Cambodia is a country with a more traumatic past than most. Recent decades have seen civil war, followed by genocide and more civil war. Despite a growing economy and rapid development, mental health workers say the psychological scars have yet to heal.
Cambodia suffers from high rates of mental illness, and very little treatment.
Psychiatrist Sotheara Chhim, who heads the Cambodia office of Dutch aid group, the Transcultural Psychosocial Organization, or TPO, says the country's dark past bubbles up in an exceptionally high rate of mental illness.
"In my opinion I think the past plays a very important role in attributing to the problem…. I think every Cambodian is like a glass carrying some water, meaning the traumatic past. If more water is put in, the glass fills easier than an empty glass," says Chhim.
A study by TPO found 35 percent of Cambodians suffer from some kind of psychiatric problem, from mild disturbance to full-blown illness.
The legacy of past conflict means more than a quarter of the population shows signs of post-traumatic stress disorder, and over 10 percent suffer major depression, even though most of the population is too young to remember the darkest years.
But there is little treatment. Only one percent of the government's health budget goes to mental health. For a population of 14 million people, there are about 40 psychiatrists, and only around 10 of them outside the capital Phnom Penh.
At the mental health ward at a hospital in the southern town of Kampot, Dr. Kim Vutha complains of a shortage of funds and medications.
He says Cambodians, particularly in rural areas, usually seek out mainstream treatment as a last resort after trying temples and traditional healers. In villages, it is quite common to find the seriously ill chained to posts or kept in makeshift cages.
Satya Pholy, a counselor in Phnom Penh, says that despite the prevalence of mental illness, many Cambodians simply do not want to acknowledge the problem.
"There's a stigma in Cambodian society," he said. "If someone talks to a counselor or goes to a psychologist or psychiatrist, 'Oh he's crazy, what's wrong with him?'"
He says traditional culture often plays a role in how mental illness is address.
"It goes back to animism and Buddhism and Hinduism, where most illnesses come from the unbalance of the wind, the soil, the fire and the water. Also, if you offended the spirits of the mountains or of the trees, you know, then the spirit will try to get you back, have revenge, make you sick," he explains.
Foreign aid organizations can not fill the gap. Sotheara Chhim says the economic crisis has meant less money for his organization, which travels around the country doing mental health outreach.
"I think mental health gets less attention, left behind in Cambodia. [The] Ministry of Health used to say keep saying mental health is one of the priorities but I don't think it's a priority," he said.
Sotheara says donor cuts forced him to fire 50 employees late last year.
Among the small government efforts to deal with the crisis, 10 new psychiatrists are being trained every year. But people working in the field, such as Sotheara, say this is still not enough.
