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1 Seminar on Health and Migration, 9-11 June 2004 Session IIB: Public Health and Migration Investing in mental health in post-conflict rehabilitation, Professor Ka SUNBAUNAT INVESTING IN MENTAL HEALTH INVESTING IN MENTAL HEALTH IN CAMBODIA IN CAMBODIA By Prof. Ka Sunbaunat Director, National Program for Mental Health Ministry of Health, CAMBODIA Geneva: 9-11 June 2004 HISTORY OF MENTAL HEALTH DEVELOPMENT IN CAMBODIA HISTORY OF MENTAL HEALTH DEVELOPMENT IN CAMBODIA National National Program for Program for Mental Mental Health Health ( soon in ( soon in 2004 ) 2004 ) 1994 1994-Now Now Mental Health Mental Health Sub Sub- Committee is Committee is established established 1992 1992 Mental Mental awareness awareness & mental & mental Health Health Services Services Developm Developm ent ent Mental Mental Health Health Training Training and and Services Services started started CMHTP CMHTP-IOM IOM No No Mental Mental Health Health Service Service Neither Neither MH MH –HR HR No Mental No Mental Health Health Service Service GENOCIDE GENOCIDE (Pol Pol Pot Pot Regime) Regime) Only one Only one Psychiatric Psychiatric Hospital Hospital 1994 1994 1979 1979- 1994 1994 1975 1975- 1979 1979 Before Before 1975 1975 GENERAL INFORMATION GENERAL INFORMATION Population: 13,000,000 Population: 13,000,000 Mental Health Policy/Plan: Mental Health Policy/Plan: Accepted by Accepted by MoH MoH Substance Abuse Policy: Substance Abuse Policy: Present (NACD) Present (NACD) National Mental Health Program: National Mental Health Program: In phase of preparation In phase of preparation Essential List of Drug: Essential List of Drug: Yes Yes Mental Health Legislation: Mental Health Legislation: Absent Absent Mental Health Financing: Mental Health Financing: Yes Yes (for Psychotropic drug only) MENTAL HEALTH RESOURCES IN CAMBODIA MENTAL HEALTH RESOURCES IN CAMBODIA Mental Health Manpower: Psychiatrist: 20 (Ratio:1/650,000) Psychiatric nurses: 29 (Ratio:1/448,276) Mental Health Facilities: Psychiatric Hospital: Psychiatric Hospital: No No In patient Unit in General Hospital: One In patient Unit in General Hospital: One (starting in June, with 8 beds) (starting in June, with 8 beds) Psychiatric Out patient Unit in Referral Hospital: 12/68 RH Psychiatric Out patient Unit in Referral Hospital: 12/68 RH Psychiatric Out patient services in health center: 16/939 HC Psychiatric Out patient services in health center: 16/939 HC Private Hospital: No No Private clinic Yes Social Insurance: No No

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Page 1: Investing in mental health in post-conflict rehabilitation ... · 1 Seminar on Health and Migration, 9-11 June 2004 Session IIB: Public Health and Migration Investing in mental health

1

Seminar on Health and Migration, 9-11 June 2004Session IIB: Public Health and Migration

Investing in mental health in post-conflict rehabilitation, Professor Ka SUNBAUNAT

�������������� �������������������������� ����������������� �

INVESTING IN MENTAL HEALTH INVESTING IN MENTAL HEALTH IN CAMBODIAIN CAMBODIA

By Prof. Ka SunbaunatDirector, National Program for Mental Health

Ministry of Health, CAMBODIAGeneva: 9-11 June 2004

�������������� �������������������������� ����������������� �

HISTORY OF MENTAL HEALTH DEVELOPMENT IN CAMBODIAHISTORY OF MENTAL HEALTH DEVELOPMENT IN CAMBODIA

National National Program for Program for Mental Mental Health Health ( soon in ( soon in 2004 )2004 )

19941994--NowNow

Mental Health Mental Health SubSub--

Committee is Committee is establishedestablished

19921992

Mental Mental awareness awareness & mental & mental Health Health Services Services DevelopmDevelopmentent

Mental Mental Health Health

Training Training and and

Services Services startedstarted

CMHTPCMHTP--IOM IOM

No No Mental Mental Health Health ServiceService

Neither Neither MH MH ––HRHR

No Mental No Mental Health Health Service Service

GENOCIDEGENOCIDE

((PolPol Pot Pot Regime)Regime)

Only one Only one Psychiatric Psychiatric

HospitalHospital

1994199419791979--19941994

19751975--19791979

Before Before 19751975

�������������� �������������������������� ����������������� �

GENERAL INFORMATIONGENERAL INFORMATION

�� Population: 13,000,000Population: 13,000,000

�� Mental Health Policy/Plan:Mental Health Policy/Plan: Accepted by Accepted by MoHMoH

�� Substance Abuse Policy:Substance Abuse Policy: Present (NACD)Present (NACD)

�� National Mental Health Program: National Mental Health Program: In phase of preparationIn phase of preparation

�� Essential List of Drug:Essential List of Drug: YesYes

�� Mental Health Legislation:Mental Health Legislation: AbsentAbsent

�� Mental Health Financing:Mental Health Financing: Yes Yes (for Psychotropic drug only)

�������������� �������������������������� ����������������� �

MENTAL HEALTH RESOURCES IN CAMBODIAMENTAL HEALTH RESOURCES IN CAMBODIA

� Mental Health Manpower:� Psychiatrist: 20 (Ratio:1/650,000)� Psychiatric nurses: 29 (Ratio:1/448,276)

� Mental Health Facilities:�� Psychiatric Hospital:Psychiatric Hospital: NoNo�� In patient Unit in General Hospital: One In patient Unit in General Hospital: One (starting in June, with 8 beds)(starting in June, with 8 beds)

�� Psychiatric Out patient Unit in Referral Hospital: 12/68 RHPsychiatric Out patient Unit in Referral Hospital: 12/68 RH�� Psychiatric Out patient services in health center: 16/939 HCPsychiatric Out patient services in health center: 16/939 HC� Private Hospital: No No � Private clinic Yes

� Social Insurance: NoNo

Page 2: Investing in mental health in post-conflict rehabilitation ... · 1 Seminar on Health and Migration, 9-11 June 2004 Session IIB: Public Health and Migration Investing in mental health

2

Seminar on Health and Migration, 9-11 June 2004Session IIB: Public Health and Migration

Investing in mental health in post-conflict rehabilitation, Professor Ka SUNBAUNAT

�������������� �������������������������� ����������������� �

MENTAL HEALTH RESOURCES IN CAMBODIA MENTAL HEALTH RESOURCES IN CAMBODIA (Cont)(Cont)

� Other Resources:� Local

World Health Organization (WHO)World Health Organization (WHO)� International

International Organization for Migration (IOM)International Organization for Migration (IOM)WHOWHONorwayNorwayLouvainLouvain DeveloppementDeveloppementiiMHLPMHLP, CIMH, CIMH

� Local partnersTrans Cultural Psychosocial Organization (TPO)Trans Cultural Psychosocial Organization (TPO)Social Services for Cambodia (SSC)Social Services for Cambodia (SSC)CaritasCaritasMMéédecindecin de lde l’’ EspoirEspoir dudu CambodgeCambodge (MEC)(MEC)Supporter for Mental Health (SUMH)Supporter for Mental Health (SUMH)

�������������� �������������������������� ����������������� �

MENTAL HEALTH SERVICES IN CAMBODIA BEFORE 1975MENTAL HEALTH SERVICES IN CAMBODIA BEFORE 1975

Pursat

Kampong Cham

Preah Vihea

Kampong Thom

Oddor Mean Chey

Battambang

Siem Reap

Stung Treng

Mondol Kiri

Kratie

Banteay Mean Chey

Rottanak Kiri

Kampong Spueu

Kampot

Kampong Chhnang

Prey Veng

Takeo

Kandal

Svay Rieng

Sihanouk Ville

Krong Pailin

Phnom Penh

Krong Kep

Koh Kong

M

Mental Health ServiceM

THAI

LAND

LAOS

VIETNAM

�������������� �������������������������� ����������������� �

MENTAL HEALTH SERVICES IN CAMBODIA 1975MENTAL HEALTH SERVICES IN CAMBODIA 1975--19791979

Pursat

Kampong Cham

Preah Vihea

Kampong Thom

Oddor Mean Chey

Battambang

Siem Reap

Stung Treng

Mondol Kiri

Kratie

Banteay Mean Chey

Rottanak Kiri

Kampong Spueu

Kampot

Kampong Chhnang

Prey Veng

Takeo

Kandal

Svay Rieng

Sihanouk Ville

Krong Pailin

Phnom Penh

Krong Kep

Koh Kong

THAI

LAND

LAOS

VIETNAM

����������������

�������������� �������������������������� ����������������� �

MENTAL HEALTH SERVICES IN CAMBODIA IN 1994MENTAL HEALTH SERVICES IN CAMBODIA IN 1994

Pursat

Kampong Cham

Preah Vihea

Kampong Thom

Oddor Mean Chey

Battambang

Siem Reap

Stung Treng

Mondol Kiri

Kratie

Banteay Mean Chey

Rottanak Kiri

Kampong Spueu

Kampot

Kampong Chhnang

Prey Veng

Takeo

Kandal

Svay Rieng

Sihanouk Ville

Krong Pailin

Phnom Penh

Krong Kep

Koh Kong

M

Mental Health ServiceM

THAI

LAND

LAOS

VIETNAM

M

Page 3: Investing in mental health in post-conflict rehabilitation ... · 1 Seminar on Health and Migration, 9-11 June 2004 Session IIB: Public Health and Migration Investing in mental health

3

Seminar on Health and Migration, 9-11 June 2004Session IIB: Public Health and Migration

Investing in mental health in post-conflict rehabilitation, Professor Ka SUNBAUNAT

�������������� �������������������������� �����������������

MENTAL HEALTH SERVICES IN CAMBODIA TODAYMENTAL HEALTH SERVICES IN CAMBODIA TODAY

Pursat

Kampong Cham

Preah Vihea

Kampong Thom

Oddor Mean Chey

Battambang

Siem Reap

Stung Treng

Mondol Kiri

Kratie

Banteay Mean Chey

Rottanak Kiri

Kampong Spueu

Kampot

Kampong Chhnang

Prey Veng

Takeo

Kandal

Svay Rieng

Sihanouk Ville

Krong Pailin

Phnom Penh

Krong Kep

Koh Kong

M

M

M

M

M

M

M

M

Mental Health ServiceM

THAI

LAND

LAOS

VIETNAM

M

M

M

M

M

M

�������������� �������������������������� ����������������� �!

� Decentralization and Community based

� Mental Health Care in General Health Care

� Basic Mental Health Care

�� Awareness on metal healthAwareness on metal health

MENTAL HEALTH CARE DIRECTION IN CAMBODIAMENTAL HEALTH CARE DIRECTION IN CAMBODIA

�������������� �������������������������� ����������������� ��

PRIORITY AREAS

� Organizational Reform/ Institutional Development(National Program for Mental Health)

� Mental Health Human Resource Development(Specialist, basic & primary mental health care training)

� Mental Health Service Provision(Basic and Primary Mental Health Care)

� Behavioral Change(Change Attitudes of mental health providers and consumers & their

communities)

� Research(Epidemiological Study of mental illness)

�������������� �������������������������� ����������������� ��

� Developing Mental Health Policy/ Plan/LegislationSupported by WHO, the Mental Health Policy/Plan developed in 2002.

� Developing National Mental Health Structure/ProgramThe roles of International Organizations through collaboration withWHO and implementation of CMHTP-CMHDP & NMHP are buildingup capacities and transfer the responsibility in MH development to theCambodian MoH.

Human Resource Development:

INSTITUTONAL DEVLOPMENTINSTITUTONAL DEVLOPMENT

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Seminar on Health and Migration, 9-11 June 2004Session IIB: Public Health and Migration

Investing in mental health in post-conflict rehabilitation, Professor Ka SUNBAUNAT

�������������� �������������������������� ����������������� ��

�Training Psychiatrists, Psychiatric Nurses�Training Basic Mental Health Care for GPs

and Nurses�Training Primary Mental Health Care for GPs

and Nurses� Introducing Mental Health in the curriculum of

the undergraduate medical students and nurse students at the TSMC and four RTC.

�Training of trainers in MH �� Training other Mental Health Professionals Training other Mental Health Professionals

HUMAN RESOURCE DEVLOPMENTHUMAN RESOURCE DEVLOPMENT

�������������� �������������������������� ����������������� ��

� �"������������������������

To enable GPs and Nurses to recognize and treat commonmental disorders.

� ����������#����������������������Integrating mental health in National Strategic Health Plan ascomponents of MPA including clinical and out reach activities

SERVICES PROVISIONSERVICES PROVISION

�������������� �������������������������� ����������������� ��

� Change the attitude of health providersRaise awareness among public and health staff about quality of mental health services and strengthen the professional ethics,…)

� Empower consumersUse inter-personal communication and mass media such as Radio/TV , magazines

� Promote healthy lifestylesUse community structure, family, consumers and multi- sectorial approaches to influence healthy practice…)Collaborate with local resources ( parents, families, teacher, authority … ) to prevent/promote mental health.

BEHAVIORAL CHANGEBEHAVIORAL CHANGE

�������������� �������������������������� ����������������� ��

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Seminar on Health and Migration, 9-11 June 2004Session IIB: Public Health and Migration

Investing in mental health in post-conflict rehabilitation, Professor Ka SUNBAUNAT

�������������� �������������������������� ����������������� ��

�������������� �������������������������� ����������������� ��

New Cases by Year

26562025

1548

7446

482641583965

2895

1341

010002000300040005000600070008000

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Ten Year AchievementTen Year Achievement

�������������� �������������������������� ����������������� �

TEN YEAR ACHIEVEMENT

Consultation by Year

2317516076

9615

50575

3866038468

3130423701

13990

0

10000

20000

30000

40000

50000

60000

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

�������������� �������������������������� ����������������� �!

$�%�&�'()�*$�%�&�'()�*