“Highly committed but overwhelmed by constraints”: a qualitative study of officials’ and health staff’s perspectives on the prison mental health system in Cambodia

Résumé fourni par la source

BACKGROUND: Prisoners have been identified in various international studies as one of the populations most vulnerable to mental health problems, yet the system's response has been notably limited. Enhancing the prison healthcare system to effectively address the challenges involved a complex undertaking compounded by the prevailing constraints and stressors faced by both inmates and prison staff, particularly in low- and middle-income countries such as Cambodia, where research is lacking. This study aimed to examine the perceptions of prison officials and healthcare staff regarding the health system's challenges in addressing prisoners' mental health and well-being and to explore strategies to improve the Cambodian prison healthcare system. METHODS: Three focus group discussions were conducted in three prisons located in various regions of Cambodia with a total of 15 participants (11 prison health staff and four prison officials). A qualitative content analysis was applied to the collected data. RESULTS: Despite limited resources, the current prison healthcare system managed to provide basic healthcare, refer severe cases, and implement certain preventive measures. However, our study revealed a lack of mental health focus within the system, although certain emotional support was provided by healthcare staff to prisoners with mental health issues. Staff displayed commitment but expressed a sense of resignation due to skills and resource constraints. Participants recommended various strategies, such as increasing awareness and offering vocational training to prisoners and room leaders, intense training for healthcare staff, and enhancing governance and external support to strengthen the prison healthcare system to foster the mental health and well-being of prisoners. CONCLUSIONS: Addressing the mental health needs within the prison setting in Cambodia demands an urgent reform of the current prison healthcare system. This entails a comprehensive collaborative effort among governmental institutions, placing emphasis on enhancing the skills and capabilities of inmates, room leaders and prison staff. Moreover, it is also essential to establish stronger partnerships with external organizations to improve health system governance.

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