Abstract
BackgroundWhile mental and substance use disorders are common worldwide, the treatment gap is enormous in low and middle income countries. Primary health care is considered to be the most important way for people to get mental health care. Cambodia is a country with a long history of war and has poor mental health and limited resources for care. The aim of this study was to conduct a situational analysis of the mental health services in the rural district of Lvea Em, Kandal Province, Cambodia.MethodsA cross-sectional situational analysis was done to understand the mental health situation in Lvea Em District comparing it with the national one. The Programme for improving mental health care (PRIME) tool was used to collect systematic information about mental health care from 14 key informants in Cambodia. In addition, a separate questionnaire based on the PRIME tool was developed for the district health care centres (12 respondents). Ethical approval was obtained from the National Ethics Committee for Health Research in Cambodia.ResultsMental health care is limited both in Lvea Em District and the country. Though national documents containing guidelines for mental health care exist, the resources available and health care infrastructure are below what is recommended. There is no budget allocated for mental health in the district; there are no mental health specialists and the mental health training of health care workers is insufficient. Based on the limited knowledge from the respondents in the district, mental health disorders do exist but no documentation of these patients is available. Respondents discussed how community aspects such as culture, history and religion were related to mental health. Though there have been improvements in understanding mental health, discrimination and abuse against people with mental health disorders seems still to be present.ConclusionsThere are very limited mental health care services with hardly any budget allocated to them in Lvea Em District and Cambodia overall. There is dire need for scaling up and integrating mental health into primary health care to improve the population’s access to and quality service of Cambodian mental care.
Highlights
While mental and substance use disorders are common worldwide, the treatment gap is enormous in low and middle income countries
The percentage of households with electricity were nearly three times higher in Lvea Em compared to country average; in contrast, the access to a clean water supply was better in Cambodia as a whole
The health strategic plan (HSP) for the years 2008–2015 was written by the Ministry of Health (MoH) with the purpose of addressing health needs of the population there mental health was included as part of the non-communicable diseases control plan
Summary
While mental and substance use disorders are common worldwide, the treatment gap is enormous in low and middle income countries. Basic training in mental health and appropriate supervision by mental health specialists can contribute to non-specialist health professionals’ ability to detect, diagnose and treat patients with mental health disorders [13], reducing the number of unnecessary investigations and inappropriate and non-specific treatments. It is a complex task of integrating mental health care into PHC but evidence has shown that community-based services are more effective and cost effective than hospitals [4]
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