SP City Hall hospitalized only 2 people in 5 months of program for dependents

In the last five months, the City Hall of São Paulo referred only two people to the inpatient places for chemical dependents available through an agreement with the state government.

An agreement that began this year provides for 59 places for municipal management in therapeutic communities located in the cities of Santo André and Arujá, in the metropolitan region. The units are part of the São Paulo government’s Recomeço program, which before the agreement was responsible for all referrals.

According to the Municipal Health Department, so far, six people have been nominated for the vacancies, but only two have accepted hospitalization. The others gave up the vacancy for personal reasons, according to the secretary. All were in cracolândia before being referred to the service for users in Armenia, central region.

The new vacancies are part of the treatment strategy for users received by the Siats (Integrated Service for Therapeutic Reception), specific reception centers for drug users in the capital. After temporary care in these places, part of the dependents can be directed to hospitalization.

In addition to the vacancies agreed with the state, the municipality has 149 psychiatric beds intended “not only for crisis and extreme chemical dependence”, according to the secretary. “The folder emphasizes that cases of hospitalization are indicated only when all therapeutic treatments available in Caps [Centros de Atenção Psicossocial] are exhausted”, informed the Health Department, citing the outpatient psychiatric treatment units in the city.

The folder still claims to have no estimate of the demand for hospitalization for chemical dependency in the city because the beds available are intended for psychiatric patients in general.

Since last Wednesday (11), when a police operation emptied the Princesa Isabel square, where Cracolândia was concentrated, groups of drug users have circulated through the streets of the central region in search of a new point.

In one of these displacements, on Thursday night (12), a user was shot dead during a riot. Raimundo Nonato Rodrigues Fonseca Júnior, 32, lived on the streets of São Paulo because of his crack addiction at least since 2019, when he was admitted to the Caps unit in Santana, in the north zone.

The profile of vacancies for drug addicts currently offered by municipal and state governments highlights the priority given to therapeutic communities in drug treatment policy.

In the city of São Paulo, in the last 18 months, 7 out of 10 hospitalizations made through Recomeço are in therapeutic communities — this number includes project visits that are not part of the recent agreement with the city hall. Of the total of 594 people hospitalized, 168 went to transit houses, a type of temporary reception of up to 30 days. The rest went to therapeutic communities, according to official data.

Unlike rehabilitation clinics, where there are doctors and prescription drugs, therapeutic communities base treatment on religion and occupational therapy. Most are run by Christian or Catholic churches. “In Brazil, this has been done for over 20 years, but it does not have the claimed effectiveness. Less than 1% actually give up drugs”, says psychiatrist Dartiu Xavier, coordinator of the Guidance and Assistance Program for Dependents at Unifesp (Universidade Federal of Sao Paulo).

In a note, the State Department of Social Development denied the low demand for hospitalization spaces and stated that “the referral of citizens to the Recomeço Program is thorough and goes through stages of screening of social data and medical examinations, with case-by-case analysis. “.

The secretariat also stressed that the treatment method is effective because people “are supported under the technical gaze of social workers, psychologists and pedagogues about living with friendships that can lead to relapses in the use of hallucinogenic substances and in behavior, posture and habits after visiting the family and returning home”.

The trend of the state government is to offer more places in therapeutic communities. The signing of a Technical Cooperation Agreement between the Government Secretariat of São Paulo and the National Secretariat for Care and Drug Prevention of the Ministry of Citizenship is under negotiation, whose pillar of treatment is religious establishments. The state government was asked about the plan, but did not comment on the agreement.

Hospitalizations in practice

A chemical dependent since the age of 15, Elvira Junqueira de Azevedo, 44, says she has already been through about 60 hospitalizations in an attempt to get rid of her addiction to crack. Some of them were in therapeutic communities. “In these places, the patients became employees without remuneration besides the food, which is precarious. It didn’t help me at all, it just made me more angry”, she says.

She says that in one of these establishments, in Jundiaí (SP), she was forced to use a hoe to dig holes in the earth and then cover them. “If I refused, I ran out of food,” she says.

Elvira says she asked to leave, but was told her mother had signed a term that prevented her from leaving the therapeutic community. “One night I ran away. I ran through the woods until I reached the highway and asked an evangelical truck driver for a ride, I told him I was being tortured”, she recalls.

Upon arriving in São Paulo, she spent a few days at a friend’s house negotiating with her mother to be able to return home without being forcibly hospitalized again.

Hospitalized for about a month in a private clinic in Araçoiaba da Serra, in the interior of São Paulo, Elvira says that the desire to be hospitalized, this time, came after suffering aggressions during a police action in Cracolândia on Avenida Paulista, where she had been 20 days due to crack addiction.

“At that time, I thought I had hit rock bottom”, he recalls. “I called my mother and asked her to pick me up. Only mothers are allowed to enter the Cracolândia da Paulista”, she says, about the agglomeration of drug users established near Praça do Ciclista.

The businessman and former councilor for Suzano Felix Romanos, 46, is also critical of the method of internment, although he generally defends it. Of the 12 hospitalizations he went through to treat his crack addiction, 10 were in therapeutic communities. “It’s an ambiguity. Therapeutic communities welcome people and take them off the streets, but they don’t see addiction as a disease to be treated. They attribute to God a cure that doesn’t exist”, he says.

During the six years he spent in therapeutic communities, the entrepreneur recalls that the number of patients he saw quitting is not enough to fill the palm of his hand. “The big problem is not being able to administer medication. But what you receive most is love. The user, on the street, becomes invisible, and there you feel loved”, says he, who lived for a period in cracolândia.

Ana Trigo, a doctor in the science of religion who studies this method of treatment, explains the daily work that seeks to make drug addicts develop discipline and self-control. “Spirituality is worked through reading biblical texts,” she says.

Therapeutic communities were legally recognized as treatment centers in June 2019, when the federal law that regulated the sector was enacted. At the time, the theme was defended by the then Chief Minister of the Civil House of the Dilma Rousseff (PT) government, Gleisi Hoffmann.