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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
�������������� �������������������������� ����������������� �
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
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
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
4
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
�������������� �������������������������� ����������������� ��
5
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
�������������� �������������������������� ����������������� �!
$�%�&�'()�*$�%�&�'()�*