They have come to this country in droves, often fleeing civil war, death and poverty, leaving behind everything they owned.

Sometimes the immigrants and refugees who seek hope in America simply break under the load.

Last week, a Manassas woman who fled the Khmer Rouge in 1979 was charged in the strangulation deaths of her two young children after relatives said she complained of "hearing voices." The woman, 29-year-old Nhoeung Khlaut, saw a psychiatrist only briefly, according to family members. Shortly before the deaths, her relatives moved her to a house in Herndon, hoping the voices would not follow.

Although mental health officials say some recent immigrants are at severe risk for mental illness, many mental health agencies are not equipped to deal with the special needs of patients who do not speak English. The officials say language and cultural barriers often prevent immigrants from seeking help when they need it.

"It's difficult to find mental health services in many areas for people who don't speak English," said Ellen Mercer, director of the Office of International Affairs for the American Psychiatric Association.

"It's very rare for {Indochinese immigrants} to seek help on their own," said Dr. Tung Tran, a Vietnamese psychiatrist in Falls Church. "Practically, if they don't speak English, they don't see how people can help them. We are taught to be strong and solve it by our own means. We are not taught to go out and tell our problems to strangers."

In the Washington area, there are few Cambodian social workers, and no Cambodian psychiatrists, according to mental health officials, who say there are greater numbers of Vietnamese mental health workers.

A 1988 survey of human services agencies by the Northern Virginia Planning District Commission found there was "insufficient" bilingual assistance to meet the demand.

According to the survey of 187 hospitals and human service and mental health agencies, more than one-third of the agencies operated without any bilingual staff members, and a limited number were available in most other agencies.

Michelle Smith, a human services planner at the commission, said that even the agencies that reported bilingual staff may have over-represented their capacities.

"Large private facilities might have a janitor who speaks Spanish who might help," Smith said. "I think the problem is significant. There are large numbers of foreign-born and language-minority people living on the edge of poverty and experiencing significant stress who could benefit from mental health services."

The stresses experienced by immigrants make them particularly vulnerable to mental illness, according to those who have worked with immigrant populations.

A 1983 study by Santa Clara County, Calif., found that Chinese and Vietnamese refugees living there suffered twice the level of depression as the general population. Thirty-four percent of Cambodians there were depressed, compared with about 9 percent of the general population, said Dr. Ken Meinhardt, medical director for the Santa Clara County Mental Health Services.

"The depression in Cambodians and Vietnamese was related to war experience and experience of getting out of the country," Meinhardt said. Few, if any, Cambodian psychiatrists escaped that country's upheaval in which millions were killed by the government, he said. "Cambodians were killed by the Khmer Rouge if they were educated."

Richard S. Mollica, clinical director of the Indochinese Psychiatry Clinic at St. Elizabeth's Hospital in Boston, established a psychiatric clinic 10 years ago to help the mentally ill in Massachusetts's large Indochinese population.

Mollica said Western-trained doctors often work without interpreters or with family members serving as translators; sometimes, he said, they miss serious illnesses.

"They don't have anyone in the health care setting to speak to these patients," Mollica said.

Tran, the Falls Church psychiatrist, said in cases in which individuals become "psychotic" or hear voices, as family members said Khlaut did, family members often seek a "supernatural explanation. They would think the voice is from God and so forth. They seek out witch doctors, sorcerers and Buddhist priests for magical intervention or exorcism."

Khlaut, 29, was charged with two counts of murder after she was found hiding in a closet with her two children, who had been strangled. Khlaut's relatives said she had been haunted by an image of a woman with long hair "calling her stupid."

Yarang Khlaut said her sister began hearing voices about a year ago, and gradually reached a point at which she did not recognize her family.

Khlaut said the woman's husband took her to a psychiatrist in Manassas, but the doctor found "nothing wrong" with her.

Khlaut was committed to Central State Hospital, a state mental institution, last Wednesday after a doctor in the jail's forensic unit told a judge that Khlaut appeared to be suffering from depression, psychosis and schizophrenia.

According to court documents, the doctor based her opinion on reports from Khlaut's family, because the doctor did not speak Khmer, Khlaut's native language.