Instructor
Carrie Herbert, right, and three psychologists meet in Phnom Penh on September
24. (Rayna Stackhouse/The Cambodia Daily)
In a country with one of the world’s highest
rates of psychological stress, Cambodia has a remarkably low number of
psychologists, and is struggling to retain those who go to work on the
front-lines of the field.
A new program at the Royal University of Phnom
Penh (RUPP) is hoping to change that.
The sheer numbers of Cambodians coping with
war-related post-traumatic stress disorder—estimated at up to a third of the
adult population—and other mental illnesses, as well as abuse, exploitation and
domestic violence, has created oversized workloads for the country’s trained
professionals.
The potential for burnout among providers of psychiatric
care is of such a concern that the university is offering a course in clinical
supervision that aims to train psychologists to provide professional support to
their peers treating patients across the country.
Lim Bouyheak, a 31-year-old psychologist, and
10 other students are in the first supervision class. Over six months, the
students will receive classroom training and opportunities to put their skills
into practice in the field.
Ms. Bouyheak knows firsthand how difficult it
can be to handle an unmanageable caseload. In her first job after receiving a
bachelor’s degree in psychology, she worked at the Maddox Chivan Children’s
Center, a facility that actress Angelina Jolie opened for children and
teenagers with HIV and AIDS.
“I felt like I was not competent to do my
work because I didn’t see improvement in my children,” Ms. Bouyheak said.
“Every time I went to work, I just felt exhausted and I felt like I didn’t want
to do that job anymore.”
After a year, she was close to quitting, but
her colleagues intervened, advising her on the importance of setting boundaries
between her life and her young clients’ needs. Following their advice, Ms.
Bouyheak sought professional counseling and found a better balance.
That type of intercession is just what German
psychologist Bernhild Pfautsch had in mind when she proposed the training
course and a program to offer a certificate in clinical supervision at RUPP.
After working as an adviser to the
university’s master’s program in psychology for more than a year, she realized
the students were graduating without the professional guidance that would help
them succeed in their first jobs.
“Here it is so hard because they have five
semesters and their internship, and they are expected to be this specialist,”
Ms. Pfautsch said.
With funding from her employer, GIZ, a German
development organization, Ms. Pfautsch collaborated with foreign and local
psychologists in Phnom Penh to create a four-part curriculum that is the first
of its kind in Cambodia. The course started in August.
During the first module, the students are
learning how a supervisor should educate, evaluate and provide psychological
support to those they are supervising. The remaining modules will also focus on
the development of skills to help young psychologists thrive.
Retention of qualified mental health
providers in Cambodia is critical for two reasons: There are far too few of
them for the population’s needs, and the number of newly trained psychologists
and counselors entering the field has slowed in recent years.
Studies have found that PTSD rates among
Khmer Rouge survivors range from 14.2 percent to 33.4 percent—significantly
higher than the 0.4 percent global prevalence, according to a mental health
survey conducted in 2012 by RUPP and Transcultural Psychological Organizations,
a mental health services NGO.
Seventy percent of the country’s population
was born after the war, but the study still found high rates of psychological
stress in that demographic. It reported that 70.2 percent of the post-war
generation has experienced at least one traumatic event, such as natural
disasters, life threatening accidents or witnessing someone physically
attacked.
The study also found Cambodia’s suicide rate
to be the second highest in the world at 42.35 per 100,000 people. In the same
year, the World Health Organization reported Cambodia’s suicide rate to be 9
out of 100,000 people.
Yet the country’s budget for mental health
care remains tiny. Less than 1 percent of the national health budget, or about
$100,000, is allocated to the Health Ministry’s department of mental health and
substance abuse excluding salaries, said Chhit Sophal, the department’s
head.
According to the World Health Organization,
Cambodia had 0.23 psychiatrists per 100,000 people in 2011, the last year for
which such statistics are available. That compares to 1.01 psychiatrists per
100,000 people in neighboring Vietnam.
RUPP is the only university in Cambodia that
offers psychology as a major. Since it began the program in 1994, it has
graduated more than 1,000 psychologists. The government does not employ any of
them, according to Dr. Sophal.
“We know that there are many psychologists
trained from RUPP, but in the government every year we have limited budget to
recruit new staff,” he said. “This is our constraint. It doesn’t mean that we
don’t have a need. We need, but we don’t have budget for that.”
That leaves a majority of graduates looking
for jobs at NGOs, where those in the sector say opportunities appear to be
dwindling. The lack of employment prospects has resulted in a reduction in the
number of students majoring in psychology at RUPP. Over the past five years,
the number has dropped by nearly 80 percent, according to the university.
There are numerous factors affecting the
department’s enrollment, said Sek Sisokhom, the chair of the psychology
department, including the 40 percent reduction in the number of students
passing the national high school exit exam, making them eligible for
university.
Just a few years ago, the job market was more
inviting. Ms. Bouyheak, who has since worked for a variety of NGOs, majored in
psychology because of the post-graduation prospects. However, the thriving job
market for such majors has dried up in the past 10 years, she said.
Low pay—about $200 a month for new
graduates—also is a factor, she said. Of the 70 to 80 others majoring in
psychology at RUPP when Ms. Bouyheak was a student, she only knows of a handful
still working in the field.
A March survey by RUPP found that a third of
the graduates from its master’s program in clinical psychology, which focuses
on assessment and treatment, are currently working as counselors or therapists,
while the rest are working as researchers, teachers in unrelated fields or have
jobs in the sales and service sector.
Even though there are many challenges in the
provision of mental health services in Cambodia, Ms. Bouyheak still has hope
for the future, and her own ability to contribute with her newly acquired
understanding of the profession.
“I want to be one person to support the other
fresh graduates in psychology or fresh counselors,” Ms. Bouyheak said. “I just
know how important it is and how much support they need. I used to be in their
shoes.”
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