Vision | The hidden problem of mental health in Timor-Leste

Mental health is a hidden problem in Timorese society, despite its impact, with lack of data on its dimension, lack of human resources and attention from the authorities, according to an expert.

“Mental health is a silent but large-scale problem. And in our society there is little understanding of how to deal with these issues”, said in an interview with Lusa Ângelo Menezes, a specialist in mental health.

“The behavior of society illustrates some of the symptoms of collective trauma. A high rate of violence against most women, a great tolerance for violence and a lot of violence among young people, among groups of young people”, he exemplifies.

Ângelo Menezes, known as Alau Deit, graduated in psychology and with a master’s degree in clinical psychology that he completed in the United States, is one of the main voices of advocacy on mental health in Timor-Leste.

“Studies show that in post-conflict countries, rates of mental health problems are higher. Post-traumatic stress, depression and anxiety, with much higher levels than in other countries. In Timor-Leste we don’t have data to demonstrate this, and without being able to demonstrate this, we don’t get more attention to the problem,” he said.

“Small situations, in Timor-Leste, lead to the appearance of violence. People find it very difficult to control anger. Culturally we are not taught to do that,” she explains.

A situation conditioned, in part, by the effects of decades of violent occupation by Indonesia, between 1975 and 1999, and by the fact that several social problems still remain to be solved, including high levels of poverty.

In the immediate future, argues Menezes, it is essential to reinforce national human resources in this area, promoting scholarships for young people in the areas of psychology and psychiatry where there are very few specialists in the country.

At the same time, and given the high lack of data and information on the problem, he advocates a joint effort by international and national specialists to “assess the state of things and understand exactly what needs to be done”.

“And then the policy, the legal framework, a mental health law that mandates institutions to care for and support people with mental health, that creates centers for mental health, rehabilitation centers to support people with mental health problems”, he explained. .

A comprehensive policy that includes, for example, a suicide prevention line, which Menezes considers to have high rates in Timor-Leste.

Although there has been occasional attention to the subject, including from the Government, the focus has been somewhat dispersed, with the Ministry of Health, for example, including mental health in the area of ​​the department of non-communicable diseases.

“There should be some specialized treatment. As it is included in this large space of non-communicable diseases, it ends up receiving very little attention”, he said, emphasizing that it is necessary to “do more”, expanding services such as those of the psychiatric center at the National Hospital Guido Valadares (HNGV), in the capital, Dili.

In recent years, Timorese authorities have given some additional attention to the problem of mental health, with the support of the World Health Organization (WHO) in efforts to raise awareness of the issue.

In addition to the existing unit at the HNGV, patients who need longer stays are transferred to the S. João de Deus Health Support Centre, in Laclubar, 100 kilometers from the capital.

“We continue to have very few specialized human resources in the country, both in terms of psychiatrists and psychologists. The issue of human resources is affected by the lack of knowledge about this area, ”he explained.

“The Government does not even promote scholarships for this area, for example. Very few people study psychology. People recognize that there is a shortage, but they don’t recognize the importance of this area for the country”, she emphasized.

With little concrete statistical data, not least because of the associated stigma, the available information on the state of things is scarce, although Menezes points to indicators of “high suicide rates”.

“No institution registers this data and monitors the evolution of the problem. But there are dozens of cases. People don’t know the link between suicide and mental health issues,” he says.

Menezes notes that many people associate the issue of mental health only with the most extreme cases, of people who occasionally are seen on the streets, explaining that in many families existing cases are hidden.

“There are cases here where people with mental health problems are locked up, even in cages, by their families. We have many examples of this. Situations where people are too embarrassed to acknowledge that people need help and so they don’t ask for help,” she said.

“Cultural issues serve as an excuse, but the fundamental issue is the associated stigma, the fear, the associated shame, the lack of knowledge about these issues. There are those who think that people with mental health are cursed by their ancestors”, said Menezes.

For this specialist, it is essential to raise society’s awareness, seeking to respond better to the problems that many, in Timor-Leste, suffer “in silence”.

“The high rate of violence against women and children and among young people is, for me, a symptom of mental health issues. When we think about violence prevention, we have to act from the behavioral side. It’s not enough to have more police or military or operations. The impact of these policing actions is short-term, but to achieve more structural effects we have to think preventively,” she said.

“I don’t think we’ll be able to solve major social problems without paying more attention to this issue. This issue is hidden, but it is like a germ, with a great impact on society. If we don’t talk about the anger, the emotional impacts of the war and the occupation, it has an impact on everyone’s behavior. And even people who are in positions of power and influence, who make decisions”, reinforced Menezes.


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