Bring Mental Health Care to Cambodians

She is 33 years old with three siblings living in Battambang province. Her family has been poor, work as laborers for supporting their family. When TPO team arrived, she shouted, pointed, sang, and behaved violently.With dirty clothing, one leg was chained attached to the pillar of the cottage, and the other leg was swollen because she tied up with string by herself. Her mother described emotionally that her family had been suffered and problematic since her daughter became mentally ill. She could not communicate and had no insight.

At the age of seven, she was abused sexually by a man and threatened to kill her life if she dared to tell anyone. The man abused her for several times and no one cared what she told even though she tried informing them. At that time, she was almost very fear, terrible and shocked.

At the age of 16, in grade 8, she was moved to new place. The road to school is difficult to travel and she went to school by boat. She was also physically and emotionally abused by her brother and parents. At the age of 19, some of hers friend in the village got married and asked to be bridesmaid for their marriage for 2 times. In the second time, she felt shocked and terrible because the makeup artist physically harassed her, reminding her of her childhood’s abuse. She could not continue her studies and dropped out of 11th grade at the age of 19.

At that time, her signs and symptoms disturbed her more frequently such as bizarre behaviors, and can’t be communicable. Her parents took her to see some traditional healers and applied harmful approaches for treating her. These made her illness more serious, however she can’t resist. She tried running away from home, and she was forced to back home and beaten physically by her brother because of running away. The treatment of traditional healers seems to be less effective and more severe and costly.

More than a month later, her father took her to a health center for treatment. The treatment her seemed more effective and made her to recover from her symptoms. Later she stopped taking the medicine, she was relapsed with some symptoms: aggressive behaviors, yelling, cursing, destroying property and run away from home.So her father concerned of her safety and compensation for her action, her family decided to lock up or chain her.

After receiving treatment for a month, her condition improved and she was able to communicate politely with others. For 2 months later she recovered from signs and symptoms, her family decided to release her. Now she can do housework, such as cooking, washing clothes and keeping the house clean.

Her parents can spend time earn extra money with feeling secured about her.

“Mom… please release me from chain, even the spirituals (Ghost) were also released during Pchum Ben day”.

A 39 years old man was chained at the back house. When the TPO team arrived one of his legs was in chained and trap in a rusty cage. His body was naked cover with dirt and can’t communicate. He sat in silent manner and less impressive with our presence.

He has been detained by his family for many years because of his violent behavior and harm. His aggressive behaviors made the villagers feel scare. He lost insight, cannot communicated, talk alone, cannot sleep, refuse to dress, destroyed materials, tore nets blanket and cloths.

The patents starting to get sick since he was 19 years old. The first symptoms were walking around with inappropriate behaviors.  He used to have a treatment from one of public hospital in Phnom Penh and traditional healers and his condition was recovered for a while. But he relapsed after his wife left him. He was chained with less care in a rusty cage because his family feel hopeless to recover.

After 2months of receiving treatment from TPO and it’s time of Pchun Ben ceremony (it’s is a significant religious ritual for Cambodian people as Buddhists. During this ritual people belief that the souls of ghost are released to get food from their living relative). In the early morning he heard Dhamma chanted by the monks because his house is not far from pagoda. His mom prepared breakfast for him and he said to his mom “Mom…, please release me even the spirituals (ghost) were released during Pchum Ben day”. After mom hearing his proposal, she feel shocked and very surprised. She feels excited emotionally because she can’t communicate with him for many years. In fact, his mom feels hopeless and never expected to recover. She felt nervous, worried, and excited because she has traumatized caused by his violent behavior. Mom had discussion with family members and then they decided to release him.

After being released, he took a bath for cleaning because he has never taken a bath for so long. In the early morning, he went to the pagoda to attend the ceremony and donated small amount of money in his pocket to the pagoda. The villagers felt very surprised with his presence because they thought that he died for so long actually he was chained. The villagers felt happy with his recovery and give him some money.  

Now he could take care himself and his family is very happy and excited with his recovery. They thanked individuals who donate for letting TPO to provide treatment with free of charge and integrate him into family.

A 34-year-old woman was under serious mental health disorder. Her family chained her for 09 months because of her aggressive and interrupting behavior. Her family contacted TPO to request treatment for her. When our team arrived at her house, the patient ignored, still talking alone, constantly seemingly angry and arguing with others. The caregivers mentioned emotionally that they decided to lock up or chain her unintentionally, it’s very suffered and difficult when they saw patient’s leg was chained to the pillars of the house. They concerned about neighbors’ reaction to her signs and symptoms and felt ashamed.  They can’t tolerant to her aggressive and disturbed behavior. The family added that it’s extremely tired, exhausted, and difficult in taking care a family member who has mental illness with aggressive and disturbed behavior. Moreover, most of family members faced mental health problems too.

The patient has been married for 10 years with one child. Due to her family is poor, she decided to go for employment in Thailand as a construction laborer. She had been mentally ill since she was in Thailand. Her husband brought to the Thai-Cambodian border and dropped her alone there and then he left. Her life was abandoned, and homeless until her family knew and take her back home.

Meanwhile, her mother bought medicine from private following to a neighbor who has a similar mental illness to treat her, but she did not recover. Her condition worsened, aggressively shouting. Her mother believed in traditional healers and took her to those for treatment, but still did not recover.

He often tried running away to where he used to live in Thailand. At that time, she ran and traveled to Thailand, where he used to work. For one week after her arrival, she was referred to hospitalize. After being hospitalized and receiving free treatment for two months, her condition improved and she was discharged. Meanwhile, she has no money, her life is homeless in Thailand. She met Cambodian laborers who is compassionate; they gave her money to buy food and travelling to the Cambodian border. When she arrived home, her illness began to worsen. She sang songs, talked alone, remained silent, restless, no sleep, can’t communicate, poor insight, aggressive ... her relatives decided to chain her. Her parents had no money for her treatment. They felt hopeless in treatment and didn’t expect to get treatment from anyone and hopeless to recover.  

After three months of treatment by TPO psychiatrist, her condition improved and the family decided to release her. Now her family felt released and longer tired of taking care of her. She could cook, wash clothes, and clean the house. The family is very excited and enthusiastic after being recovered and unchained. They said they have never expect about her recovery and it would be amazing  and wonderful for her family to have a specialist visit their house where is rural area and provide treatment for free of charge.  Her family is deeply grateful to TPO and generous individuals who donate to rescue her daughter's life because they have heavy burdens on their shoulders and now they feel released and have time to earn for supporting family.

A 32-year-old woman was chained and left under an unoccupied old house, without wall and lying on a piece of board with old clothes, and ignoring the presence of the therapists. She speaks alone, and she has less insight.

She has been suffering from mental illness since 2013 and at that time she was referred to Kampong Cham Provincial Hospital with the support for medical and travel expenses by a humanitarian NGO. After recovering for several months, she relapsed and walked out and was sexually abused several times. For her safety and prevention from abuse, her father decided to chain her because she went out and was raped and she had four children by abusers. The first, second and third children are being adopted. Currently, her father, a widower, is looking after her and her fourth child, who was just 9 months old.

The district team in charge of women's and children's affairs asked TPO to provide treatment for her mental illness. When the treatment team arrived and then made assessment for making diagnosis and prescribing medicine. The treatment team also did psycho-education on psychosis, causes and effective treatment to villagers and relatives, and help them change their negative attitudes toward patient and provide support to patient and her family.

Her neighbors and relatives gave her food and her father looked after her. She also received support from partner organizations and district-level women's affairs officials such as money, materials and food, as well as receiving fund from the government for the poor during Covid-19 epidemic.

After receiving treatment from TPO for 10 months, the patient recovered and she was communicable. She gained more insight and knew her baby and expressed love for him. She was unchained by her family. The living conditions of her family are better because the father can go out to work to earn extra income as well to grow crops and to raise animals, which is also supported by the partner organization.

Patients can take care of herself and can take care of her baby, and could do housework such as: bathing, washing clothes, washing dishes, and cooking. Her family was happy and excited to see her better condition and able to take care of herself and raise chickens, ducks, grow vegetables, take care of her baby and want to do small business for a living.

After receiving information on Facebook, requested for help, the TPO team reached to the patient's home. When walking in about 10 meters away, a young woman screamed and threw objects at TPO therapists.

The female patient, 32 years, is a daughter of widow and lives in poverty under the veranda of a relative’s house. The mother works as a seller for children at public primary school for earning very small income to pay for medicine fee at private doctor in neighboring district. Patient’s mother said her daughter is a good person, diligent in learning and also a source of support for her in old age. But everything turned out to be hopeless after her daughter became seriously mentally ill.

The patient has been suffering from mental illness for 10 years and she was referred to mental health of public hospital in Phnom Penh and many traditional healers, but did not get better and then her mother felt hopeless to be relieved. In the last three years, her daughter's illness has worsened, and she has been violent, beating her mother and anyone who comes near her.

For preventing everyone safely, her mother decided to lock up or chain her with the cooperation of local authorities and neighboring villagers. She was chained for three years.

At the first session, the patient was unable to communicate. She does not sleep, shouts, curses, no insight, talk alone, no longer knows his mother, and paranoid.

After receiving treatment for three months, the patient was better from signs and symptoms of psychosis, then her mother decided to unchain her. Meanwhile, the provincial authorities built the house for this family with donation of land from his relatives as well issued legal letter for house possession.

The patient’s mother thanked TPO and individuals who donate to TPO for providing treatment for mentally ill patients who are chained or locked up, giving her family life new hope.