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Indradevi:
Community Mental Health
Work in Cambodia
 By
Laura Wald -- While living in Vietnam for the last six months, I
had the opportunity to visit a project in Phnom Penh, Cambodia funded
by the Ignacio Martín-Baró Fund. The Indradevi Association, or IDA,
is a grassroots organization of six people that works with sex workers
and squatters in Phnom Penh. They offer STD and HIV education, and home
care for people with AIDS. However, in the course of their work, the
group noticed that many of their clients were coming to them seeking
informal counseling for personal problems arising from their situations
of extreme poverty, disenfranchisement, violence, and crime in their
communities. IDA thus sought funding from the Martín-Baró Fund to open
a counseling center, train peer counselor volunteers, and run weekly
mental health education workshops in the community.
 Cambodia has been
in a nearly constant state of civil strife since 1970. Half a decade
of civil war was followed by five years of the Khmer Rouge ‘killing
fields’ during which an estimated 1.7 to three million Cambodians died.
According to Dy Ratha, president of IDA, even after 1979, when the Vietnamese
invaded and drove Pol Pot from power, the new government never returned
the land that the Khmer Rouge had taken from the peasants. Now, millions
are landless and  have
had to move to the cities where jobs and housing are difficult to find.
Moreover, many girls and young women are sent to the cities to become
sex workers as the only way to earn money.
Since receiving
the grant from the Fund, the group has trained fifteen volunteers, seven
men and eight women, who now offer peer counseling in their communities,
make referrals to the counseling center, and educate their neighbors
about ways of coping with the stresses of living in an environment of
extreme poverty where there is a constant threat of violence. IDA has
also opened a counseling center located in one of the main squatter
districts in Phnom Penh. It is open three half-days a week and by appointment,
and an average of two to three clients a week come for individual counseling
with problems related to domestic violence, substance abuse by a family
member, insomnia, and other social and economic stresses. The staff
note that there has been a good deal of resistance to the notion of
mental health counseling, which may account for the low number of clients
currently coming to the center.
Weekly workshops,
however, are the main focus of Indradevi’s community mental health work.
During my visit, I was invited to attend a workshop, which IDA held
in the squatter area that sprawls out of sight behind the street on
which their office is located. The poverty in Phnom Penh is striking;
the city has few paved roads, many run-down buildings, and a general
feeling of fatigue and wariness about it. In the squatter area shacks
are made of wood, lending a false air of stability, since they can be
razed any time residents do not pay regular bribes to local police and
officials.
We made our way
to an orphanage that was hosting this week’s community mental health
workshop, and were immediately flocked by children who hugged me and
kissed me on sight, fascinated to see a foreigner. Some of the children
are being trained in classical Cambodian dance, which requires grace
and synchronization. They were going to perform at the Royal Palace
that day, but first they performed four intricate dances for us in full
makeup and elaborate costumes.
After the dance,
we began the two-hour workshop, which was attended by 23 community members.
Two IDA staff led the workshop, and were clearly very skilled in drawing
out participants and creating a warm and supportive environment. They
talked about common symptoms of stress experienced by Cambodians, emphasizing
common cultural metaphors and complaints such as headaches and ‘thinking
too much.’ They emphasized focusing on tasks and goals that are achievable
and helped participants brainstorm about their particular stressors
and ways to address them while the group ate a snack of fruit and sandwiches.
Most of the people talked about difficulties with housing, finding jobs,
poor nutrition, children’s illnesses, substance abuse, and domestic
violence resulting from the stresses of poverty. Participants were eager
to talk about their situations and were very receptive to learning about
basic problem-solving strategies.
While the president
of Indradevi is very involved in human rights work and brings that consciousness
to her work at IDA, the group does not talk explicitly about these topics
in their counseling work. They note that they are afraid to do so in
the workshops because they are never sure if there are government officials
planted in the group to keep an eye on them, something that is apparently
not uncommon. In Cambodia, even hinting that mental health is affected
by immediate social conditions may be viewed as a threat to the state,
and the mere act of doing of mental health work can be considered subversive.
This is especially the case when the model emphasizes psychosocial stress,
the approach of Indradevi. Mental health is understood as a product
not just of biology but also of immediate circumstances and stresses
in this model, an assumption that acknowledges the sociopolitical in
a subtle, unspoken way.
The work of Indradevi
is admirable. The group has clearly developed a rapport with this community
of the very poor and disenfranchised. The workshop participants continue
to fill rooms after six months, and are beginning to be more open to
seeking help and addressing the mental health needs of their community.
As in many other countries throughout the world, what may be a foreign
concept, mental health, is becoming a recognized priority as groups
like Indradevi discover ways to define it in locally meaningful ways.
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English
to Spanish translations
courtesy
of Melisa Flores
©
2007, Ignacio Martín-Baró Fund for Mental Health & Human Rights
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