Timor-Leste

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The mental health services in the Democratic Republic of Timor-Leste are in the process of developing. Prior to independence in 1999, there were no mental health services available in Timor-Leste. Also in 1999, an organization called Psychosocial Recovery and Development in East Timor (PRADET) was established through a collaboration of Australian mental health workers and funded by the Australian government’s overseas development agency, AusAID. In 2002, the government established the East Timor National Mental Health Project (ETNMHP) as its mental health service. PRADET continued as a local non-governmental organisation (NGO) to complement government services by providing psychosocial support, counselling, and community education. The government has a national mental health strategy (Ministry of Health Timor-Leste, 2005), which emphasises both a primary care approach to mental health services and partnerships with non-government service providers. The National Mental Health Strategy was developed as a guideline for the health workers to deliver mental health services in Timor-Leste. 

Essentially, there are 1.14 psychiatrists per 100,000 people in Dili (the capital city), and none in the rest of the country. Each district has an allocated mental health worker with basic training in mental health and a background in nursing or public health. Referrals for initial assessment are made directly to counsellors working in PRADET. Because of the lack of mental health professionals and the traditional beliefs of the Timorese, the acceptance towards mental health services is still low in Timor-Leste. 

The mental health model in Timor-Leste is 100% community based. No other information could be found for any organization or government body addressing the formal certification, regulation, or training of professional counsellors in Timor-Leste.

Most counselling/mental health services are accessible in the capital, Dili.

• Government mental health care is predominantly community-based and integrated into primary health care. 
• Non-government organisations (NGOs) provide a psychosocial rehabilitation service (PRADET), long-term stay service (Klibur Domin),  and inpatient psychiatric service (São João de Deus, Laclubar). 
• Social sector and civil society efforts exist to promote and protect the rights of people with disabilities, including people with mental health problems. 

There is currently no mental health legislation and insufficient numbers of training opportunities for mental health personnel in Timor-Leste. Thus, the mental health services are still in the process of developing and the acceptance towards counselling is still low. Additionally, there are strong animist beliefs in the Timorese culture. People with mental illness and their families may feel they are being punished by an ancestral spirit, customary or natural factors. Hence, most people prefer to seek help from traditional healers for treating mental illness.

For a deeper exploration of the counselling profession in the country, interested readers are recommended to read the following journal & website articles:

• Hall, T., Kakuma, R., Palmer, L., Minas, H., Martins, J., & Armstrong, G. (2020). Service user and family participation in mental health policy making in Timor-Leste: a qualitative study with multiple stakeholders. BMC Psychiatry, 20(1). doi:10.1186/s12888-020-02521-3
• Hawkins, Z. (2010). A decade of mental health services in Timor-Leste. International Psychiatry, 7(1), 11–13. doi:10.1192/s174936760000093x