2015 ANNUAL REPORT TPO VISION CAMBODIAN PEOPLE LIVE WITH GOOD MENTAL HEALTH AND ACHIEVE A SATISFACTORY QUALITY OF LIFE.

TPO MISSION TO IMPROVE THE WELL-BEING OF CAMBODIAN PEOPLE WITH PSYCHOSOCIAL AND MENTAL HEALTH PROBLEMS, THEREBY INCREASING THEIR ABILITY TO FUNCTION EFFECTIVELY WITHIN THEIR WORK, FAMILY AND COMMUNITIES.

TPO VALUES TPO PEOPLE ARE PROFESSIONAL, COMMITTED, AND ALWAYS STRIVE FOR QUALITY. WE ARE KEEN TO LEARN AND REAL TEAM PLAYERS. WE ARE TRUSTWORTHY AND HONEST PEOPLE WHO ALWAYS DEMONSTRATE RESPECT AND EMPATHY AND VALUE EACH INDIVIDUAL’S OPINION.

TRANSCULTURAL PSYCHOSOCIAL ORGANIZATION (TPO) TPO Building, #2-4, 023 63 66 991 (Treatment Center) Oknha Vaing Road (St 1952), 023 63 66 992 (Admin) Sang Kat Thmey, 023 63 66 993 (Training) , [email protected] PO Box 1124, www.tpocambodia.org Phnom Penh, Cambodia www.facebook.com/tpocambodia

DEAR FRIENDS OF TPO CAMBODIA,

I am pleased to present to you TPO’s Annual Report Everyone at TPO feels so proud of this achievement of TPO activities for 2015. This report reflects our and especially the present of His Majesty strongly tireless efforts to contribute to improve mental encourage us to continue doing good work to improve wellbeing of Cambodian people of all colors. mental health of Cambodian people.

The year 2015 was the year of “Great Pride” as TPO All this achievement was made possible thanks to celebrated its 20 Year Anniversary and Inauguration the generous support from all of our donors. TPO of TPO Treatment Center under the auspices of His Management and its Board of Director would like to Majesty King Norodom Sihamoni of the Kingdom of express sincere thank donors and taxpayers in their Cambodia. respective country for supporting Cambodian people.

This anniversary marks 20 years of TPO’s existent I hope you will find this report useful. and 20 years of TPO serving mental health services for Cambodian people. During the past 20 years, TPO Sincerely yours, Cambodia’s mental health services benefited to more than 200 thousands people in Cambodia. This means that TPO contributes to improve mental wellbeing of individual and family, increase knowledge and skill of Dr Sotheara Chhim mental health professionals and para-professionals. In addition, we have contributed knowledge into Executive Director the field of mental health, psychology and psychiatry through our research and publication.

1 OUR PROJECTS

Improving Mental Health for Survivors of This 2013–2017 project is funded by the Australian Government’s 1 Gender-Based Violence & Sexual Assault Department of Foreign Affairs and Trade (DFAT).

Partnership Program for Protection of Children (3PC)

Access to Justice for Women

Community Responses to Violence against Women & Children

Justice & Relief for Survivors of the Khmer Rouge

Truth, Reconciliation & Healing – Towards a Shared Future

Mental Health Care & Psychosocial Services for Cambodian Prisoners

Strengthening Local Mental Health Systems

Enhancing Mental Health Literacy among Village Health Support Groups

Operation Unchain

2 In 2015, promoting gender equality and gender-based violence. TPO established improving access to psychological services and ran 12 self-help groups with a total for survivors of gender-based violence of 81 members. We provided additional and sexual assault were again a priority individual counseling to 26 people. About for TPO’s community mental health team 465 community members (367 women in Battambang. Our staff in Battambang and 98 men) including survivors of continued to strengthen capacity to 19 violence, men with a drinking problem, and community resource people (CRPs) on vulnerable groups such as children at risk Mental Health First Aid such as identifying and female heads of households, received signs of anxiety, depression, and how psycho-education from TPO Cambodia. to support community members with All participants in the self-help groups as psychological problems, for example well as those who received counseling through relaxation and meditation. In reported a significant improvement in the 2015, our CRPs had identified and provided state of their mental health. emotional support to 126 survivors of 2015 Annual Report 3 OUR PROJECTS

Improving Mental Health for Survivors of Gender-Based Violence & Sexual Assault

Partnership Program for This project is funded by the UNICEF 2 Protection of Children (3PC) via Friend International (FI).

Access to Justice for Women

Community Responses to Violence against Women & Children

Justice & Relief for Survivors of the Khmer Rouge

Truth, Reconciliation & Healing – Towards a Shared Future

Mental Health Care & Psychosocial Services for Cambodian Prisoners

Strengthening Local Mental Health Systems

Enhancing Mental Health Literacy among Village Health Support Groups

Operation Unchain

4 In 2015, TPO is selected by Friend Inter- years old (53 girls) participated in Child national to work together as a partner Friendly Club, which allows children to to strengthen child protection system express and share their feeling, experience in response violent against children and in the group of children who are witnesses/ to promote a protective family environ- direct experience of violence. The Child ment. TPO’s focus is to provide support Friendly Club for children aim to increase and service to survivors of gender-based self-confidents, reduces stress/anxiety for violence, vulnerable children and local children in family violence. authorities in the community (Battambang This project identified and supported 15 province, Banan district, Kanteu 1 and GBV’ families who have improve their Kanteu2). This project complements with psychological wellbeing to participate in the current project funded by DFAT, which chicken raising programme. These 15 aims to improve mental wellbeing through families have received training on chicken livelihood support. raising and a capital of $150/family to build TPO also selected and trained to 24 cage, and to buy chicken. 6months after children club representative members, receiving this support, 11 out of 15 families who are formed by World Vision, on basic have increased numbers of chicken and mental health. This training aims to create a they can earn income from the chicken response and protection system to children raising. at risk. About 79 children between 8-12

2015 Annual Report 5 OUR PROJECTS

Improving Mental Health for Survivors of Gender-Based Violence & Sexual Assault

Partnership Program for Protection of Children (3PC)

In 2015, this project was funded by GIZ (German Access to Justice for Women 3 Society for International Cooperation) and operating with support from Cambodia’s Ministry of Women’s Community Responses to Violence Affairs (MoWA). against Women & Children

Justice & Relief for Survivors of the Khmer Rouge

Truth, Reconciliation & Healing – Towards a Shared Future

Mental Health Care & Psychosocial Services for Cambodian Prisoners

Strengthening Local Mental Health Systems

Enhancing Mental Health Literacy among Village Health Support Groups

Operation Unchain

6 In 2015, one of the aims of TPO’s expressed the desire to stay at the community mental health teams in Siem forefront of tackling mental health Reap and Kampong Thom provinces issues in their communities. Those was to support disadvantaged women trained CRPs have managed to provide in two districts: Chum district an emotional support to 134 survivors ( province) and Stoang of GBV through relaxation exercise, district (). control of anger management, and The women and girls we worked with referral for needed services. there are victims of gender-based With these CRPs we established and violence – most often perpetrated ran 20 self-help groups for 222 people within the family – who have been and we provided individual counseling lacking access to medical care, social to 61 people (Women=37, Men=24). services and justice. TPO has helped We ran 33 psycho-education sessions them gain access to these services about gender-based violence and while also providing mental health care mental health for a total of 1,459 villag- and psychological support. We have ers (F=1115, M=344). TPO referred also worked with the perpetrators 14 clients for other services including of this violence to rehabilitate them. psychiatric treatments and shelter With this work we aim to help build service from CWCC. Ten clients were better informed, healthier and peaceful referred in by LAC, Banteay Srey, communities where women can feel PDoWA SR and the First Step Organi- safe, empowered and confident. zation to get our psychological support We continued to provide coaching and from the TPO’s counselor. follow up in mental health to commu- nity resource people (CRPs) who had

2015 Annual Report 7 OUR PROJECTS

Improving Mental Health for Survivors of Gender-Based Violence & Sexual Assault

Partnership Program for Protection of Children (3PC)

Access to Justice for Women

Community Responses to Violence This project is funded by Investing in Children and 4 against Women & Children their Societies (ICS). It is managed by our Community Team Leader from our Siem Reap team, but we have Justice & Relief for Survivors of set up a dedicated field office in Chi Kraeng itself in the Khmer Rouge order to serve the community better. Truth, Reconciliation & Healing – Towards a Shared Future

Mental Health Care & Psychosocial Services for Cambodian Prisoners

Strengthening Local Mental Health Systems

Enhancing Mental Health Literacy among Village Health Support Groups

Operation Unchain

8 The community of Chi Kraeng (in Chi while in collaboration with our project Kraeng district, ) is in partners we also aim to improve the living many ways typical of many communities conditions of the families of survivors of across Cambodia which remain over­ this violence by facilitating appropriate whelmingly plagued by violence, in support. particular violence against women and During this year, TPO trained to 21 new children. A 2014 study done by This Life Community Resource People (CRP) in Cambodia (TLC) and Investing in Children mental health first aid. As a result of this and their Societies (ICS) showed that this training, trained community resource issue is of serious concern. After a joint person are able to provide emotional feasibility study by TPO Cambodia, TLC support to 138 community members and ICS, which further confirmed the (F=94, M=44) seek help from them urgent need for support to this community through listening to victims’ problem, to address this issue, we have started – in provided some relaxation techniques to partnership with TLC and ICS – to assist victim to help them express their stressful. the Chi Kraeng community in addressing About 1,010 community members (852 violence against women and children and women and 158 men) include survivors in building local capacity to respond to of violence, men with a drinking problem, this kind of violence. Together with the disabled people, and vulnerable groups members of the community themselves, such as children at risk, received psych- we aim to address gender inequality, education from TPO’ counselors. In develop more positive and non-violent collaboration with CRPs, we established family relationships, and increase the 12 SHGs with approx. 118 SHG members accessibility and availability of health care (73 women and 45 men). TPO also services. TPO’s role in this 2014–2015 provided additional individual counseling pilot program is to improve the mental to 39 clients (30 women and 9 men). wellbeing of survivors of gender-based violence through psychological support,

2015 Annual Report 9 MS. CHHORN CHHOUN Ms. Chhorn Chhoun 32 years old, living in Kompong village, Chikraeng Commune, Chikraeng district. She married a man who was solider at the age of 18. She said both love each other but they did not have official marriage certificate. Ms. Chhoun has 7 children, 3 of them are girls. Ms Chhoun said her husband abuse alcohol, committed domestic violence, gambling and had many extra-marital affairs with many women. They both are non-skill workers; all of their children don’t go to school because they have to help earn the income to pay back the house and land loan.

Since I stay together with my husband, I My first daughter died when at the age of 3 have seen that my husband drinks, smokes, days old and my second son died when he gambles and has many extra-marital affairs. was 2 months old. With these continuing I experienced violence perpetrated by him lose, my husband had gradually showed most of the time during the course of our some mental symptoms such as not being marriage. well focusing, not more taking care on me,

10 he start drinking severely and he commits One day, there was an awareness raising severe physical abuse toward me. One day, organized by ICS, TLC and TPO in my I was unconscious as a result of severe village, I had shared my feeling in the big physical abuse. My husband pulled my hair, group. The village chief who was also trainee punching in face, hit my head and beating of TPO recommended me to get support my legs and arms, which made my entire from TPO. body swollen. After this accident happened, TPO staff has provides individual counseling my husband and I were living separately. to me about 15 sessions that I have My husbands left home and lived with his participated. TPO staff allow me to express mistress. Three months after separation, my feeling, tell the story that I experienced my husband wanted to reconcile with me etc. TPO counselors explain me about the and wanted to get along with me again but impact of the conflict toward myself and my I rejected. As the result of my rejection, my family, and inform me about how to coping husband had migrated to work in Thailand with psychological problems resulted from about 3 months and he returned back home. violence. Again, my husband made another request to reconcile with me and I accepted his. My After receiving counseling for about 15 family was living in peace for short period, sessions, I have gain confident to share and the family conflict started to occur again and discuss about problem with my husband that could lead to any violence at anytime. in calming way. My husband started to This conflict made me having psychological understand my feeling, thus he started to symptoms such as fearful without reasons, change his behavior and stop being violence excessive worry, thinking too much, tension, again. I also stop drinking alcohol myself headache, dizzy, sleeping problem, panic because my husband is no longer pose a when my husband use emotional threatening threat to me again. toward me, difficult in breathing, drinking alcohol to deal with my fear.

2015 Annual Report 11 OUR PROJECTS

Improving Mental Health for Survivors of Gender-Based Violence & Sexual Assault

Partnership Program for Protection of Children (3PC)

Access to Justice for Women

Community Responses to Violence against Women & Children

Justice & Relief for Survivors of In 2015, these projects were funded by GIZ 5 the Khmer Rouge (German Society for International Cooperation), Swiss Foundation and UNVFVT (United Nations Truth, Reconciliation & Healing – Towards a Shared Future Voluntary Fund for Victims of Torture).

Mental Health Care & Psychosocial Services for Cambodian Prisoners In 2015, we continued to help alleviate the human suffering resulting from trauma – for individual, fami- Strengthening Local Mental Health lies and the community – by supporting witnesses Systems and civil parties as well as their families and commu- nities in the context of the Extraordinary Chambers Enhancing Mental Health Literacy among Village Health Support Groups in the Courts of Cambodia (ECCC), also known as the “Khmer Rouge Tribunal”. Working in close cooperation with the Witness and Expert Support Operation Unchain Unit (WESU) and the Victims Support Services (VSS)

12 of the ECCC, we provided a variety of psychosocial the Khmer Rouge. Their ability to recognize and services. These ranged from on-site psychological identify problems increased substantially and support before, during and after ECCC proceedings, they strengthened their repertoire of coping and trauma treatment. With this project we also skills which they now feel confident using to raised awareness of trauma, torture and mental help manage their emotions and improve their health issues with the wider Cambodian population, daily functioning. We also provided psychological of the consequences of the Khmer Rouge regime and on-site support at the ECCC to 31 survivors of the ongoing transitional justice process. (witness) as well as 135 counseling sessions with 83 case 002 civil parties via our telephone Our team provided Testimonial Therapy – a Counseling Hotline. Six other clients received culturally relevant trauma therapy program – to 10 a total of 64 psychiatric consultations and 26 survivors (all civil parties in Case 002 at the ECCC) counseling sessions. and organized 2 public testimonial ceremonies during which the testimonies were read out loud Live radio shows – re-broadcast about 20 times and handed over by monks to the survivors in a – informing the Cambodian public about mental Buddhist ritual which acknowledges the survivors’ health issues as a consequence of the Khmer suffering and enables them to pay respect to those Rouge regime, as well as the proceedings at the deceased during the Khmer Rouge regime. Another ECCC. We also worked on publications intended 32 survivors (also civil parties in case 002, 28 Female) to inform and educate the public while also benefitted from participating in TPO’s self-help group keeping as a historical record. Testimonial Book program. This support had an undeniable effect on published in Khmer and English and launched. the participants: they learnt to express their feelings During this year, TPO has organized few events and needs, which brought them relief as well as a together with RUPP and KdK on “Inter-generation feeling of being connected with others. They feel dialogue on forced marriage” and train to partner better understood and feel relief at their experiences organization such as CHRAC,YRDP, ECCC being acknowledged. They also became aware of lawyers, Peace Corps on “Trauma and Self-Care”. how some physical symptoms they struggle with are a consequence of their traumatic experiences under

2015 Annual Report 13 OUR PROJECTS

Improving Mental Health for Survivors of Gender-Based Violence & Sexual Assault

Partnership Program for Protection of Children (3PC)

Access to Justice for Women

Community Responses to Violence against Women & Children

Justice & Relief for Survivors of the Khmer Rouge

Truth, Reconciliation & Healing – 6 Towards a Shared Future USAID and the American People are generously funding this project, which is carried out by TPO Cambodia as Mental Health Care & Psychosocial lead organization and Youth for Peace Cambodia (YFP) as Services for Cambodian Prisoners subcontracting partner. Note that figures above refer to the USAID fiscal reporting period for this project which is Strengthening Local Mental Health Sept 2013 to Sept 2014. Systems

Enhancing Mental Health Literacy among Village Health Support Groups

Operation Unchain

14 With this project, TPO (in cooperation including torture, forced labor, starvation, with its project partner Youth For Peace) imprisonment and the witnessing of brutal aims to complement the process of killings. The therapy has given them have a retributive justice* at the Extraordinary better understanding of the link between Chambers in the Courts of Cambodia their past experiences and current health (ECCC) with restorative justice** at the problems, and they were provided with grassroots level. In particular, we aim to a safe environment to open up and share help traumatized victims improve their their story as well as their problems, first mental well-being and strengthen their with a TPO counselor, then with other resilience and coping abilities. We also survivors, family, friends, neighbors. This work to generate healthier relationships has brought them relief and acceptance. between various ‘identity groups’ in We also organized five truth-telling Cambodian society, i.e. generate a better ceremonies during which we gathered a understanding of the complexity of victim– total of 393 people (231 female) – trauma perpetrator identities and relationships, survivors and their communities – to and work towards a shared vision of the listen to and acknowledge the survivors’ past and the future. We do this through personal stories. This hugely contributed trauma work, truth-telling, dialogue and to restoring the victims’ dignity and rights, memorialization initiatives in 6 provinces and reduced stigma against them. These (Takeo, Kampot, Battambang, Kampong ceremonies allowed the communities to Chhnang, Banteay Meanchey and Pailin). strengthen their sense of solidarity, peace and reconciliation. Some former Khmer We provided a four-day Testimonial Rouge expressed feelings of collective guilt Therapy as a part of trauma treatment and responsibility, of empathy towards to 30 trauma survivors who had the victims and a desire to reconcile with experienced a wide range of traumatic them, while some victims have developed events during the Khmer Rouge regime more positive feelings towards former * Justice that considers punishment as a response to crimes ** Justice that focuses on the needs of the victims, the offenders, and the community 2015 Annual Report 15 Khmer Rouge. We also had 392 members the process of dialogue, TPO staff has of various communities participate in our provided on going counseling to partici- film-based community dialogues, which pants throughout the entire dialogue. organized 8 film sessions in 5 provinces. We also set up a counseling hotline to During this year, TPO has organized 2 primarily provide additional support to dialogues between victims and perpetra- Khmer Rouge survivors and young people tors, one is held in after they’ve attended our activities, but and other in . we are also open to receiving calls from The first dialogue in Battambang has been others who are interested in our services. completed; the victims and perpetrators During our first year, we provided to 107 have been reconciled. The dialogue was clients, for both on site counseling and completed with Buddhist ceremony having phone counseling to 48 clients who had 18 participants, which includes relatives of testimonial therapy trauma treatment from the former KR, the victims, the former and 59 clients who received counseling KR’s village chief, the victim’s village chief, throughout the project’s implementation their neighbor and monks. in the second year. Last but not least, TPO has provided training on Mental Health The second dialogue includes one former to 54 of youths and Memory Committee KR and 2 direct victims in Kampong members under the project run by TPO’s Chhnang province. In this dialogue, TPO partner, Youth for Peace (YfP). has developed 4 video-exchanges. In

16 disclosed her story to the public. She I talked to my children, they neither feels that her past story still haunting believed nor understood me. In contrast, her, therefore her physical health was when I talked with my TPO counselor, deteriorated. When she was thinking he listened to me and supported me so too much, her chest became tense and that I much more relieved.” it was disturbing. As she mentioned that Mrs Pol Put’s story was one among the CASE “I never had a chance to talk about my other 6 stories that had been read aloud STUDY story, so when I was reminded of the to a hundred of people. It was her first regime, my tears dropped. I have no one time she experiences hundreds of people to share my feeling and memory except Mrs. Pol Put is a former KR and currently listening to her story. She felt excited but TPO counselor who could help me living in Kampong Chhnang province. also nervous. She felt much relieved as relieves my suffering”. Before she attended TPO Testimonial her story disclosed to the public. Further- Therapy (TT) and Truth-Telling Cere- Throughout the TT sessions, Mrs Put was more, she felt excited that younger mony, she had never told history to given opportunities to talk about her past, generations understood her feelings. anyone except her husband and her so she learned that it was a very good One month later after she has received children. She felt disappointed when experience for her. Nevertheless, she TPO interventions, she felt even more the children did not believe what she mentioned that it was not easy for her to relieved and could attend more social experienced during the Khmer Rouge recall the past memories because while events. Her psychological conditions regime. “If my children did not believe she was talking about them, her body have improved. She felt fresh in her me, so who else would I tell my story? became shaking as well she endured body. Moreover, in whatever activities as such, I did not want to recall my story with the other psychological reactions. At she took part, she felt clear because she anymore”, said Pol Put. the entire sessions, she received mental did not think too much like before. She health support from her counselor in Prior to the Testimonial Therapy and said “TPO treatment is very good for order to re-experience her psychological Truth-Telling Ceremony conducted people like me, so I wish that others can reactions in the process of healing. She felt in Kampong Chhnang, she had never benefit from such services too.” more supported and mentioned, “When

2015 Annual Report 17 OUR PROJECTS

Improving Mental Health for Survivors of Gender-Based Violence & Sexual Assault

Partnership Program for Protection of Children (3PC)

Access to Justice for Women

Community Responses to Violence against Women & Children

Justice & Relief for Survivors of the Khmer Rouge

Truth, Reconciliation & Healing – Towards a Shared Future

Mental Health Care & Psychosocial Our prison project is funded for 3 years (2014–2016) 7 Services for Cambodian Prisoners by Dynamic Share (DS) and the Swiss Government through the Swiss Agency for Development and Strengthening Local Mental Health Cooperation (SDC). Systems

Enhancing Mental Health Literacy among Village Health Support Groups

Operation Unchain

18 Cambodia’s prison population constitutes health problems tackled TPO staff were one of the most disadvantaged groups in generalized anxiety syndrome (GAD), Cambodian society. Adequate health care sleeping disorders, epilepsy, alcohol and for prisoners with pre-existing mental substance abuse disorders, and bipolar health conditions, and for those who affective disorder. Twenty of the prisoners develop mental health problems while in we worked with completed the treatment prison, is lacking. TPO Cambodia is the – some of them were discharged (i.e. no only NGO providing such services. We longer required treatment) while others have been bringing mental health care were released from prison or transferred and psychosocial services to Cambodian to other prisons making further treatment prisoners since 2012. With this project, impossible. Also, 65 inmates participated approved by the General Department in the life skills training program, which of Prisons in Cambodia, we support helps them, develop their personal prisoners, both male and female, in four awareness, interpersonal relationships, of Cambodia’s 26 prisons: Correctional and psychologically prepare for their Center 1, Correctional Center 2 (both also release and plan their future. In prisons, known as “Prey Sar”), Kandal Provincial we ran self-help groups with 49 inmates. Prison and Kampong Chhnang Prison. We Many of our clients in prison have shown can also provide crisis support in other a marked improvement in their psycho­ prisons at the request of prison staff. logical well-being and have provided In 2015, 110 inmates (66 men, 44 women) positive feedback about TPO’s support. received psychiatric treatment and As one inmate said that: “I can see my counseling thanks to TPO Cambodia, new life from what I have learnt, we are totaling 116 sessions by our counselors. very grateful for TPO life skill program, it Almost half of these prisoners were is like God who come to help, and it is like suffering from depression, whereas a special property which I have never had psychotic disorders constituted the before, our lives are in our hands now.” second-most common diagnosis. Other

2015 Annual Report 19 OUR PROJECTS

Improving Mental Health for Survivors of Gender-Based Violence & Sexual Assault

Partnership Program for Protection of Children (3PC)

Access to Justice for Women

Community Responses to Violence against Women & Children

Justice & Relief for Survivors of the Khmer Rouge

Truth, Reconciliation & Healing – Towards a Shared Future

Mental Health Care & Psychosocial Services for Cambodian Prisoners

Strengthening Local Mental Health This program is funded by the Belgian university 8 Systems NGO Louvain Coopération (LD). LD and TPO have Enhancing Mental Health Literacy been working together since 2008 to strengthen among Village Health Support Groups Cambodia’s mental health care systems.

Operation Unchain

20 TPO kicked off a new 2014–2016 project service from their departments. We also funded by Louvain Coopération which aims trained 83 village health support groups to strengthen local mental health systems (VHSGs) from seven health centers of in Kampong Cham and Tboung Khmum Chamkar Leu referral hospital on Mental provinces in such a way that they are able to Health First Aid (MHFA). offer accessible, good-quality and culturally Throughout the year, 877 people received relevant mental health care to the community, mental health services through the OPDs in an efficient and sustainable manner. To do of 2 referral hospitals and 6 health centers so, TPO is working from two field offices in the target areas. The total number inside provincial referral hospitals: one in of clinical work sessions done by the Chamkar Leu Referral Hospital (Kampong outpatient department staff and social Cham province) and in Ou Reang Ov Referral workers totals 1679 consultations. About Hospital (). 90 people were referred by VHSGs to We continued to provide technical support access mental health service after they on mental health services in eight out-patient received training on MHFA. departments (OPDs), namely in 2 referral TPO also organized a 2-day Continuous hospital and 4 health center in Chamkar Leu Medical Education workshop for 26 district, in 2 health centers in Ou Reang Ov Cambodian psychiatrists and psychologists, district. In this year, TPO has provided training which also contributes the strengthening course on basic counseling kill to 4 OPD staffs. Continue Medical Education for Psychiatrists. the local mental health system. The topic This training will help OPD staff to provide this year was “Bipolar Affective Disorder/ proper counseling to clients who seeking BAD”.

2015 Annual Report 21 OUR PROJECTS

Improving Mental Health for Survivors of Gender-Based Violence & Sexual Assault

Partnership Program for Protection of Children (3PC)

Access to Justice for Women

Community Responses to Violence against Women & Children

Justice & Relief for Survivors of the Khmer Rouge

Truth, Reconciliation & Healing – Towards a Shared Future

Mental Health Care & Psychosocial Services for Cambodian Prisoners

Strengthening Local Mental Health Systems

Enhancing Mental Health Literacy This program is funded by Direct Aid Program (DAP) 9 among Village Health Support Groups of the Australian Embassy in Phnom Penh.

Operation Unchain

22 Far left: Training on Mental Health First Aid to Village Health Support Group in Chamcar Leu. Left: Film production on mental health first aid, for Village Health Support Group trainings.

This project is part of an existing TPO each OD, on mental health first aid (MHFA). project called “Strengthening Mental Health This training enable VHSGs to identify people System in Cambodia” which is funded by with mental health problem, help them if Louvain Cooperation (LD) from Belgium. The they can and refer people them to the mental objective of this project is to strengthen local health clinic in the referral hospital. At the mental health system that enable the local same time, the doctors and nurses can also referral hospitals and health centers to offer refer patients from the mental health clinic an effective and sustainable quality mental back to community for VHSGs to monitor health services to the community in Kampong medication compliance and support them in Cham and Tbong Khmum provinces during anyway they can. 2014-2016. To achieve this, TPO project In 2015, TPO trained to 66 VHSGs on Mental supports Referral Hospitals and health center Health First Aid, which is included 4 topics in Chamkar Leu Operational District (OD) in such as Anxiety disorder, Depression disorder, and O Raing Oav Psychosis and alcohol used. About 89% of OD in Tbong Khmum province to set up and trained VHSGs are able to identify and provide run Mental Health Clinics there. TPO project emotional support to mental ill patients. trains doctors and nurses in each Referral Hospital on psycho-pathology and psycho- • 175 mental ill patients were identified by pharmacology to enable them make diagnosis trained VHSGs and prescribe medication. • 124 of total mental ill patient were received In addition to the support at the referral emotional support by trained VHSGs hospitals/health centers, TPO psychologists • 44 of them were referred to HC and opera­ train Village Heath Support Groups (VHSGs), tional district to get mental health service. who is already part of the health system of

2015 Annual Report 23 OUR PROJECTS

Improving Mental Health for Survivors of Gender-Based Violence & Sexual Assault

Partnership Program for Protection of Children (3PC)

Access to Justice for Women

Community Responses to Violence against Women & Children

Justice & Relief for Survivors of the Khmer Rouge

Truth, Reconciliation & Healing – Towards a Shared Future

Mental Health Care & Psychosocial Services for Cambodian Prisoners

Strengthening Local Mental Health Systems

Enhancing Mental Health Literacy among Village Health Support Groups The fundraiser is still open; so if you would like to contribute please contact [email protected] 10 Operation Unchain or (+855) 23 63 66 992.

24 Opposite left: A patient being chained, before treatment. Right: The patient, recovered and unchained, is able to communicate. In Cambodia, there are still many mentally ill patients who have been locked up at home Far right: There are more patients being or chained to trees by desperate family chained up; and they members. This happen in communities need treatment. around the country, because family members do no know how to deal with the patients, In order to treat and unchain as many patients there are no mental health service available in as possible, we decided to run an online fund- their community and they lack the finances to raising campaign to raise more funds. The online seek help further or to even take care of the fundraising campaign was a success; in the end patients. we raised $5,510 online, plus $17,314 in contri- butions direct to TPO till the end of December TPO has been working in response to mental 2015. TPO collaborate with Department of health issues, but due to funding limitations Mental Health and Substance Abuse (DMHSA) to we can’t respond to all needs in Cambodia. set up a mobile team traveling to rural areas to Fortunately, during TPO’s 20th Anniversary treat patients, educate family on how to take care Celebration in 2015, His Majesty King of mentally ill patient. Norodom Sihamoni of Cambodia kindly donated US$5,000 to TPO Cambodia. So far, TPO has treated 41 mentally ill patients (16 With this donation, TPO team set up a new females and 25 males) in 12 provinces (Svay Rieng, project called “Operational Unchain” to raise Takeo, Kampong Cham, Tbong Khum, Battam- awareness of mental health issues in rural bang, Siem Reap, Kampong Thom, Kratie, Kandal, Cambodian communities and demonstrate Banteay Meanchey, Prey Veng and Kampong that there are alternative to chaining up family Chhnang). Fourteen out of 41 mentally ill patients members struggling with mental illness. have been successfully unlocked/unchained.

2015 Annual Report 25 TPO TREATMENT CENTER

TPO’s Treatment Center, funded by the TPO Dementia, 1.16% Drug Abuses, 2.33% Trust Fund, continued to provide mental health Mental Others, 3.20% services to a variety of patients from all over Retardation, 1.45% Cambodia. The numbers of consultations PTSD, 1.74% continues to be high with 6,547 consultations in 2015. Clients received various types of Anxiety Disorder, treatment and support from TPO according to 10.61% their diagnoses. A part from responding to an unmet need for mental health services, TPO’s Sleep Disorder, Treatment Center aims to generate income for Mood 11.63% TPO contributing to the organization’s long-term Disorder, sustainability and self-reliance. Also, throughout 39.97% 2015, we put a considerable effort into further developing and strengthening our clinical capacity – for details, see under Organizational Capacity Building. Between 20-30% of patients at this Alcohol Related center received free treatment because they are Disorder, 5.09 % Schizophrenia/ too poor. Epilepsy, 3.02% Psychosis, 19.62%

26 TPO TRAINING CENTER

TPO’s Training Center offers a variety of training skills, teach people how to better manage stress courses on a number of mental health topics. or anger as well as courses in child development We run ‘standard training courses’, which are and parenting skills. multi-day group trainings provided on a regular This year, we also delivered 10 tailor-made basis, as well as ‘tailored-made courses’, which courses to 313 participants (160 females) from a are developed and delivered by TPO according wide range of local and international NGOs such to the specific needs of an organization. All as NGO Forum, World Renew, ANZ Royal, SOS, training is run by experienced and qualified Danish Red Cross, CCHR. TPO also provide trainers with degrees in relevant fields such as clinical supervision to AFESIP’ counselors who psychology, social work, psychiatry or psychiatric works in shelter. For this clinical supervision aims nursing. While responding to a demand in the to strengthen the quality of counseling service market for mental health training, TPO’s Training and to give a space for counselors to express Center also generates income contributing to their feeling and challenges in working for victims the organization’s long-term sustainability and of rape or trafficking. Tailor made-course that we self-reliance. were provided included Stress Management, In 2015, we ran eight standard courses with 63 Managing Misbehavior in Children, Mental participants (40 females). Participants came from Health First Aid (MHFA), Home base counseling different NGOs, The demand was highest for our service, Trauma healing and Basic counseling. All courses strengthening participants’ counseling up, we trained 376 participants (200 females).

2015 Annual Report 27 RESEARCH & CONSULTANCY

With support from the DANISH INSTITUE facilitators for pain treatment have received and acknowledgment. Thus Testimonial AGAINST TORTURE (DIGNITY), TPO training on this pain treatment. Therapy provides an opportunity to did a randomized control trial to investigate have their story acknowledge and the This study will continue in 2016 and full the effectiveness of Pain Treatment protocol opportunity for them to share their story results will be published throughout that year. which we had been developed and pilot to the world. The ultimate longer-term goal will be to use tested by TPO’ senior counselors in 2014. this treatment protocol to address the broad TPO also has contributed to local and The pain treatment protocol is culturally array of chronic pain experienced by patients international research on a variety appropriate treatment protocol to respond in Cambodia. of topics (e.g. fall-out of the Khmer to chronic pain patients who suffers from Rouge regime, torture, trauma healing, torture under Khmer Rouge time. For this TPO also launched the preliminary result of intergenerational trauma, transitional study we screened 300 out of 4,000 civil our randomized control trial on “Effectiveness justice) by providing relevant information party applicants. TPO did interview 156 of Testimonial Therapy” – A Study on a and insights to researchers from various respondents out of 300. As the result, 113 culturally adapted trauma treatment program institutions and organizations around the responded had meet selection criteria and as used by TPO Cambodia to treat survivors world. Often, TPO has received these they were assigned into 6 treatment groups of genocide in Cambodia, funded by Center researchers at its office in Phnom Penh and 6 control groups. We conducted intake/ for Victims of Torture (CVT) to launch this for interviews and discussion. TPO has baseline assessments, 2nd (3 month) and 3rd result. As the result of the study, it does also hosted various Cambodian and (6 month) follow-up assessments while by show the testimonial therapy adapted to international students as well as interns year’s end, TPO had delivered Pain Treat- Cambodian Context is really effective in for periods up to several months, to ment to all 55-treatment participants, and all dealing with the suffering/pain of Khmer provide them with the necessary practical 58 control participants after these had been Rouge survivors. This study also highlight the experience in their chosen field or psychologically assessed at the 6-month point. needs’ victims of severe trauma need more support them with their research. psychosocial support than bio-medical model. In this year, the pain treatment manual in Survivors need truth, justice, compassion Khmer and English was finalized. TPO’s

28 ADVOCACY & AWARENESS RAISING

In 2015, TPO staffs have again frequently We planted the “TPO Tree of Hope and Pages/TortureFundMeeting.aspx engaged in meetings with government Peace” in honor of torture survivors and On 2 July 2015, At Meta House in Phnom officials, partner NGOs and other as a symbol that rehabilitation works, Penh, TPO launched our new publication stakeholders as well as in advocacy events with blessing from monks. “My Testimony” which contains the and awareness raising campaigns to promote This year’s UN theme “Right to Rehabil- personal life stories of 10 survivors of the mental health care, psychosocial well-being itation” is linked closely to TPO’s works Khmer Rouge regime. In this workshop, and the need for services in Cambodia thus in providing support and treatment to we had discussed the ongoing psycho- furthering TPO’s mission. Project-specific survivors of Khmer Rouge regime. As the logical impact of the regime on individuals activities such as our 15 radio shows (with NGO at the forefront of trauma treat- and Cambodian Society. This publication about 80 re-broadcasts) have been listed ment for torture survivors in Cambodia, and the event were funded by GIZ. earlier in this report. and members of the International Reha- Our participation in the Youth Mental The UN’s International Day in Support of bilitation Council for Torture Victims, we Health Day at the Royal University of Victims of Torture (26 June) remained high will keep joining to rehabilitation. Phnom Penh on the occasion of World on our agenda in 2015. TPO team hosted In Geneva, Switzerland, The UN Fund a short tree planting event and ceremony for Victims of Torture, brought together at Choeung Ek (Aka the “Killing fields”) near practitioners and experts in the medical, Phnom Penh. We gathered to honor torture Psychological, legal and social rehabilita- victims, to listen to survivors sharing their tion of torture victims to exchange knowl- experiences and challenges they have faced edge and best practices. Dr Sotheara and continue to face. This event allowed Chhim, TPO Executive Director, was us to send a message of hope, speak out interviewed about TPO’s work with and demand that the right, to rehabilitation torture survivors of the Khmer Rough. becomes a reality for all tortures survivors, http://www.ohchr.org/EN/NewsEvents/ In Cambodia and elsewhere in the world.

2015 Annual Report 29 Far left: Planting Tree of Peace and Hope to commemorate the International Day Against Torture on June the 26th. Left: Study Tour of Psychology Students from Royal University of Phnom Penh, Department of Psychology.

Mental Health Day on 2 October was again overcome stigmatization and denial and offer to name but a few. We have posted one of the highlights of the year. More than healing and rehabilitation. The consortium of regular updates about the proceedings at 2,000 visitors participating in the activities. NGOs (Khmer Arts, TPO Cambodia, Kdei the ECCC as well as TPO’s own work TPO staff made themselves available to Koruna and Bophana Centre) in coordination across projects and across locations. discuss the questions students had and also with the Extraordinary Chamber in the Court We’ve attracted attention to the needs offered some part of art therapy, mini-coun- of Cambodia (ECCC), Victims Support for mental health care in Cambodia, seling session, mindfulness exercise, a video Section (VSS) and the lead co-lawyers and to the widespread issues of gender- film on psychological First Aid. (LCPL) for project design and develop the based violence and substance abuse full proposal and a fundraising strategy. in Cambodian communities. We’ve TPO had participated in the Consultation shared our challenges and successes, Workshop with Civil Parties with funding Throughout 2015, we have continued to our schedules for TPO’s public mental from UN Women. About 50 civil parties actively use social media (in particular TPO’s health training courses, and provided were invite to a one-day workshop at Khmer Facebook page) to raise awareness about our readers with interesting articles and Art Theatre in Takhao on 22nd October mental health and to promote and report on background information about mental 2015. The aim of the workshop is to consult the events mentioned above. Other causes health topics. We have also worked in with 4 different organizations about a future we’ve supported through our social media the background on making the TPO reparation project title “Pka Sla Angkar”. efforts the WHO’s World Health Day, World website more easy to navigate for the The project intends to combine classical Suicide Prevention Day, the UN International public, more manageable for our staff Khmer dance theatre and film documentary Day for the Right to the Truth concerning and with the facility to better link our with community dialogue and psychosocial Gross Human Rights Violations and for the communications. We plan to share our intervention to bring the experiences of Dignity of Victims, the UN International Day improved website with you in the course forced marriage and gender based violence for the Elimination of Violence against Women of 2015. to the attention of a larger audience aiming to and the accompanying 16-day campaign,

30 ORGANIZATIONAL CAPACITY BUILDING

In 2013, we also continued to build our organizational capacity by strengthening our staff’s skills, competencies and abilities, to allow us to fulfil our mission and goals

PARTNER IN TRAUMA HEALING (PATH) PROGRAM

As one of the Center for Victims of which are used by all our counselors across Research & Monitoring coordinator Torture’s (CVT) Partners in Trauma our projects and locations (and currently representative M&E part and the Healing (PATH), TPO benefitted again in also being produced in audiovisual format). clinical manager/clinical supervisor 2015 from CVT’s support to expand our This clinical unified approach is further from Clinic attended the annual ability to provide high-quality mental health complemented by regular internal learning workshop organized by the Center services and healing of survivors, to perform sessions and case presentation sharing for for Victims of Torture in Tbilisi, monitoring and evaluation and to develop TPO’s clinicians. We also strengthened our Georgia – This workshop aim to as an organization. In 2015, we continued clinical monitoring capacity by testing and review and reflect on experience to benefit from the in-house support of an validating the TPO Unified Clinical Tool we and all three domains (OD, M&E experienced PATH psychologist providing had previously developed to capture all the and Clinic). In this workshop, TPO support, training and mentoring thereby common clinical signs and symptoms reported staff who represents all these three strengthening TPO’s clinical capacity. As a by respondents during our assessment work domain decided to select Clinical result, we’ve rolled out a clinical supervision in Cambodian communities. June 2015, domain as sustain the gain which we system and policy and we finalized and TPO’s admin manager representative the are going to integrate across all the documented our counseling guidelines Organizational Development (OD) part, program of TPO.

2015 Annual Report 31 FINANCIAL STATEMENT – 2015 ACCOUNTS

DONORS INCOME 2015, EXPENDITURE CLASSIFICATION EXPENDITURE (US$) 2015 (US$) (US$) DFAT 92,783 60,912 Activity costs 450,229 BMZ* 4,788 5,359 Support costs 58,515 CVT-PATH 37,545 51,787 Personnel costs 478,377 DAP 49,574 25,216 Staff capacity building 10,430 Dignity 49,307 88,578 Total 997,552 DYNAMIC SHARE & SDC 76,691 76,691 *: Final Reimbursement 2014 ICS 46,536 57,278 GIZ-KRT 48,955 39,505 TPO Finance were audited by GIZ-ATJW 83,754 78,469 PriceWaterHouseCoopers (PWC) LD 78,030 74,179 SWISS FOUNDATION 24,983 24,983 UNTF* 5,144 - UNVFVT 31,975 31,975 USAID 192,267 180,249 Friend International (FI) 19,129 18,285 Private Donation (Operation Unchain) 22,824 8,082 TRUST FUND 133,267 176,004 Total 997,552 997,552

32 Others (BMZ, 0%; FI, 2%; UNTF, 1%) DFAT, 9%

Trust Fund, 13% CVT-PATH, 4%

Operation DAP, 5% Unchain, 2% Sta Capacity Dignity, 5% Building, 1%

Dynamic Share, 8% USAID, 20%

Personnel Activity ICS, 5% Costs, Costs, 48% 45%

GIZ-KRT, 5%

UNVFVT, 3% GIZ-ATJW, 9% Support Swiss Foundation, 3% LD, 8% Costs, 6%

2015 Annual Report 33 OUR PEOPLE

TPO currently has 51 staff members, and offices in Phnom • TAING Soeung Hun, Social Worker and Senior Counselor Penh (HQ and Treatment Center) and in the provinces of • SUN Solida, BA in Psychology Battambang, Siem Reap (SR town and ), • SORM Rothana, BA in Psychology Kampong Thom, Kampong Cham and Tboung Khmum. • THLEN Sokunnara, BA in Psychology All staff members are Cambodian. Key positions: KEY MANAGEMENT STAFF THERAPISTS & TRAINERS • CHHIM Sotheara, PhD, Executive Director • ANG Sody, MD, Psychiatrist • LENG Bunlay, Finance Manager • CHEA So Ousaphea, Registered Nurse • LOK Meas, Office Manager • CHHAY Marideth, Senior Counselor • ANG Sody, Head of Treatment Centre • CHHIM Sotheara, MD, Psychiatrist, MPM, PhD Candidate • TAING Sopheap, Head of Research, Monitoring & • CHOR Sonary, Sociologist, Counselor Evaluation • KEO Sothy, MD, Psychiatrist • SOK Phaneth, Head of Training Unit • LONG Borom, Counselor • MUNY Sothara, MD, Psychiatrist, MA in Public Health COMMUNITY TEAM LEADERS • OM Chariya, BA in Psychology, MA in Peace Education • KIM Sophornn, Battambang • PICH Panha, BA in Psychology, MA in Public Health • LAO Lun, Battambang • ROS Saray Endeth, BA in Psychology • NUTH Lady, Kampong Thom • SANG Seum, Psychiatric Nurse • PENG Vanny, Siem Reap • SEANG Leap, BA in Psychology, BA in Law • SOK Phaneth, BA in Psychology, MA in Counseling Psychology

34 TPO CAMBODIA ORGANIZATIONAL CHART

Board of Directors

External Advisors Executive Director MH Practitioners

MH Practitioners Justice & Relief for Survivors of the KR Treatment Center Nurse

Receptionist MH Practitioners Chamkar Leu Strengthening Local MH Systems Training Center

Assistant MH Practitioners O Reang Ov MH Care & Psychosocial Support for Prisoners Finance

MH Practitioners Truth, Reconciliation & Healing Admin Assistant

Assistant MH Practitioners Research and M & E Drivers Access to Justice Community Responses to Violence Improving MH for Survivors for Women Against Women & Children of GBV & Sexual Assault Housekeepers Guards Kampong Thom Siem Reap Chi Kraeng Battambang Community Team Community Team Community Team Community Team Assistant

MH Practitioners MH Practitioners & Guard MH Practitioners MH Practitioners & Guard

MH = Mental Health. HR and IT done by Admin. Fundraising by ED; Head of Research, M&E; Project Leaders; External Advisors. Data Collection is done by individual teams.  In blue colour are TPO projects, four of which have project managers reporting directly to the Executive Director, while the other three projects are implemented via community teams reporting to the Research and M&E manager.  In green colour are community teams; they report to their line managers above them.

2015 Annual Report 35 OUR BOARD OF DIRECTORS • Belgian Government through the university NGO • Dr. VAR Chivorn – Chairman, Executive Director, Louvain Coopération (LD) Reproductive Health Association of Cambodia (RHAC) • Center for Victims of Torture (CVT) • Mr. KHANN Sareth – Vice-Chairman, Professor, • DIGNITY Danish Institute Against Torture Psychology Department, Royal University of • Direct Aid Program (DAP), Australian Embassy Phnom Penh • Dynamic Share (SD), Switzerland • Dr. LIM Siv Lang – Treasurer, Physician, • German Federal Ministry for Economic Cooperation National Center for Dermatology, MoH and Development (BMZ) via the German Society for • Ms. UNG Kimkanika – Board Member, Acting International Cooperation (GIZ) Department Head, Social Work Department, • Investing in Children and their Societies (ICS) Royal University of Phnom Penh • Swiss Foundation • Oknha Dr. Tan Kim Meng – Board Member, • United Nations Voluntary Fund for Victims of Torture Executive Director, HOPE Medical Center and Deputy (UNVFVT) Director of Development of Sihanouk Hospital • Swiss Agency for Development and Cooperation (SDC) OUR PARTNERS & SUPPORTERS • Friend International (FI) In 2015, collaborations with government, other • Operation Unchain NGOs, education and research institutions, health INTERNATIONAL PARTNERS professionals, other service providers and advocates • Australian Red Cross/Australian Volunteers for for human rights and health care were again at the • International Development (ARC/AVID) core of what we do. And of course we could not • Office of the High Commissioner for Human Rights of have done it without our donors as well as all the the United Nations (OHCHR) others who have supported us in various ways. • Palo Alto University, Palo Alto, California, USA • Berkeley Center for Human Rights, California, USA 2015 PROJECT SPONSORS • UN WOMEN (United Nations Entity for Gender • American Government and the American people Equality and for the Empowerment of Women) through USAID • Australian Government through DFAT (Department of Foreign Affairs and Trade)

36 LOCAL PARTNERS • Youth for Peace (YFP) • (Siem Reap) • Khmer Arts Academy (KAA) • Cambodian Human Rights Action Committee (CHRAC) • … and the provincial and local authorities of all the • Cambodian Human Rights and Development places in Cambodia we have worked in throughout Association (ADHOC) 2015 as well as the Community Resource People • Cambodian League for the Promotion and Defence of helping people with mental and psychological problems Human Rights (LICADHO) around the country. • Cambodian Women’s Crisis Centre (CWCC), Siem Reap TPO CAMBODIA IS A MEMBER OF: • Access to Justice Asia (AJA) • Extraordinary Chambers in the Courts of Cambodia • Cooperation Committee for Cambodia (CCC) (ECCC) and its • International Rehabilitation Council for Victims of Torture • Witness and Expert Support Unit (WESU) and Victims (IRCT), Denmark. Support Section (VSS) • MEDiCAM • Kdei Karuna (KdK) • Legal Aid of Cambodia (LAC) OUR THANKS ALSO GO TO: • Commune Counsel for Women and Children (CCWC) • META House (German Cambodian Cultural Center), PP. • Ministry of Health (MoH) and its Provincial Departments • Bophana Audiovisual Resource Center, Phnom Penh of Health (PDoH) • Department of Media and Communication (DMC), • Ministry of Interior (MoI), the General Department of • All visitors, students, researchers, journalists, mental Prisons (GDP) and the Prison Authorities of Correctional health workers, human rights workers and members of Centre 1, Correctional Centre 2, Kandal Provincial the general public who, both in Cambodia and around Prison, Kampong Chhnang Provincial Prison the world, have shown interest in our work and helped • Ministry of Social Affairs, Veterans and Youth Rehabilita- spread the word about our work and the need for tion (MoSVY) and its Provincial Department (PDoSVY) mental health care in Cambodia. • Ministry of Women’s Affairs (MoWA) and its Provincial • All monks who have participated in our Testimonial department (PDoWA) Ceremonies throughout 2015 • Royal University of Phnom Penh (RUPP), Department of Psychology & Social Work • Women’s Media Centre of Cambodia (WMC)

2015 Annual Report 37 OUR SINCERE THANKS TO:

SWISS FOUNDATION

Copyright: Text TPO Cambodia 2015; Photos TPO Cambodia 2015, unless otherwise stated. Logos of current donors on the back cover used with kind permission from the donors. Printing: Mokod Reach Printing House, Phnom Penh, Cambodia Design & Layout: Saravan.co

Printing funded by Australian Government's Department of Foreign Affairs and Trade (DFAT)