Rio de Janeiro’s Mental Health Care Facilities Lack Medicines and Professionals

RIO DE JANEIRO, BRAZIL – Hit hard by cuts in city government funding and lack of federal transfers, patients in Rio‘s municipal public mental health network face a shortage of medication, depleted teams of professionals, and an increasingly poor facility structure. Since he took office, Mayor Marcelo Crivella has cut nearly 30 percent of the city’s funds for psychosocial care.

A cross-check of data conducted by news site UOL based on information from “Rio Transparente”, the city’s public data portal, shows that, since he took office, Crivella has reduced funds for psychosocial care by 28.5 percent. In 2016, the last year of Eduardo Paes’ administration, R$56.5 million (US$14.1 million) were spent in the field, while in 2018 transfers fell to R$40.4 million. And the cuts continue: through the end of July, the city government has spent only R$20.4 million.

The Municipal Secretariat of Health states that “no service has functioned with a team below the minimum provided for in a municipal ordinance.”

In addition to the cuts introduced by the municipality, the problem is aggravated by the federal government. Data from the State Health Coordination obtained by state deputy Flávio Serafini, president of the Congressional Front in Defense of Mental Health and Anti-Manicomial Struggle in the Legislative Assembly of Rio (ALERJ), show that the Ministry of Health has failed to assist in funding 15 mental health facilities in the capital enabled by the portfolio itself to be granted federal funding. Throughout the state, the figure reaches 30 facilities — all of which should receive more than R$8 million per year.

“Rio has a serious issue because, at the same time as the city government is cutting funds, the Ministry of Health is changing its performance, depriving the network of even more funds. Medicine, food, and professionals are scarce in the facilities. This aggravates treatment and pushes patients into the street unattended,” says Serafini.

The Ministry of Health did not comment on the lack of transfers.

In the case of street dwellers, the city government provides psychosocial care teams as part of the Street Clinic program. However, today the city only has seven teams, divided by region.

Lack of medication and professionals

Relatives of mental health network users heard by UOL report that cuts and changes in facility management, with the replacement of social organizations, have hindered treatments.

UOL has obtained a list of drugs lacking in the Psychosocial Care Center (CAPS) Eliza Santa Roza, in Taquara (West Zone). Stocks are depleted of major medications: Levozine 25 mg, used to treat psychotic patients and to relieve anxiety, delirium, and confusion; Diazepam 5 mg and 10 mg, used in the treatment of anxiety disorders; Carbolitium 300 mg, used in the treatment of manic episodes in bipolar disorders; and Haldol 5 mg, prescribed for delusion, hallucination, and confusion.

A relative of the patient, who asked not to be identified for fear of reprisals, says that the lack of medicines is so frequent that the families have developed strategies not to interrupt the treatments.

“Families have to act as a drug bank. And a family in possession of the drug gives it to those who do not have it. Regardless of the psychiatric disorder, patients must not interrupt their treatment because they may experience a collapse.”

The Municipal Health Department only concedes to the lack of Diazepam 5 mg and Carbolitium 300 mg. According to the portfolio, the drugs are in the purchasing process. As for the other drugs, the secretariat says that “eventual shortages of these drugs in facilities are occasional cases and their replenishment is carried out as soon as requested by the facility’s pharmacist.”