On a lonely post – Insights from psychiatric consultations in Siem Reap

There is a small consultation room here which, unlike the other rooms in the clinic, is decorated with colorful carpets, toys, and imaginative children's drawings. It is the workplace of Dr. Thida, the hospital's only psychiatrist to date.

There are only about a hundred psychiatrists in the whole of Cambodia for a population of 17 million. Around 40 percent of the population suffers from mental health problems, and the suicide rate is well above the global average (1).

For a day and a half, Dr. Thida translated the patient consultations for me and told me exciting but also sad stories from her everyday working life. I would like to share the most important impressions of my visit here using a few case studies.

The problem of compliance

Many children only come for appointments every few months, as their parents cannot always afford (or are unwilling to pay for) the long journey. Religious beliefs and spirituality play a particularly important role among rural populations. Many parents first take their children to healers or use traditional medicines or therapies, often at exorbitant prices, before turning to doctors.

A 10-year-old boy sits stiffly on a chair, eyes wide open, speaking in a monotone voice – presumably due to drug abuse. However, his stepmother is convinced that his “soul has been stolen” because his mother died with “bad karma.” Instead of taking him to the hospital, she regularly takes him to a healer, who has now referred her to the hospital to get medication. Dr. Thida suspects that the healer is enriching himself through conventional medicine.

Difficult parent-child relationships

Here, grandparents or aunts often take care of children from several families. Parents have to work hard to meet their children's basic needs. Many believe that a good education and sufficient money are the most important things. There is often a lack of understanding, time, or energy for emotional support in difficult times.

A 12-year-old boy travels with his grandmother from far away because his performance at school has declined. The emotionally detached boy explains that his biological father locked him in a room from morning until midnight while he went to work. His mother would only take him in if he got good grades. That is why the boy wants to become a child monk, which for many children from poor backgrounds is the only way to get a good education. When Dr. Thida asks him what three wishes he would have if he had a magic lamp, he has only one answer: “To do well in school.”

Transgenerational trauma

Many parents grew up in a climate of fear and uncertainty. This also shapes the next generation. Traumatized parents may be less emotionally available. There is evidence that extreme trauma can leave molecular traces (e.g., changes in stress hormone regulation) that are passed on.

Thida herself recounts: As a child, I often heard things like, “Eat up, I had to eat my neighbors' meat to survive back then,” or “Be quiet at night—when someone was loud in our house, the soldiers came and shot them.”

The border conflict with Thailand

It has driven countless families from their homes, many of whom now live in overcrowded refugee camps. This traumatic experience hits the vulnerable psyche of children particularly hard.

One teenager suffers from paranoia. He feels like he is being watched, breathes rapidly, and wants nothing more than to hide under the table. He currently lives in a refugee camp. The resettlement triggered his condition.

The lack of child protection in Cambodia

The protection of children is legally the responsibility of the Ministry of Social Affairs, Veterans and Youth Rehabilitation (MoSVY). However, this ministry is chronically underfunded and has little enforcement power in practice (2).

A teenage girl experiences domestic violence and is involved in criminal gangs. Unfortunately, the psychiatrist cannot help her escape this situation. The girl would end up on the streets, which in her case would be even more dangerous than leaving her with her family.

Screen addiction

This is a growing problem. Many children spend several hours a day in front of a cell phone from the age of one. Motor and language development delays are increasingly being observed in children. Many poorer families hope that their children will learn English better through high social media consumption and thus have a professional advantage.

Overall, these challenges demonstrate the importance of a family-oriented approach to therapy at Kantha Bopha Hospital. Dr. Thida tries to achieve as much as possible in the few consultation hours available by providing good information and targeted medication. Often, it is enough to show parents the importance of good communication with their children. There is often simply not enough time and resources for the intensive individual therapy that would often be indicated.

An exciting approach is to involve monks and religiosity in issues related to mental health. For example, more and more monks are being trained to teach relaxation and mindfulness techniques in schools.

Thida recommends that the family of an eight-year-old girl with acute psychosis arrange for a monk to perform a spiritual cleansing of their home. The girl believes she is being haunted by deceased relatives. The whole family is extremely fearful and religious. Perhaps the monk can reassure the parents and thus have a positive influence on the child.

There is still a lot to be done in the area of mental health in the country. Around 80 percent of the children she sees report suicide attempts or plans. She is currently training other doctors at the hospital through peer tutoring and hopes that more professionals will soon be found to support her work in Siem Reap.

I am incredibly impressed by Thida's commitment. She is a lone fighter who, despite the difficult circumstances, is there for the children with a lot of passion and sincere compassion. In my private life, I have also found Thida to be an open and lovable person. I wish her every success and hope that more colorful therapy rooms will soon complement hers.

With best regards from Siem Reap

Marah

1.      TPO Cambodia [Internet]. [cited 2025 Aug 30]. The Need. Available from: https://tpocambodia.org/the-need/

2.      Williamson J, Gross P. DCOF-UNICEF ASSESSMENT OF “STRENGTHENING SYSTEMS TO PROTECT VULNERABLE CHILDREN AND FAMILIES IN CAMBODIA.”