Brazil lives ‘2nd pandemic’ in mental health, with crowd of depressed and anxious

“The name of the disease is sadness, the worst it has,” says Gerson Hein, 48, wiping his forehead with his forearm on a sunny winter morning. As he holds a green sapling of tobacco, his boots smeared with dirt, he points to the five oxen on the other side of the fence.

“They’re all so happy grazing, but you always have to pay attention. If one isolates itself from the flock, puts its ears down and withers its tail, something’s wrong.” The farmer talks about the animals, but the subject is people: “It’s the same in human beings, it gives and kills”.

Gerson luckily never saw it up close, but his property is in a region where hanging cases no longer shock. The city is Venâncio Aires (RS), one hour from Porto Alegre, which historically has one of the highest suicide rates in Brazil.

There were nine deaths and 38 attempts in the first six months of this year alone, with farmers like him being the most common victims. The gaucho municipality of 72 thousand inhabitants reflects a country that is mentally ill and accumulates a crowd of depressed and anxious people and, consequently, of the dead.

The total number of deaths in the country from self-harm has doubled from about 7,000 to 14,000 in the last 20 years, according to Datasus, without considering underreporting. This equates to more than one death per hour, surpassing deaths from motorcycle accidents or from HIV.

The curve goes against the direction of the rest of the world, but follows the trend of Latin America, according to the WHO (World Health Organization), which attributes the worsening to poverty, inequality, exposure to situations of violence and absence or to inefficiency of prevention plans.

“It’s all about trying to get out of the life we ​​lead”, says Ana Paula da Silva, 39. She says that she has episodes of self-mutilation and that she tried to take her own life five times, remembering a childhood of absences: “Sometimes , we only had lunch or dinner”.

She started working at 14 and became a prostitute on the streets of Venâncio after she lost her father, an alcoholic. She also surrendered to cocaine and drinking. Today, she feels better and tries to start over with conversation circles and hot water from the mate she likes at Caps (Psychosocial Care Center).

Rio Grande do Sul always occupies the top of the Brazilian ranking, for reasons that even the state suicide prevention committee has difficulty understanding. The hypotheses go through the culture inherited from the German colonization: “In the South, mental health is seen as nonsense, as if the person did not want to work”, says the coordinator of the committee, Andréia Volkmer.

In Vale do Rio Pardo, where Venâncio Aires is located, there is also the economic factor of a region that depends essentially on tobacco and, therefore, on the climate and the quality of the crop. Many victims there are men over 50, tobacco growers who no longer feel productive.

Researchers also cite organophosphate pesticides as triggers of depression. The city, however, says that the cases vary a lot and puts the factor in the background: “We identified many people who had suffered violence or were violent, for example”, says nurse Patrícia Antoni, coordinator of the municipal committee.

The reasons are complex and multiple, but “the most dangerous word is when the person says ‘I’m tired’, then they have to run”, says psychiatrist Ricardo Nogueira, professor at Ulbra (Lutheran University of Brazil) and author of two books and a manual on suicide prevention in the state.

He describes the act as the endpoint of “the six Ds”: hopelessness, depression, unemployment, lovelessness, helplessness, and despair. To prevent suicide is, then, to prevent mental suffering in its various forms. And they are not few.

The range of disorders reaches more than 300 types, according to the DSM 5 classification, an international reference created by the American Psychiatric Association. But the most common are anxiety and depression, problems that Brazil is well aware of, as different surveys show.

A WHO survey in 2017 pointed to Brazil as the country with the highest rate of anxiety in the world (9.3% or 18 million people) and the third highest in depressive (5.8% or 11 million), very close to the USA and Australia (5.9%) —the entity considers that it is not possible to talk about ranking, because they are estimates.

Today, however, these numbers are far from reality. The effects of grief, fear and isolation from Covid-19 have been explosive in the last two years (although the period has not significantly influenced suicides, specifically).

The latest more comprehensive survey, by Vital Strategies and the Federal University of Pelotas, showed that those who say they have been diagnosed with depression rose from 9.6% before the pandemic to 13.5% in 2022. The Brazilian Association of Psychiatry cites that a quarter of the population has, has had or will have depression in their lifetime.

“We are coming out of the coronavirus pandemic and into a mental health pandemic,” says Nogueira. “At the height of Covid, we would go to see patients at home and they would say: ‘doctor, for God’s sake, open the bars, because then at least we stop drinking when they close’.”

As bars closed, so did mental health services, which stifled demand and made patients in crisis increase. At Caps da Restinga, in the extreme south of Porto Alegre, for example, the 3,000 annual consultations for chemical dependents became 14,000, including more women and middle-class people.

In recent months, the team at the Restinga unit had to pay special attention to the Van-Ká indigenous village, belonging to the Kaingang ethnic group, a few kilometers away. One of its leaders, Eli Fidelis, 51, committed suicide after years of deep depression.

“Here we have our parties. Fewer wakes, which are not supposed to happen anymore”, says Nerlei, 38, the youngest of eight siblings, indicating a covered and circular space. “A while ago we didn’t even know what depression was”, says another brother, chief Odirlei, 40.

Eli is an example of a portion of the population that has triple the Brazilian suicide rate, directly related, among other factors, to alcoholism. The phenomenon is not widespread, but located in specific communities and ethnicities and concentrated in adolescents, according to the Ministry of Health.

Other strata that spark alerts are police and LGBTQIA+ people. The chances of a young person in this second group having a mental disorder is three times greater for anxiety, twice for depression and five times for post-traumatic stress, showed a study carried out in schools in São Paulo and Porto Alegre in 2019.

Adolescents and young adults in general are now the biggest concern in the country and in the world, with rates of self-harm soaring above average.

The organization insists that suicide is preventable, recommending four main guidelines for countries: making it difficult to access the main methods used; qualify the work of the media so that it neutralizes reports and emphasizes stories of overcoming; expand and strengthen mental health services, training professionals to identify early cases; work on socio-emotional skills in teaching spaces.

At Escola Municipal Dom Pedro 2º, in Venâncio, for example, the figure of sunflowers is used, which “look at each other on cloudy days”. It has become common for students to call their teachers when they see something wrong with their peers.

With this, they avoided the mood swings and crying that often started for no reason in the classroom. “There is no vaccine against suicide. What you have to have is sensitized, trained and qualified people”, recalls psychiatrist Ricardo Nogueira.

Where to look for help?

Mental Health Map

Site maps different types of service: www.mapasaudemental.com.br

CVV (Life Appreciation Center)

Volunteers answer toll-free calls 24 hours a day at number 188: www.cvv.org.br.

What is the Brazil series on the couch

Depression, anxiety, burnout, schizophrenia, suicide: the explosion of mental disorders was cited exhaustively during more than two years of pandemic. However, little has gone into the capacity of the public mental health system, which has been undergoing major psychiatric reform for more than 20 years. The Brazil on the couch series discusses the size of the problem, the capacity of the SUS, the end of asylums, myths and prejudices that dominate the subject and possible solutions.