{"id":33872,"date":"2016-12-27T14:28:44","date_gmt":"2016-12-27T17:28:44","guid":{"rendered":"http:\/\/www.rioonwatch.org\/?p=33872"},"modified":"2020-05-16T13:59:45","modified_gmt":"2020-05-16T16:59:45","slug":"mental-health-challenges-in-rios-favelas","status":"publish","type":"post","link":"https:\/\/rioonwatch.org\/?p=33872","title":{"rendered":"The Challenge of Mental Health in Rio’s Favelas"},"content":{"rendered":"

Clique aqui para Portugu\u00eas<\/em><\/strong><\/a><\/p>\n

Psychological problems, when untreated, can have severe impacts that go beyond basic mental health<\/a>. Even minimal anxiety can lead to an accumulation of a stress hormone known as cortisol, which can lead to a deteriorating physical state. In disadvantaged areas, like some favelas<\/a>, for example, the amount of stress faced by residents on a daily basis can be extremely high. An elevated measure of this stress, called allostatic load, is related to decreases in capacity to self-regulate, make plans, and working memory. According to Martha J. Farah<\/a>, who studied the psychophysiological effects of living in poverty in the U.S., there is a strong negative correlation between years living in poverty and cognitive brain functioning.<\/p>\n

In Rio de Janeiro, a city known for its\u00a0harsh inequalities<\/a>, mental health is often set aside on the list of priorities. Professionals and residents alike, however, agree that it is a problem that needs to be urgently addressed.<\/p>\n

The Brazilian government has developed a system of Family Health Clinics<\/a>\u00a0focused on prevention and promotion of health and part of the broader\u00a0SUS (Unified Health System)<\/a>. Since 2008, the system<\/a> has widely expanded, and family health outposts are now spread throughout the city of Rio, covering 56,8% of the city\u2019s communities, up from 3.5% in January of 2009<\/a>. The system also accounts for emergency health care in its UPA (Emergency Care Units)<\/a> outposts. Although the preventive care in the family units accounts for mental health, there also exist\u00a0additional health posts<\/a> dedicated to severe mental\u00a0disorders, known as CAPS (Community Psychosocial Centers)<\/a>. Despite this, assistance to those needing basic mental health prevention or treatment remains deeply\u00a0insufficient.<\/p>\n

\"Rocinha<\/a><\/p>\n

Joana Thiesen is one of the psychiatrists\u00a0based at a Family Health Clinic\u00a0in Rocinha<\/a>, the largest favela in Brazil. She also works at the health unit in another South Zone<\/a> favela, Pav\u00e3o-Pav\u00e3ozinho<\/a>, and has just started at the Catete unit, where the health system is used by favela residents as well as those from the formal city. She facilitates group therapy sessions with an aim at harm reduction\u2013in Rocinha, she deals with a lot of alcoholism and other drug addictions. An advantage of these group therapy sessions, she says, is that they allow for an exchange of coping mechanisms that an individual, professional therapist could not come up with. Health professionals often live different day-to-days than many favela residents, among which \u201cmany have already developed abilities to deal with this.\u201d<\/p>\n

Natalia Helou Fazzioni, a researcher in health anthropology at the Rio de Janeiro Federal University (UFRJ), speaks differently of group therapy after her experiences in Complexo do Alem\u00e3o<\/a>, a complex of favelas in Rio\u2019s North Zone<\/a>. For her, this model is inadequate for a community like Alem\u00e3o, where those seeking mental health support could be\u00a0relatives\u00a0of policemen or\u00a0of drug traffickers, or otherwise find themselves in conflict with one another, making group therapy unproductive. Even in situations where the existing problem is unrelated to violence<\/a>,\u00a0mental health is an intimate thing that may be hard to open up about. Incidentally, opening up is a lot of what mental health treatment is about. Fazzioni says individual psychological treatment needs to be made available to those who might, some day, need it: \u201cPsychological assistance isn\u2019t always necessary, many of these people solve their problems through individual means, through religion, other things. But the option of treatment through psychology, psychoanalysis, has to be available.\u201d<\/p>\n

Doctors Without Borders (MSF)<\/a> attempted to call attention to this when, from 2007 to 2010, they ran an emergency health clinic in Complexo do Alem\u00e3o. In addition to basic emergency health care, MSF deployed psychologists to their outpost, located in the middle of the complex. Douglas Khayat, one of these psychologists, lamented the lack of mental health support but praised the limited success that the MSF project had on residents of Alem\u00e3o. \u201cPeople started to talk about things that they never talked about. This has an immediate effect in terms of relieving tension, and of course when you relieve tension, with directed view, you have a gain in terms of quality of life,\u201d he says.<\/p>\n

According to Douglas, psychologists in Brazil prefer\u00a0the private sector where they can charge high amounts. This contributes to a widespread preconception\u00a0that \u201cmental health problems are problems of the rich, the poor don\u2019t have time to be sad, because they have to make a living, raise their children, build a house\u2026,\u201d as Natalia Fazzioni points out. Irenaldo Hon\u00f3rio\u00a0da Silva, a physical therapist and president of the neighborhood association\u00a0of Pica-Pau<\/a>, a favela in the North Zone, says people in favelas still believe that mental health problems are taboo. According to him, the lack of health infrastructure in the community contributes to this problem: \u201cThere are many people here affected by depression. And they don\u2019t succeed in getting better because there is no adequate care.\u201d<\/p>\n

\"Irenaldo<\/a><\/p>\n

Unfortunately, adequate mental health treatment is often replaced by quick-and-easy medication practices. Rivotril, a calming\u00a0prescription drug, is\u00a0sold at low prices and in extreme quantities<\/a> in Brazil. In the U.S., the\u00a0prescription drug is known as\u00a0Klonopin (medical name clonazepam<\/em>), and is\u00a0considered one of the most dangerous<\/a> on the market today. Fazzioni denounces the medicalization of Brazil\u2019s mental health problems, explaining the difficult situation faced by\u00a0doctors who are not specifically trained in psychology and often face a long line of patients, most of whom are looking for the quickest (efficiency aside) remedy out there. In favelas, the cheap price of Rivotril makes this remedy attractive. For those who don\u2019t get access to such prescription drugs, alcohol and other street drugs are accessible and can become the patient’s\u00a0escape from day-to-day challenges.<\/p>\n

These challenges are of a wide scope in Rio\u2019s favelas, and often differ from those of middle- and upper-class Brazilians living in the formal city. On top of economic and family stress, favela residents often have to deal with the stress of violent outbursts<\/a>\u00a0and at times excruciating forced\u00a0evictions<\/a> from their communities. The constant worry that shootings may erupt close by or that one’s home and community are otherwise insecure have severe effects on stress levels and, subsequently, on mental health. Douglas Khayat argues that this was made worse by the implementation of the Pacifying Police Units (UPPs)<\/a>, which made violent altercations between police and drug traffickers more frequent in Alem\u00e3o. With the resulting unpredictability, he said, favela residents have to be on constant alert. This was amplified by constant police operations<\/a> in various favelas during the recent\u00a0Rio 2016 Olympic Games<\/a>. Impacts of violence on residents\u2019 mental health are all the more serious when family clinics have to suddenly close down in times of violence. Joana, who has experienced such situations in Rocinha, says residents often complain that the clinic closes at times when residents are in most dire need of its support.<\/p>\n

Marize Bastos da Cunha, a health researcher at<\/span>\u00a0Fiocruz<\/a>,\u00a0says she has seen an increase in diabetes and hypertension in recent years, a problem she believes is directly tied to increases in chronic depression and anxiety. \u201cThe government is investing in weapons<\/a> more than health and people\u2019s living conditions.\u201d Echoing Irenaldo, she says that depression is still an invisible problem, particularly among favela youth. \u201cYouth\u00a0are only an object of health politics to talk about pregnancy and drugs. So this young person is living an extremely dramatic day-to-day, he is suffering from stomach problems, mental health problems, lack of perspective in life, hypertension, obesity…. And this young person has no specific care program designed for him or her.\u201d<\/p>\n

Living conditions can\u00a0also be\u00a0a barrier to a healthy mind. Favela residents may have limited living space, streets can be crowded and dirty, sewage may\u00a0run freely due to the lack of\u00a0an adequate sewerage system<\/a>. These conditions are the precursor to a number of\u00a0health problems, such as\u00a0tuberculosis<\/a>. Irenaldo, of Pica-Pau, has been demanding that Rio\u2019s city government<\/a>\u00a0set up better infrastructure in his community for years<\/a>. He believes that the lack of an adequate sewerage or trash removal system has severe impacts on his community\u2019s well-being, and that mental health problems are more frequent within his\u00a0favela due to poor living conditions.<\/p>\n

Government neglect<\/a>\u00a0is thus a major contributor to mental health problems.\u00a0A good example is the City’s\u00a0Morar Carioca<\/a>\u00a0program, which since 2010 had promised to bring missing services into hundreds of favelas. Instead, the program has left communities like Pica-Pau waiting<\/a>, and then reliving abandonment<\/a>, over and over again<\/a>. The abandonment of favelas<\/a> by the government not only leaves them in a precarious state that contributes to mental health challenges, but can create a sense of desperation for residents, and thus\u00a0causes increased depression and anxiety for those who are forced to live\u00a0with the consequences.\u00a0Stigmatization<\/a> of favela populations can also have similar impacts, as those living in favelas feel marginalized in the city and, sometimes, end up feeling a sense of shame towards where they come from.<\/p>\n

This stigmatization is of course\u00a0unfounded, and favelas have come to increasingly represent values of\u00a0creativity\u00a0and community<\/a>.\u00a0In fact, the\u00a0resilience<\/a> residents have found to deal with mental health is thanks mainly to\u00a0the self-built\u00a0assets of favelas, such as collective action<\/a>, creativity<\/a> and community.<\/p>\n","protected":false},"excerpt":{"rendered":"

Clique aqui para Portugu\u00eas Psychological problems, when untreated, can have severe impacts that go beyond basic mental health. Even minimal anxiety can lead to an accumulation of a stress hormone known as cortisol, which can […]<\/a><\/p>\n<\/div>","protected":false},"author":113,"featured_media":34507,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[1277,1288,1290,335,1282,336,1329],"tags":[32,892,2329,107,203,755,1862,147,37,5,15,155,519,423,1817,12,156,924,343,951,30],"writer":[2133],"translator":[],"illustrator":[],"photographer":[],"class_list":{"0":"post-33872","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-uppwatch","8":"category-highlight","9":"category-civilsociety","10":"category-policies","11":"category-research-analysis","12":"category-violations","13":"category-by-international-observers","14":"tag-complexo-do-alemao","15":"tag-family-health-clinic","16":"tag-fiocruz","17":"tag-health","18":"tag-inequality","19":"tag-infrastructure","20":"tag-mental-health","21":"tag-morar-carioca","22":"tag-north-zone","23":"tag-olympics","24":"tag-pacifying-police-unit","25":"tag-pavao-pavaozinho","26":"tag-pica-pau","27":"tag-psychological-terror","28":"tag-psychology","29":"tag-rocinha","30":"tag-south-zone","31":"tag-sus","32":"tag-trauma","33":"tag-upa","34":"tag-urban-violence","35":"writer-alix-vadot"},"_links":{"self":[{"href":"https:\/\/rioonwatch.org\/index.php?rest_route=\/wp\/v2\/posts\/33872","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/rioonwatch.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/rioonwatch.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/rioonwatch.org\/index.php?rest_route=\/wp\/v2\/users\/113"}],"replies":[{"embeddable":true,"href":"https:\/\/rioonwatch.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=33872"}],"version-history":[{"count":0,"href":"https:\/\/rioonwatch.org\/index.php?rest_route=\/wp\/v2\/posts\/33872\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/rioonwatch.org\/index.php?rest_route=\/wp\/v2\/media\/34507"}],"wp:attachment":[{"href":"https:\/\/rioonwatch.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=33872"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/rioonwatch.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=33872"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/rioonwatch.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=33872"},{"taxonomy":"writer","embeddable":true,"href":"https:\/\/rioonwatch.org\/index.php?rest_route=%2Fwp%2Fv2%2Fwriter&post=33872"},{"taxonomy":"translator","embeddable":true,"href":"https:\/\/rioonwatch.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftranslator&post=33872"},{"taxonomy":"illustrator","embeddable":true,"href":"https:\/\/rioonwatch.org\/index.php?rest_route=%2Fwp%2Fv2%2Fillustrator&post=33872"},{"taxonomy":"photographer","embeddable":true,"href":"https:\/\/rioonwatch.org\/index.php?rest_route=%2Fwp%2Fv2%2Fphotographer&post=33872"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}