A responsive evaluation of mental health treatment in Cambodia: Intentionally addressing poverty to increase cultural responsiveness in therapy

Abstract

Mental health issues are significant contributors to the global burden of disease with the highest incidence in resource poor countries; 90% of those in need of mental health treatment reside in low resource countries but receive only 10% of the world's resources. Cambodia, the eighth least developed country in the world, serves as one example of the need to address mental health concerns in low-income, resource poor countries. The current study utilises responsive evaluation methodology to explore how poverty-stricken Cambodian clients, therapists and supervisors experience Western models of therapy as culturally responsive to their unique needs. Quantitative and qualitative data were triangulated across multiple stakeholders using numerous methods including a focus group, interviews, surveys, case illustrations and live supervision observation and analysed using constant comparative analysis. Emerging findings suggest that poverty, material needs, therapy location and financial situations greatly impact the daily lives and mental health conditions of Cambodians and hinder clients' therapeutic progress. The local community needs and context of poverty greatly hinder clients' therapeutic progress in therapy treatment and when therapy does not directly address the culture of poverty, clients did not experience therapy as valuable despite some temporary decreases in mental health symptoms.

Cross‐cultural supervision in international settings: experiences of foreign supervisors and native supervisees in Cambodia

“…Cambodia continues to rebuild from decades of civil war and the Khmer Rouge genocide. Mental health needs are especially high with regard to anxiety disorders (24.7%) depression (16.7%) and posttraumatic stress disorder (7.6%) (Khann et al, 2016), and are exacerbated by extreme poverty (Seponski et al, 2014). Governmentally, there is a lack of infrastructure, a decentralized mental health system, and limited funding available for mental health services (Stewart, Tsong and Peou, 2010).…”

“…Interest in family therapy is increasing in Cambodia (Seponski, Lewis and Megginson, 2014), yet psychotherapy practice is not sanctioned or licensed and there are no formalized training or supervision requirements (Chan, 2013;Sim, 2012). Due to the newness of therapy training, the availability of supervisors in Cambodia is limited and supervision is conducted by visiting Western or expatriate therapists (Nhong Hema, personal communication, 26 March 2010).…”

Development of mental healthcare in Cambodia: barriers and opportunities

“…The importance of culturally appropriate mental healthcare has also been recognised previously [ 56 – 59 ], resonating with the third theme, “Developing a model for the Cambodian culture and context.” Mental health service development has to be affordable and appropriate for the current situation in Cambodia. The post-conflict societal context, cultural influences and health beliefs in Cambodia require additional efforts to develop community-based mental health services that are appropriate for the country’s current needs.…”

“…The importance of culturally appropriate mental healthcare has also been recognised previously [56][57][58][59], resonating with the third theme, "Developing a model for the Cambodian culture and context. " Mental health service development has to be affordable and appropriate for the current situation in Cambodia.…”

Exploring Contextual Trauma in Cambodia: A Sociointerpersonal Perspective on Posttraumatic Stress Disorder

“…Testimonial therapy has been previously used in Cambodia and has served as an opportunity for communal and individual healing (Agger, Igreja, Kiehle, & Polatin, 2012). As the model demonstrated that current stressors at individual and community levels were more salient than previous war traumas in impacting PTSD symptoms, such interventions need to be combined with a focus on alleviating poverty and providing more accessible mental and physical health care (Jarl et al, 2015;Seponski, Lewis, & Megginson, 2014).…”