch the videos, they can learn about life issues and how to overcome them” he says. “The videos can give them ideas on how to improve their lives and bring peace to their minds.”
Chhe Kimsan, 63, from Kandal province, is also at the Khmer Soviet Friendship Hospital alongside Ms Rathana waiting to collect medicine to treat her anxiety, which she has been enduring for five years.
“I am always concerned about my son’s future, which makes me stressed,” she says. “He does not listen to my advice.”
“If I do not come here to get my medicine to treat my illness, I cannot sleep at night,” she adds. “I panic, get headaches and stay awake all night worrying.”