PROFILE Mental health services in Cambodia:
Sarah J. Parry
and Ewan Wilkinson
Mental health services in Cambodia required
rebuilding in their entirety after their
destruction during conﬂict in the 1970s.
During the late 1990s there was rapid growth
and development of professional mental
health training and education. Currently, basic
mental healthcare is available primarily in
urban areas and is provided by a mixture of
government, non-government and private
services. Despite the initial rapid growth of
services and the development of a national
mental health strategy in 2010, signiﬁcant
challenges remain in achieving an acceptable,
standardised level of mental healthcare
Cambodia is a country in Southeast Asia, bor-
dered by Thailand, Laos and Vietnam, with a
population of 15.8 million.
remains predominantly rural although the distri-
bution reduced from 81% to 68% rural between
1998 and 2016.
The national poverty rate
declined from 48% in 2007 to 13% in 2014.
The majority (97%) of the population is
The Cambodian concept of health is
complex, rooted in Hindu-Buddhist beliefs, ani-
mistic spiritual beliefs, the concept of luck and
astrology, and physical/somatic concepts.
Religious and traditional healers play an import-
ant role in physical and mental healthcare in
Traditional approaches to health-
care are usually used ﬁrst, particularly in rural
As in many cultures, there remains sig-
niﬁcant stigma associated with mental disorders
The people of Cambodia experienced a pro-
longed period of intense conﬂict, loss and societal
disruption between 1967 and 1975 owing to civil
war, followed by the Khmer Rouge period until
1979, with up to one-third of the population
dying from starvation, disease or execution. In
1975, Cambodia had just two psychiatrists, run-
ning a single 800-bed psychiatric hospital with a
patient population of approximately 2000.
During the Khmer Rouge period the mental
health services in their entirety were destroyed,
leaving no psychiatrists or other trained mental
When the Paris Peace
Agreement was signed in 1991, marking the ofﬁ-
cial end of the Cambodian–Vietnamese War
Cambodia had to completely rebuild the health,
education and community services.
long-lasting effects of genocide and war com-
pound the challenge of rebuilding the country,
as complex trauma continues to affect the mental
well-being of the people of Cambodia.
epidemiological data show a high prevalence of
substance misuse, neurological and mental disor-
ders compared with normative populations.
Rebuilding mental health services in
In 1992, the Mental Health Subcommittee of the
Cambodian Ministry of Health was formed to
develop the country’s mental health services.
Between 1994 and 2004, partnerships with the
International Organization for Migration and
the University of Oslo trained 26 psychia-
and 40–45 psychiatric nurses.
A combined total of 600 nurses and primary
care doctors were trained in basic mental health-
through partnerships including the
Harvard Training Program.
In 2005, the Cambodian University of Health
Sciences took over the 3-year psychiatry residency
There are currently
approximately 60 psychiatrists in Cambodia:
1 per 260 000 people,
compared with 7068
(1 per 9300 people) in the UK.
Despite the rapid early growth in the number
of mental health professionals, when international
funding ended the training opportunities
There has been no psychiatric
nurse training in the country since 2006.
Furthermore, it was estimated in 2012 that 30%
of the psychiatrists and 90% of the primary care
physicians who had received the basic mental
health training were no longer involved with clin-
ical mental healthcare.
have left to work in other medical specialties
or for non-governmental organisations (NGOs).
The Royal University of Phnom Penh has
offered a bachelor’s degree in psychology since
1994 and a master’s degree in clinical psychology
and counselling since 2008.
Department of Social Work, established in 2008,
offers both bachelor’s and master’s programmes
in social work.
However, there are no established
posts for psychologists or social workers in public
and most graduates work for NGOs.
In 2012, the total health expenditure in
Cambodia was US$1033 million.
spending comprised just under 20% of this ﬁgure:
MBBS, BSc (Hons), Researcher,
OMF International, Phnom Penh,
Cambodia. Email: sarah316103@
MBChB, FFPHM, Visiting
Professor of Global Public Health,
Institute of Medicine, University
of Chester, UK
Conﬂicts of interest: None.
Keywords. Low- and middle-
income countries; rebuilding;
strategic plan; mental health
service development; Cambodia.
First received 15 Feb 2019
Final revision 22 Aug 2019
Accepted 16 Oct 2019
© The Authors 2019. This is an
Open Access article, distributed
under the terms of the Creative
Commons Attribution licence
licenses/by/4.0/), which permits
unrestricted re-use, distribution,
and reproduction in any medium,
provided the original work is
BJPSYCH INTERNATIONAL page 1 of 3 2019 1
US$199.1 million. Of the total government health
spending, it was estimated that 0.02% was on
There are 25 provinces in Cambodia, includ-
ing the capital city Phnom Penh. In 2015, there
were 1141 community health centres, 102 referral
hospitals, 25 provincial referral hospitals and 9
national hospitals in Phnom Penh. There is no
current systematic referral pathway between
health centres and hospitals, which is a signiﬁcant
barrier for delivering integrated mental
The rapid growth in mental health services
through international funding in the late 1990s
led to government mental health clinics operating
in 95% of provinces and three in-patient psych-
iatry units were available for emergency assess-
ments by 2007.
However, in 2010 this had
reduced to two in-patient psychiatry units provid-
ing a total of 14 beds,
and 60% of the referral
hospitals and 2% of community health centres
provided mental health services.
of government in-patient beds has remained
low, at 10–15, since 2010.
In 2018, the few
specialist out-patient mental health services were
predominantly located in urban centres.
The Centre for Child and Adolescent Mental
Health is the only specialist child and adolescent
mental health service in Cambodia; it is a govern-
ment service supported by an international
In 2012, there were between 11 and 14 drug
treatment and social affair centres in Cambodia.
These centres were designed to address drug
dependence and provide social rehabilitation ser-
vices. A community-focused approach to addres-
sing the high prevalence of substance misuse in
Cambodia has since been proposed.
A signiﬁcant proportion of healthcare in
Cambodia is provided by private for-proﬁt and
private not-for-proﬁt services, which operate
alongside the government health services.
2015, there were 8488 registered private health-
care facilities and over 180 healthcare-related
NGOs in Cambodia.
A few of these organisations
provide mental healthcare services. People with
mental disorders may be restrained at home as
relatives are not aware of other options; this is a
focus for some human rights organisations.
NGOs tend to work independently and access to
the services they provide depends on geograph-
ical location and target population.
Psychosocial services frequently focus only on
meeting immediate basic needs, including shelter
and there are limited services
providing psychological therapies.
are accessed, there is often a reliance on medica-
tion alone rather than addressing psychological
needs, owing to the lack of resources.
some NGOs are currently focusing on providing
psychological services, including trauma-focused
therapy and eye-movement desensitisation
A number of psychological services are
also available through the rapidly growing private
and a small number of private
in-patient psychiatric beds are available.
Availability of medication
There is currently limited availability of psycho-
tropic medications, particularly in rural areas.
There is no uniﬁed regulation of how or by
whom psychotropic drugs are prescribed.
Patients are frequently prescribed several psycho-
tropic medications without being given informa-
tion on the drugs or why they have been
In 2012, the psychotropic medica-
tion available was mainly older generations of
and medication shortages
Development of a mental health strategy
In 2010, the Cambodian government issued the
Mental Health and Substance Misuse Strategic
Plan for 2011–2015.
This outlined the vision,
mission and strategy for development of the men-
tal health services in Cambodia as well as some of
the key challenges faced. The vision was for ‘All
Cambodian people [to have a] high level of men-
tal health and psychosocial well-being, contribut-
ing to the quality of life’and the mission was
‘To ensure all Cambodian people will have access
to the highest quality mental health and substance
Despite this promising strategic plan there
have been several challenges to its implementa-
tion and limited progress has been made
since the initial rapid growth in the late 1990s.
It was acknowledged in the subsequent Health
Strategic Plan for 2016–2020 that the system was
ill-equipped and provided limited services.
Mental healthcare funding remains low, human
resources remain limited
and training initiatives
and projects frequently rely on external fund-
Developing legislation and regulation for
delivering mental healthcare was identiﬁed as a
goal in the strategic plan,
but there are cur-
rently no national clinical guidelines for diagnosis
and treatment of mental disorders and no mental
health legislation in Cambodia.
The global picture
The burden of disease attributable to mental dis-
orders is increasingly being recognised as a global
It has been noted in recent
years that, despite the growing recognition of
the importance of mental health, progress and
development of services has remained slow in
low- and middle-income countries (LMICs).
Five challenges for global mental health identiﬁed
•integrating mental health services into the
•improving accessibility to effective psycho-
2BJPSYCH INTERNATIONAL page 2 of 3 2019
•training multidisciplinary mental health
•providing community-based care and rehabili-
tation for people with chronic mental disorders
•strengthening the mental health competence
of all health professionals.
The slow progress in developing mental
healthcare services in LMICs
has resulted in
calls for continued evaluation and analysis of the
barriers to improving mental healthcare in
order to best inform future initiatives and policy.
The ﬁve challenges
listed above are of great
relevance to developing mental healthcare ser-
vices in Cambodia, and the importance of devel-
oping community care is recognised in the
Mental Health and Substance Misuse Strategic
The initial growth in the number of
trained mental health professionals and services
was an extraordinary achievement. Despite this,
it is widely acknowledged that the treatment gap
remains wide for people with mental disorders
in Cambodia and the government’s mental health
plan is yet to be fully implemented.
opportunities need to be restarted and main-
tained, together with efforts to prevent attrition
of professionals. More resources are needed to
address the treatment gap, improve the quality
of mental health services and implement school-
and community-based preventive initiatives.
S.P. thanks OMF International and Mrs Shirley Sinclair (OMF
Cambodia) for her support in writing this paper.
S.P. conceived the study in discussion with E.W. S.P. carried out
the literature review and drafted the manuscript and both
authors critically revised the manuscript for intellectual content.
Both authors read and approved the ﬁnal manuscript. S.P. is guar-
antor of the paper.
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