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Post-conflict countries often have high rates of undiagnosed mental health issues. Chief among these is Post-Traumatic Stress Disorder (PTSD), a mental health condition that occurs when a person has witnessed a psychologically traumatic event such as a war or natural disaster. Symptoms include fearful thoughts, flashbacks, and bad dreams, and can become problematic over a person’s lifetime, sometimes causing the sufferer to self-medicate with alcohol or drugs. At particular risk of developing PTSD are veterans and civilians who have experienced combat, undergone torture or imprisonment, or witnessed acts of brutality or violence.
As a result of the Indonesian occupation and 2006 crisis, about one in five people in Timor-Leste have personally seen or experienced an incidence of conflict-related violence. A consequence of this is that, according to some estimates, Timor-Leste has one of the highest rates of undiagnosed PTSD in the world. One study finds that 16.7 percent of the Timorese population suffers from PTSD, while another puts the rate at 15.1 percent. It is important to recognize that these studies only look at certain areas of the country and do not necessarily take the specifics of Timorese culture into account. In the absence of official government data, we can only guess at the true scope of the problem. Nevertheless, if these studies are correct, as many as one in six Timorese people may currently be living with PTSD.
Globally, only about one percent of people suffer from PTSD, highlighting how serious the issue of conflict-related mental health is for Timor-Leste. Moreover, the problem appears to be getting worse rather than better. Because mental health issues can intensify if left undiagnosed, the number of people suffering from PTSD in Timor-Leste has increased over the last decade.
Despite the high incidence of PTSD, Timor-Leste has remarkably low capacity for dealing with mental health issues. According to the WHO, there are only three mental health professionals per 100,000 people. Many of these professionals have low levels of training on mental health issues – in some cases, their training has only lasted a few days or weeks. There are no public mental health hospitals in Timor-Leste and only limited options for outpatient treatment. There is also little reporting of mental health issues and no official government statistics, meaning that NGOs working on mental health issues largely operate in the dark.
In addition to a lack of health capacity, there is also the problem of social stigmatization. Many people do not seek treatment for PTSD because they do not wish to be seen as bulak, or “crazy.” In general, there is little open discussion about mental illness, meaning that sufferers are often left feeling ashamed, isolated, and afraid to seek help. People should understand that PTSD, while problematic for the sufferer, is a normal reaction to experiencing a traumatic event. Just like a physical wound, people sometimes develop mental issues in response to difficult experiences, and, also like a wound, such conditions can be addressed if the sufferer gets treatment and support.
Fundasaun Mahein (FM) hopes to a start a nation-wide dialogue on this sensitive topic and urges the government, civil society, and everyday people to take the problem of conflict-related trauma seriously.
First, FM seeks open and honest discussion about mental health issues. PTSD is a common psychological response to witnessing violence, and public discussion about this issue can help remove stigma and allow sufferers to seek help without fear of judgment. Part of this effort will require spreading awareness of the signs and symptoms of PTSD, so that friends and family members can identify and support potential sufferers.
Second, FM urges the government to offer mental health services for veterans and civilians who have been exposed to violence. In the US, for example, veterans of the wars in Iraq and Afghanistan undergo screening for PTSD after their deployments and can access free mental health treatment when they return home. About 11 percent of American soldiers who fight in Afghanistan and 20 percent of those who fight in Iraq go on to develop PTSD, yet the prevailing view is that PTSD is the fault of the war, not the warrior. The government of Timor-Leste has a responsibility to provide for the people who have sacrificed their wellbeing for this country’s security.
Moreover, FM urges greater cooperation and coordination between the security sector, including the F-FDTL and PNTL, and public and private health providers. The government should prioritize developing a nation-wide capacity for treating mental health conditions, including creating mental health centers, training more mental health professionals, and supporting NGOs like PRADET working on these issues. In particular, the government should implement the recommendations of “Chega!”, the final report of the Commission for Reception, Truth, and Reconciliation, to construct a Trauma Healing Center and provide community-based mental health services to people in the districts.
Finally, FM recognizes the need for more research on PTSD in Timor-Leste. We encourage the government to work with NGOs and academics to collect data and generate statistics on the incidence of mental health issues in Timor-Leste, and to do so in a way that takes Timor-Leste’s diverse geography and culture into account. Currently, we do not know for certain how many people suffer from PTSD, where they tend to be concentrated, what factors aggravate their condition, and how their condition affects those around them. Only by understanding the scope of the problem can we begin to address it.
Too often, we focus on the political and economic components of conflict recovery while ignoring the human component. Timor-Leste cannot heal unless its people heal, and this effort starts with addressing the mental effects of years of collective trauma.
