As a modernising country with an economic growth rate that easily surpasses its closest neighbours, Cambodia is on the verge of a massive change. The rise in mobile phone usage and internet penetration creates an expectation of increased, if not, constant, connectivity.
Society is increasingly becoming more high-strung as more and more people become wired. Compartmentalising certain parts of life becomes impossible – and this is only the start of the problem.
No matter how rich, poor, old or young – as Cambodia marches on towards modernity, new benchmarks have been set for the society, and not everyone is faring well with the changes.
The impossibility to completely disconnect, paired with the perception that our peers seem to be faring much better than us, creates a certain amount of stress that may lead to depression, or even exacerbate existing mental conditions.
The issue of stress isn’t something Cambodians should ignore, according to the director for the mental health department of Phnom Penh’s Cambodia-Russia Friendship Hospital, Chhok Tida.
“Given the history of Cambodia, the baseline figures on the issue of mental health [of Cambodians] will not be as good as its neighbours,” said Thida. “Cambodia, and Cambodians, are no strangers to trauma.”
Indeed, a study conducted by the Royal University of Phnom Penh in 2012 found that almost one-fifth of Cambodians suffer from generalised anxiety disorders – and the same survey cites a World Health Organisation (WHO) study that places the nation’s suicide rate at five times the reported rate in Thailand.
According to the most recent data released by the Interior Ministry in 2016, suicide is the third most commonly reported cause of accidental deaths in Cambodia – just behind traffic-related incidents and the umbrella category of “others”, which includes chronic illnesses.
Of the 658 suicide-attempt cases, 651 lives were lost. In the first six months of 2017 alone, 49 suicide attempts were reported in the capital, resulting in the loss of 39 lives.
These numbers seem to indicate a positive trend when compared with the figures released in 2015, when the number of suicides reported peaked at 743 cases. But upon closer analysis, the figures actually paint a grim picture.
Because of the rising number of suicides, the National Police began to keep records of such cases in 2011, and within the five years since data collection began, the figures suggest that the number of suicides have increased by at least 31 percent.
As such, it is in fact relevant to question the readiness of Cambodia’s mental healthcare system. While it can be argued that not all reported suicides have a direct correlation with pre-existing mental conditions, one has to concede that a 31 percent increase in suicide related fatalities is a figure that cannot be brushed aside.
One may argue that it isn’t statistically significant to warrant an early intervention – given the limitation of Cambodia’s coffers. But is the government and its institutions even remotely ready to deal with the situation, should the symptom turn into a full-blown meltdown?
The short answer is no. Simply by looking at the crowds in front of the psychiatric ward at the Cambodia-Russia Friendship Hospital – the biggest hospital in Phnom Penh with a dedicated psychiatric ward – one will immediately see that it is bursting at the seams.
“On an average day, our psychiatric ward sees about 300 prospective patients,” explained Thida. “Each of our psychiatrists generally handles two new patients, in addition to the 15-20 follow-ups each day – so the doctor-to-patient ratio is definitely not as high as we would like it to be, and sometimes we have to turn away patients due to overcapacity.
“The influx is caused by the lack of mental healthcare professionals in provinces,” she added. “Many who have been stationed in the provinces often opt for a transfer to Phnom Penh – lured by the better pay and conditions offered in the capital.”
As a result, almost half the provincial health centres have ceased to offer full psychiatric services. “The referral centres in Kampong Speu, Kampong Chhnang, Kampong Cham and Kandal provinces have been hit the most by the exodus [of mental health professionals] and as such are operating at a reduced capacity,” lamented Thida. “As a result, sometimes general practitioners in rural areas have to act as a primary mental healthcare advisors too.”
While this ad hoc approach seems to be working, at least for the time being, it is clear that the sector will greatly benefit from increased funding from the government. According to another WHO report released in 2015, the government spends about 1.5 percent of its budget on healthcare – lower than other countries within the same socio-economic bracket, and even more so when compared with the amount that has been earmarked for defence and internal security, which has been on the rise since 2008.
Many think there is room for some improvement.
While the closed-door politicking behind the decision is not her domain, Thida recognises the urgent need to increase the reach of primary mental health care services across Cambodia, as more and more people are coming forward to seek help.
“Stigma surrounding mental health is on the decline, as evidenced by the increasing number of patients suffering from psychosis that are being admitted to the hospital,” she said. “However, generalised anxiety is on the rise too – not only in Cambodia, but all across the globe – and as such, the development of Cambodia’s mental health services should, at least, reflect this rise in awareness among Cambodians.”