Han Visot thought the overhead lights in his hospital room were X-ray machines. He was sure the FBI was monitoring his movements and had bugged the room, which he called “the container.” He used a chair to barricade the door.
Medical records from Mr. Visot’s three days at Minneapolis’ North Memorial Medical Center in February 2012 show that a psychiatrist and two doctors concluded he was suffering from schizophrenia and paranoid delusions.
Some two-and-a-half years later, Mr. Visot, who was born in Cambodia but spent his adult life in the U.S., obeyed the voices in his head and returned to his homeland to become the “president of Cambodia.”
In August, the 51-year-old stood outside the Royal Palace with a giant white banner painted in bright blue letters declaring that Prime Minister Hun Sen, along with his wife and son, had died and that he was the new leader of Cambodia.
Mr. Visot was promptly arrested.
Although police raised questions about Mr. Visot’s mental health as soon as he was detained, he was deemed fit to stand trial by the prosecutor in his case at the Phnom Penh Municipal Court and the next day sentenced to two years in prison for incitement.
Representing himself at the trial, Mr. Visot protested the verdict, saying the court had failed to prove the prime minister and his family were still alive.
According to Cambodia’s Criminal Code, a defendant suffering from a mental illness that “suppresses his/her discernment” is protected from being held criminally responsible for their actions.
Back in Minnesota, Mr. Visot’s family and friends are scrambling for answers. They know his ability to reason is impaired; they watched it deteriorate as his once-successful life in the U.S. fell apart.
“He’s been wrongfully imprisoned,” said Sapaula Mao, Mr. Visot’s half-sister, from her home in Minnesota. “The way Cambodia handled this, it’s an injustice.”
Like his father before him, Mr. Visot developed schizophrenia in his late 40s. But before that, he had established himself as a savvy businessman and pillar of his family, having led them away from the Khmer Rouge and to a comfortable life in Minnesota.
“My brother kept the family together,” Ms. Mao said. “If it wasn’t for him, we wouldn’t be here in America.”
Ms. Mao said her parents fled the murderous Pol Pot regime in 1976 and were separated from Mr. Visot and their other children for at least four years. They were reunited in a refugee camp along the Thai border in 1980.
“My mother didn’t believe it was her son when she first saw him,” Ms. Mao said. “It wasn’t until she ran her fingers through Visot’s hair and remembered a scar that he had. My mother was so happy because her golden child was safe and, most importantly, alive.”
It was a young Mr. Visot who took charge of finding a new home for his family. As the only child who could read and write English, he handled all the necessary paperwork to obtain refugee status in the U.S., where the family immigrated in 1983.
After graduating from high school in Minnesota’s St. Louis county, Mr. Visot studied at the University of Minnesota and eventually earned a Master of Business Administration from nearby Metropolitan State University in 1994.
The following year, he opened a personal-care assistance business, training families to provide for seriously ill or disabled relatives, and developed it into a financially successful enterprise with almost 100 employees.
Yun Yann, a business partner and friend of 20 years, began noticing a change in Mr. Visot’s behavior about three years ago.
“When he came to the office, he would talk about angels he’d spoken to, and how he could control the rain,” Mr. Yann said from Minnesota. “When he was not afflicted, he was sharp, brilliant. To see him in this condition, it’s sad.”
Mr. Yann, a psychiatric nurse, said their venture went “belly up” as Mr. Visot’s condition worsened.
“His paranoid delusions were so extreme that he accused me of being an FBI agent,” he said. “He would say his wife was having an affair with the angels.”
Mr. Visot’s wife, whom he met on a trip back to Cambodia about 10 years ago, eventually filed for divorce amid his repeated accusations of infidelity.
But having lost one of his two homes to foreclosure, Mr. Visot continued living with his ex-wife and two young children. He picked up odd jobs in factories and became reclusive, obsessed with video games and playing his guitar.
As his family and friends became increasingly concerned, they had him evaluated at North Memorial in 2012. But he refused treatment and delved further into his delusions.
He began speaking of “a call” to return to Cambodia and lead the country.
Ms. Mao, Mr. Visot’s half-sister, still cannot understand why he felt compelled to return to Cambodia.
“We begged and begged him not to go to Cambodia, but you just can’t stop a grown man from doing what he wants to do,” Ms. Mao said.
“We knew something like this would happen,” she said.
“Schizophrenia is terrifying, it steals you away—it stole my brother.”
Both Ms. Mao and Mr. Yann have reached out to the U.S. Embassy in Phnom Penh for help, but have been met with a wall of silence.
“They won’t tell us anything,” Ms. Mao said. “Only that someone from the embassy visited him at Prey Sar prison.”
Jay Raman, a spokesman for the embassy, explained that for privacy reasons, only Mr. Visot could authorize the embassy to discuss his case.
Sam Pracheameanith, spokesman for the Ministry of Justice, declined to answer questions about how the courts assess the mental state of defendants.
“Please go ask the court, as it operates every day,” he said.
Judge Im Vannak, who presided over Mr. Visot’s case, refused to discuss why no psychiatric evaluation was carried out.
But Dr. Muny Sothara, chief of the psychiatric ward at the Preah Kossamak Hospital in Phnom Penh, said the courts rarely, if ever, conduct mental-health assessments.
“There is really no process in place to assess them before trial and prison,” Dr. Sothara said. “The court should have a system to evaluate the mental health of the accused, but it has not yet been established.”
Chok Thida, head of the mental health department at the Khmer-Soviet Friendship Hospital, said the only time she assesses patients facing criminal charges is when the defense lawyer submits a request. (Representing himself, Mr. Visot failed to make such a request during his trial, which lasted less than two hours.)
Once in prison, there are no resources available to those suffering from a mental illness, with the exception of services provided by the Transcultural Psychosocial Organization (TPO) Cambodia.
Although TPO operates a mental health program at Prey Sar prison, it declined to discuss Mr. Visot’s case, citing patient confidentiality regulations.
In the U.S., meanwhile, Mr. Visot’s loved ones remain in the dark about his condition.
“He’s too paranoid regarding food prepared by others. He thinks it’s poisonous and laced,” Mr. Yann said. “That’s the No. 1 concern for us.”
Ms. Mao said she’s trying to find a lawyer in Cambodia to file an appeal on behalf of her brother.
“I just want to bring my brother home.”