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Background: Prisoners have been identified in various international studies as one of the populations mostvulnerable to mental health problems, yet the system’s response has been notably limited. Enhancing the prisonhealthcare system to effectively address the challenges involved a complex undertaking compounded by theprevailing constraints and stressors faced by both inmates and prison staff, particularly in low- and middle-incomecountries such as Cambodia, where research is lacking.This study aimed to examine the perceptions of prison officials and healthcare staff regarding the health system’schallenges in addressing prisoners’ mental health and well-being and to explore strategies to improve the Cambodianprison healthcare system.

Methods: Three focus group discussions were conducted in three prisons located in various regions of Cambodiawith a total of 15 participants (11 prison health staff and four prison officials). A qualitative content analysis wasapplied to the collected data.

Results: Despite limited resources, the current prison healthcare system managed to provide basic healthcare, refersevere cases, and implement certain preventive measures. However, our study revealed a lack of mental health focuswithin the system, although certain emotional support was provided by healthcare staff to prisoners with mentalhealth 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 toprisoners and room leaders, intense training for healthcare staff, and enhancing governance and external support tostrengthen 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 reformof the current prison healthcare system. This entails a comprehensive collaborative effort among governmentalinstitutions, placing emphasis on enhancing the skills and capabilities of inmates, room leaders and prison staff. 

Introduction: Globally, studies show that young prisoners experience higher rates of mental health disorders and suicidal behaviors than adult prisoners and the general population. In Cambodia, there is a lack of information on the mental health situation of young prisoners and the response of the prison system to that reality. This thesis aimed to explore the mental health, well-being, and healthcare needs of young Cambodian prisoners by examining their mental health status, evaluating life skills interventions, identifying coping mechanisms, and proposing strategies to strengthen the prison health system based on insider perspectives.

Methods: Conducted in four selected prisons, the thesis used both quantitative and qualitative methods. The quantitative studies assessed mental health and evaluated the impact of a Life Skills Education (LSE) intervention. The qualitative approach explored the perspectives of young prisoners and staff regarding mental health, coping mechanisms, and prison healthcare challenges.

Results: The findings revealed high levels of mental health problems but low suicidal behaviors. Younger age, lower education, and drug use were linked to higher ill-mental health. While the LSE intervention improved mental health, the differences with the control group were not statistically significant. Qualitative insights revealed loneliness, lack of family support, and unmet basic needs as young prisoners´ concerns. Staff noted the limited healthcare services available and stressed the need for reforms, including mental health awareness, staff training, and governance improvements.

Conclusion: The thesis highlights high levels of mental health problems among young prisoners in Cambodia and calls for contextualized mental health interventions. Future efforts should focus on strengthening mental health services, staff training, and prison reforms to better support young prisoners' well-being.

Background: Globally, studies have indicated a significantly higher prevalence of mental health disorders and suicidal behaviours among young prisoners compared to adult prisoners and the general population. In Cambodia, the experience of historical trauma and contemporary challenges exacerbate mental health concerns among young people, yet there is a lack of adequate mental health resources and research within the prison system. To address these issues, there is a critical necessity for comprehensive assessments of mental health needs, interventions tailored to local contexts, and reforms in the prison healthcare system, all of which are essential for improving the well-being and quality of life of young prisoners in Cambodia and beyond.

Aims: This thesis aimed to address the mental health, well-being, and healthcare needs of young Cambodian prisoners by exploring their mental health situation, efficacy of life skills interventions, coping mechanisms, and health system strengthening strategies, all informed by insider perspectives to enhance their well-being.

Methods: The thesis was conducted in four selected prisons. Both quantitative and qualitative approaches were used to fulfil its aims. The quantitative component was used to assess the current mental health of youngprisoners and to evaluate the impact of the Life Skills Education (LSE) intervention. The qualitative elements aimed to explore the perspectives of both young prisoners and prison staff regarding their current mental health status and coping mechanisms and the strategies applied to enhance the prison health system.

Results: The quantitative findings revealed high levels of mental health problems but low suicidal behaviours among the participants. Factors such as younger age, lower education, and a history of drug use were associated with higher level of mental health problems. While the LSE intervention led to an improvement in mental health, the differences with the controlgroup were not statistically significant. Qualitative insights highlighted the challenges faced by young prisoners, including loneliness, lack of family support, and unmet basic needs, impacting their mental wellbeing.Some employed coping strategies, but overall there was a reliance on self-help and family support due to the limited availability of healthcare services acknowledged by prison staff. Staff emphasized the need for reforms, including mental health awareness activities, staff training, governance improvements, and external support to enhance prison healthcare services.

Conclusion: This thesis revealed a high level of mental health problems among young prisoners in Cambodia, underscoring the critical need for contextualized mental health interventions. While the impacts of the LSE programme were limited, it lays the groundwork for future improvements. Perspectives from both young prisoners and staff emphasized the importance of self-help strategies and staff training. Moving forward, policymakers should prioritize mental health services and reforms to better support young prisoners' well-being in Cambodian prisons.

សង្ខេបនិង្ខេបបទជាភាសាខ្មែរ (Abstract in Khmer) 

ក្េចខតីក្្តីម (Background) 

ក្ៅទូទងាំ ពិភពក្ោខ ការេិខាបានបង្ហាញពីអត្រាខ្ពេ់ននបញ្ហាេុខ្ភាព្លូ វ ចិត្តនិងការក្្វីអត្តឃាត្ខនុងចាំក្ោមជនជាប់ឃុាំជាយុវវយ័ ក្បីក្្ៀបនឹងជនជាប់ឃុាំក្ពញ វយ័ និងត្របជាជនទូក្ៅ។ ក្ៅត្របក្ទេខមពុជា បទពិក្ោ្ន៍ននការប ៉ះទងគិច្លូ វចិត្តជាត្របវត្តិ ោស្តេតនិងបញ្ហាត្របឈមខនុងេម័យបចចុបបននក្ន៉ះ ក្្វីក្ោយប ៉ះពាល់ដល់េុខ្ភាព្លូ វចិត្ត របេ់យុវវយ័ កាន់តត្្ងន់្ងរ ប ុតនតក្ៅមានខងវ៉ះខាត្្នធានត្នខេុខ្ភាព្លូ វចិត្ត និងការ ត្រោវត្រជាវេមត្រេបក្ៅខនុងត្របព័នធពនធនាគារ។ ក្ដីមបីក្ ៉ះត្រោយបញ្ហាទងាំ ក្ន៉ះ មានភាព ចបាាំ ច់យ ងខាលងាំ ខនុងការវាយត្នមលក្ោយត្ររប់ត្រជុងក្ត្រជាយពីត្ត្រមូវការេុខ្ភាព្លូ វចិត្តការ អនតរារមន៍តដលត្រេបាមបរបិទខនុងត្រេុខ និងខាំតែទត្រមង់ត្របព័នធេុខ្ភាពពនធនាគារ តដលទងាំ អេ់ក្ន៉ះមានោរៈេាំខាន់េត្រមាប់ការក្លីខខមពេ់េុខ្ុមាលភាព និងរុែ ភាពជីវត្ិ របេ់ជនជាប់ឃុាំជាយុវវយ័ ខនុងត្របក្ទេខមពុជា និងត្របក្ទេដ៏នទក្ទៀត្។ 

ក្គាលបាំែង (Aims) 

ក្គាលបាំែងនៃនិក្ខេបបទក្ន៉ះ គឺង្ ើម្បើខាំែត្់េមាគល់បញ្ហាេុខ្ភាព្លូ វចិត្ត េុខ្ុមាលភាព និងត្ត្រមូវការតែទេាំ ុខ្ភាពរបេ់ជនជាប់ឃុាំជាយុវវយ័ ក្ៅត្របក្ទេខមពុជា ក្ យតេវងយល់ពីោានភាពេុខ្ភាព្លូ វចិត្តរបេ់ពួខក្រ ត្របេិទធភាពននការអនតរារមន៍ បាំែិនជីវត្ិ យនតការក្ ៉ះត្រោយ និងយុទធោស្តេតពត្រងឹងត្របព័នធេុខាភិបាលពនធនាគារ តដលទងាំ អេ់ក្ន៉ះ ត្រត្ូវក្យងាមទេសនៈផ្ទាល់របេ់អនខក្ៅខនុងពនធនាគារក្ដីមបីពត្រងឹង េុខ្ុមាលភាពរបេ់ពួខក្រ។ 

វ្ិីោស្តេត(Methods) 

និក្ខេបបទក្ន៉ះ ត្រត្ូវបានក្្វីក្ ីងក្ យត្របមូលទិននន័យក្ៅខនុងពនធនាគារចាំនួន បួន ក្ យក្ត្របីត្របាេ់វ្ិ ីោស្តេតត្រោវត្រជាវទងាំ តបបបរមាិ ែ និងរុែភាព។ ការត្រោវ ត្រជាវតបបបរមាិ ែ ត្រត្ូវបានក្ត្របីក្ដីមបីវាយត្នមលេុខ្ភាព្លូ វចិត្តបចចុបបននរបេ់ជនជាប់ឃ ជាយុវវយ័ និងក្ដីមបីវាយត្នមលលទធ្លននការអនតរារមន៍អប់រជាំ ាំែិនជីវត្ិ (LSE) ។ ការ ត្រោវត្រជាវតបបរុែភាព មានក្គាលបាំែងតេវងយល់ពីទេសនៈរបេ់ជនជាប់ឃុាំជា យុវ វយ័ និងមស្តនតីពនធនាគារ អាំពីោានភាពេុខ្ភាព្លូ វចិត្តបចចុបបននរបេ់ពួខក្រ និងយនតការ ននការក្ ៉ះត្រោយ ត្រពមទងាំ យុទធោស្តេតតដលបានអនុវត្តក្ដីមបីពត្រងឹងត្របព័នធេុខ្ភាពពនធ នាគារ។ 

លិទធ្ល (Results) 

លិទធ្លននការត្រោវត្រជាវតបបបរមាិ ែ បានបង្ហាញពីខត្រមិត្ខ្ពេ់ននបញ្ហាេុខ្ ភាព្លូ វចិត្តប ុតនតមានអត្រាននបញ្ហាអត្តឃាត្ទបខនុងចាំក្ោមអនខចូលរួមទងាំ អេ់។ ជន ជាប់ឃុាំតដលមានោយុកាន់តត្ត្ិច ការអប់រទាំ ប និងត្របវត្តិននការក្ត្របីត្របាេ់ក្ត្ររឿងក្ញៀន ត្រត្ូវបានរខក្ឃីញថាមានខត្រមិត្បញ្ហាេុខ្ភាព្លូ វចិត្តខ្ពេ់។ ការអនតរារមន៍អប់របាំ ាំែិន ជីវត្ិ ក្្វីក្ោយមានភាពត្របក្េីរក្ ីងនូវេុខ្ភាព្លូ វចិត្ត ប ុតនតភាពខ្ុេគានរវាងត្រខុមតដល បានចូលរួមការអប់របាំ ាំែិនជីវត្ិ និងត្រខុមតដលមិនបានចូលរួម មិនមានេាិត្ិខ្ុេគានជា ខាលងាំ ក្នា៉ះក្ទ។ លិទធ្លននការត្រោវត្រជាវតបបរុែភាព បានរូេបញ្ហាខ់ពីបញ្ហាត្របឈម របេ់ជនជាប់ឃុាំជាយុវវយ័ រួមមានភាពឯក្កា ខងវ៉ះការគាត្រាំទពីត្ររួោរ និងត្ត្រមូវការ មូល ានមិនត្រត្ូវបានបាំក្ពញត្ររប់ត្រគាន់តដលទងាំ អេ់ក្ន៉ះប ៉ះពាល់ដល់េុខ្ុមាលភាព្លូ វ ចិត្តរបេ់ពួខក្រ។ ជនជាប់ឃុាំមួយចាំនួន ក្ត្របីត្របាេ់យុទធោស្តេតក្ ៉ះត្រោយបញ្ហា េុខ្ុមាលភាព ាមរយៈការពឹងត្ែខក្លីការជួយខ្លួនឯង និងការគាត្រាំទពីត្ររួោរ ក្ យ ោរក្េវាតែទេាំ ុខ្ភាពក្ៅខនុងពនធនាគារក្ៅមានខត្រមិត្។ មស្តនតីពនធនាគារ បានេងកត្់ ្ងន់ក្លីត្ត្រមូវការេត្រមាប់ខាំតែទត្រមង់ រួមទងាំ េខមមភាពអប់រក្ាំដីមបីបក្ងកីនការយល់ដឹង អាំពីេុខ្ភាព្លូ វចិត្ត ការបែតុ ៉ះបោត លមស្តនតី ការតខលមែអភិបាលខិចច និងការគាត្រាំទពី ខាងក្ត្រៅក្ដីមបីពត្រងឹងក្េវាតែទេាំ ុខ្ភាពពនធនាគារ។ 

េននិ ាន (Conclusion) 

និក្ខេបបទក្ន៉ះ បានបង្ហាញពីខត្រមិត្ខ្ពេ់ននបញ្ហាេុខ្ភាព្លូ វចិត្តខនុងចាំក្ោម ជនជាប់ឃុាំជាយុវវយ័ ក្ៅខនុងត្របក្ទេខមពុជា ក្ យបានរូេបញ្ហាខ់ពីត្ត្រមូវការេាំខាន េត្រមាប់ការអនតរារមន៍េុខ្ភាព្លូ វចិត្ត តដលមានការតខេត្រមួលាមបរបិទពនធនាគារ។ លិទធ្លពីការអប់របាំ ាំែិនជីវត្ិ ក្ៅមានខត្រមិត្ ប ុតនតខមមវ្ិ ីអប់រក្ាំន៉ះ ោច្តល់មូល ាន ត្ររឹ៉ះេត្រមាប់ការតខលមែនាក្ពលអនារត្។ ទេសនៈទងាំ ពីេាំោខ់ជនជាប់ឃុាំជាយុវវយ័ និងមស្តនតីពនធនាគារបានេងកត្់្ងន់ក្លីោរៈេាំខាន់ននយុទធោស្តេតជួយខ្លួនឯង និងការ បែតុ ៉ះបោត លមស្តនតី។ េត្រមាប់ក្ពលអនារត្ អនខបក្ងកីត្ក្គាលនក្យបាយរួរតត្្តល់ ោទិភាពដល់ក្េវាេុខ្ភាព្លូ វចិត្ត និងការតខទត្រមង់ត្របព័នធេុខ្ភាពពនធនាគារ ក្ដីមបី គាត្រាំទដល់េុខ្ុមាលភាពរបេ់ជនជាប់ឃុាំជាយុវវយ័ ក្ៅខនុងត្របក្ទេខមពុជាក្ោយកាន់តត្ ត្របក្េីរ។

Purpose – Young prisoners are one of the most vulnerable groups in society for mental health problems and ill-being. Therefore, there is a crucial need to understand their physical, psychological and social situations. This study aims to explore young Cambodian prisoners’ experiences and perceptions of mental health and well-being, their determinants and their coping strategies.

Design/methodology/approach – Six focus group discussions were carried out in three prisons with atotal of 48 young prisoners between the ages of 15 and 24 years (50% women, 50% men). Semistructured questions guided the discussions, and thematic analysis was applied to analyse the data.

Findings – Young prisoners reported multifaceted experiences of mental health and well-being. The majority described adverse mental health experiences, while some revealed better well-being, partlyinfluenced by the socio-economic support from outside the prisons and previous involvement or not indrug abuse. The experience of physical overcrowding without emotional attachment among the fellow prisoners was perceived as the overarching determinant of loneliness and mental health problems, while socio-emotional support and rituals were described as the most important coping mechanisms.

Originality/value – This pioneering study from Cambodia gives young prisoners an opportunity to voice their experiences and perceptions of mental health and well-being in the prison setting. The findings inthis study underline the importance of prison authorities tackling overcrowding to promote well-being andreduce mental health problems. Also, the coping mechanisms outlined by the participants should be considered when planning psychosocial interventions.

Introduction: Numerous studies globally confirmed that young prisoners are more susceptible to mental health problemscompared to adult prisoners and the general population. The lack of life skills has been reported as one of the main reasons forthis vulnerability. This study aimed to assess the effectiveness of a life skills education program on mental health and life skillsamong young prisoners in Cambodia.

Method: This is an intervention study, applying a ‘difference-in-difference’ analysis. The life skills education program wasimplemented to promote essential skills for mental health and social competence among young prisoners. Mental health and lifeskills competence were evaluated using the Youth Self-Report and Life Skills Development – Adolescent Form scales, respectively.Four prisons were selected from a total of 24 prisons in Cambodia, a post-conflict country in Southeast Asia. A total of 412 youngprisoners aged 15–24 years participated in the study and were randomly assigned to intervention and control groups.

Results: Both the intervention and control groups reported decreased mental health problems (DiD=3.78, p=0.34) and improvedlife skills competencies (DiD=0.39, p=0.80) after the intervention; however, the differences were not statistically significant.

Conclusion: The life skills intervention program had no significant effect on young prisoners’ mental health and life skillscompetencies. Further studies should be conducted to evaluate the impact of the life skills education program in the prison setting,particularly in low- and middle-income countries (LMICs) such as Cambodia.

Building on the value of engaging with and enabling the participation of marginalised young people in research, theaim of this article was to profle practical and procedural issues faced when conducting studies with young peoplewho experience some form of marginalisation. Drawing on observations and research experiences from four diversecase studies involving young people who were either imprisoned in Cambodia, living in informal urban communitiesin North India, residing in rural northern Sweden or attending school in rural Zambia, learnings were identifed underthree thematic areas. Firstly, a need exists to develop trusting relationships with stakeholders, and especially the participating young people, through multiple interactions. Secondly, the value of research methods that are creative andcontext sensitive are required to make the process equitable and meaningful for young people. Thirdly, it is importantto fatten power relations between adults and young people, researchers and the researched, to maximise participation. These fndings can inform future youth research in the feld of global public health by detailing opportunitiesand challenges of engaging in research with young people on the margins to promote their participation.

Background: Incarceration and mental health problems are known to have a strong empirical association. Many studies have confirmed the high prevalence of mental health problems among young prisoners in particular, yet none has been conducted in Cambodia.

Objectives: This study aimed to assess the level of mental health problems and suicidal expressions, and determine the associated risk factors among young prisoners in Cambodia.

Method: This was a cross-sectional study among 572 young prisoners between the ages of 15 and 24 from three prisons. Sociodemographic data and detailed information on participants’ profiles were gathered, and mental health problems and suicidal expressions were assessed using the Youth Self-Report (YSR) and the Attitude Towards Suicide (ATTS) questionnaires, respectively.

Results: Mental health problems as revealed by the mean YSR scores were: 25.97 for internalizing and 18.12 for externalizing problems; 11.88 for anxiety/depression, 9.97 for aggressive behaviours and 7.53 for somatic complaints. Social problems, attention problems and rule breaking behaviour were in the range of 8.10 to 8.49. Withdrawal depression and thought problems mean scores were 6.55 and 6.66, respectively. Mental health problems were associated with younger age, lower educational background, and shorter duration of incarceration. Around 16% had thought about their own death, and 12% expressed wish to die. Suicide ideation, planning, and attempts were reported by almost 7%, 2%, and 3% of participants respectively. Prior drugs users thought about death significantly more than their counterparts while suicide ideation was significantly lower among prisoners with higher education.

Conclusion: Mental health problems and suicidal expressions among young prisoners warrant well-planned mental health services that are integrated into the current prison health system. A contextualised intervention that takes into account age, education, duration of incarceration and previous drug use may contribute to improve the mental well-being of young prisoners in Cambodia.