The Democratic Republic of Timor-Leste (East Timor) occupies the eastern half of the island of Timor, which lies north-west of Australia and within the eastern Indonesia archipelago. The population is approximately one million, of whom 45% are below the age of 15. Average life expectancy is 59.5 years and 50% of the population live below the national poverty line of US$0.88 per day. The official languages are Tetun and Portuguese, with Indonesian also used. The majority of the population are Catholic but also hold traditional animist beliefs.

Timor-Leste, a Portuguese colony for over 400 years, was invaded by Indonesia in 1975 following Portugal's rapid decolonisation. During the following 24 years of occupation, anti-insurgent and terror campaigns were carried out by the Indonesian military, with mass internal displacements of people and war-induced famines. Following a majority vote for independence in a 1999 referendum, a violent backlash from pro-Indonesia groups caused further deaths and mass destruction of buildings and infrastructure. Intervention by Australian-led peacekeeping forces restored stability, and the territory was administered by a United Nations mission until full independence was gained in 2002.

History of mental health services

During the years of Indonesian administration there were no mental health services in East Timor. In 1999, Psychosocial Recovery and Development in East Timor (PRADET) was founded by a partnership of mental health practitioners from Australia. Sixteen Timorese health workers underwent basic mental health training in Australia and returned to form the core staff of PRADET (Zwi & Silove, 2002). In addition to providing assessment, diagnosis and treatment for people with mental illness, the staff of PRADET trained district health nurses in their follow-up care.

In 2002, the government established the East Timor National Mental Health Project (ETNMHP) as its mental health service, with technical support and training provided by a team of Australian mental health workers. PRADET continued as a local non-governmental organisation (NGO) to complement government services by providing psychosocial support, counselling and community education. In 2008, the ETNMHP became the Department of Mental Health within the Ministry of Health.

Psychiatric morbidity

An epidemiological study conducted in 2004 reported a point prevalence of psychosis (meeting DSM–IV criteria) of 1.35% and post-traumatic stress disorder of 1.47% (Silove et al, 2008).