Universities Reject Health Ministry's 'Titian' Programme for Clinical Psychologists

Strengthening mental health services is an urgent necessity. The public should not have to face psychological issues without access to nearby, affordable, and quality services. Puskesmas, as first-level health facilities, should be the initial gateway for citizens to receive psychological assistance, from education and early detection to basic counselling, psychosocial support, and referrals when problems become more complex. Therefore, the idea of expanding mental health services to the primary care level deserves support. The Ministry of Health bears a significant responsibility to ensure mental health services are closer to the community. However, a good objective does not automatically justify all methods. This is why the rejection of the clinical psychologist ‘Titian’ programme by universities offering psychology education must be understood proportionally.

This rejection is not a refusal to provide psychological services to the public at Puskesmas. What is being rejected is the mechanism to fulfil the mental health workforce through a ‘Titian’ programme that could become a shortcut, blur professional education standards, and create uncertainty regarding authority and rationale, as the clinical psychology specialist profession does not yet exist. The rejection is not from just one or two universities. It is a collective and widespread stance taken by both public and private higher education institutions providing psychology education: more than 174 universities submitted a joint statement, while 26 universities also sent letters independently. This fact demonstrates that the objection to the ‘Titian’ programme is not merely an administrative matter, but also an academic and ethical concern about the governance of the psychology profession.

A collective response letter from AP2TPI dated 15 June 2026 affirmed this position. AP2TPI stated it understands and respects the national need to strengthen mental health services, including at Puskesmas and other health facilities. However, fulfilling this need must maintain the suitability of competence, professional authority, educational levels, quality assurance, and statutory provisions. In the same letter, AP2TPI declared that its member universities could not participate in the clinical psychologist ‘Titian’ programme. This stance should be seen as a reasonable warning. In mental health services, the focus is not merely on workforce numbers or job formations. Those who come to the Puskesmas are human beings with anxiety, sadness, inner wounds, family pressures, loneliness, and sometimes a loss of hope. They need help that is close, but also safe. Therefore, the state must not conflate service needs with professional education mechanisms.

Under Law Number 23 of 2022 on Education and Psychological Services, professional psychology education is part of the higher education system. Professional programmes produce psychologists. Specialist competencies, including clinical psychologists, are obtained through specialist professional education conducted by universities in accordance with higher education standards and quality assurance systems. Within this framework, clinical psychologist competence cannot be positioned as the result of a short training course, a competency add-on, or a ‘Titian’ programme outside specialist professional education. If the ‘Titian’ programme is treated as if it can produce authority equivalent to specialist education, a double standard emerges. Universities are asked to maintain the quality of professional education, while simultaneously a fast-track route is opened that potentially bypasses these standards.

Another error is the use of the term ‘clinical psychology’ as if it were the single keyword for all psychological services in the health sector, as if every mental health service in a health facility must be answered by a clinical psychologist. In reality, a clinical psychologist is a professional position with specific authority, not an academic label that can be attached through additional training. Mental health services at Puskesmas must also not be narrowed solely to a sickness paradigm. If all mental health issues are understood only as diagnoses, disorder management, clinical registration, and practice licensing, primary care loses its character. Puskesmas should be strong in the wellness paradigm: mental health promotion, prevention, early detection, mental health literacy, family strengthening, psychosocial support, initial counselling, and referral. At this point, the general psychologist—much like a general practitioner at a Puskesmas—holds a highly relevant position. A general psychologist is not an unfinished professional but a graduate of professional psychology education with the competence to provide psychological services according to their standards and authority. In primary care, general psychologists can assist with psychological problem screening, public education, basic counselling, family support, community strengthening, and collaboration with doctors, nurses, midwives, health cadres, schools, and local governments.

Of course, not all cases can be handled by a general psychologist at the Puskesmas. Cases with high clinical complexity still require a clinical specialist psychologist or other professionals according to the referral system. This is precisely how a good health system works: there is primary care, referrals, specialisation, and a clear division of authority. What is needed is not forcing general psychologists into a ‘Titian’ pathway to be deemed fit, but rather formally structuring their role within primary care.