For those dealing with psychological illnesses, the arrival of Covid-19 made mental health care even more necessary. After six months, economic activities are returning to normal, even though there are more than 14,000 cases of the disease in the informal settlements of Rio de Janeiro, according to a mapping of the Painel Unificador Covid-19 nas Favelas (Unifying Panel of Covid-19 in the Favelas), released on October 5.

The challenges of this crisis were predicted by the World Health Organization (WHO), which treated the pandemic not only as a health and humanitarian issue, but also as a mental health one. About 30% to 50% of those in socioeconomic and psychosocial vulnerability, such as slum dwellers, are more likely to develop some form of mental disorder or face worsening symptoms.

Carlos César de Carvalho, a psychiatrist at the Center for Psychosocial Care (CAPS, as they are known in Brazil), provides support in six Maré units and has been working in the 16 favelas that make up the complex for over five years.

Mental struggles are defense mechanisms developed by the brain to deal with certain situations, he said. Alarms should go off when the sensations go beyond the level of protection. “Having feelings is in no way a disorder. Each person will develop a mechanism to give direction to this suffering. Talking about it is an important way to work on these issues.”

Anna Cláudia Neves, a 45-year-old communicator and resident of Salsa e Merengue, in Maré, has been dealing with anxiety, panic disorder and depression for three years. Without being able to renew her prescriptions, she experienced an abstinence crisis.

“I was crying and trembling. Only after the reactions subsided I understood that it was because of the lack of medication. I couldn’t go to the Family Clinic because the priority was to protect myself from the coronavirus”, she said.

Although the National Sanitary Surveillance Agency (ANVISA) has changed the rules to make it easier to receive medication at home and for patients to buy higher quantities at once, in the favelas, it doesn’t work like that.

Neves’s uncertainties were also motivated by the local situation. Maré is the territory with the most confirmed cases of coronavirus in Rio, totaling 1,667 (as of October 6), a number certainly underestimated because of underreporting (for every 10 residents, only three were tested or diagnosed).

According to the Unifying Panel of COVID-19 in the Favelas of Rio de Janeiro, drawn from reports of residents and community leaders, there are more than 14,651 cases and 1,941 deaths in the city’s favelas.

Increased Demand for Services

Mental health in Brazil is a right of all citizens, as is access to public services. For slum dwellers, the anguish is compounded by a host of violences – racial, gender, police – and the lack of access to basic entitlements. These are also important factors in the rise and aggravation of disorders.

“The increase in demand for care, often due to anxiety or depression, is a consequence of the extra stress that the population of Maré faces, which is very much linked to social and economic vulnerability,” Carlos Cesar explained.

Mental health care for the more than 140.000 residents of Maré is provided by primary care professionals of the Family Clinics. There are four of them: Augusto Boal, Jeremias Moraes da Silva, Diniz Batista dos Santos and the Centro Municipal de Saúde Américo Veloso. Most services were suspended during the pandemic, and the Centers for Psychosocial Care (CAPS) had to adapt to a remote format.

“We have the issue of social distancing, of not being able to be close, and wearing a mask can be a barrier for this interpersonal contact. The CAPS philosophy centers a lot around the collective, and this contact during the pandemic is impaired, as well as the decreased attendance,” Carlos César said.

One alternative was to offer psychological services through digital channels, which are permitted by law. Telephone and online services were provided, as well as the opening of exclusive Covid-19 wards for patients. At CAPS Magal, for example, WhatsApp care and discussion groups were fundamental.

The solution reaches many, but not all, Carlos César said. “In some, more fragile situations, people don’t have easy access to a telephone and the internet”. Thus, for more serious cases, face-to-face service was maintained.

The care strategies go beyond consultations. Health care professionals have the freedom to make home visits to maintain the relationship with patients. But it is insufficient. Demand increased during the pandemic, but the number of professionals did not.

The 14th edition of the Bulletin “De Olho no Corona!” (Keeping an eye on the corona), which addressed the impacts of the health crisis on the mental health of the Maré population, showed this clearly. The need for investment to expand psychiatric and psychological care is urgent, especially when the only alternative is the severely underfunded Unified Health System (SUS).

Neves has been on a wait list at the National Regulation System (Sisreg) for two years to receive psychiatric care in one of Maré’s clinics. When she finally gets the treatment that she needs, she wishes to pursue a degree in Psychology.

Until then, she dedicates her time and energy, along with her sister Simone Laur, to the Maré Minds project, which has been offering free online psychological support to about 200 residents since March 2020, in addition to daily monitoring by 10 volunteer health care professionals. During Yellow September, project members distributed posters around the favelas to raise awareness of mental disorders and take part in the global suicide prevention campaign.

Volunteers carry out their tasks using a borrowed computer, two cell phones and data packages. “We’re really doing it for the cause, getting our hands dirty. We want to keep the project going after the pandemic, because there will be children and mothers who will need help. More than that, the patients themselves are asking that we host group sessions when everything reopens”, he says.

Historically Vulnerable

Local initiatives emerged as social support during the pandemic as a way to counter the lack of investment in public health care. The situation was put on the spotlight since health care professionals suffered salary delays and layoffs in 2019, just months before the pandemic took hold.

“We do not see a change in public power to restructure these services. The context of mental health in terms of care and service was already precarious and unable to cope before the pandemic,” said Luna Arouca, social worker and coordinator of Espaço Normal, a project of Redes da Maré, which works with homeless populations and drug users in Maré.

In this difficult scenario, Telemedicina SAS Brasil has strengthened its online and free services to those living in marginalized neighborhoods of Rio de Janeiro and São Paulo. They have already carried out more than 4,000 consultations.

“When we talk about mental health in the favela, diagnosis and treatment are important, but they are not everything. Confrontation of the problem happens by strengthening citizenship”, said Thiago Melício, professor and psychologist, who works with marginalized populations.

“Public policies can offer a better structure for confrontation, so that people can access the policies of assistance, justice and education. Those are the structures that will form this network of citizenship.” Carlos César agrees. “We can spark mobilization to improve people’s lives by helping them search for the realization of dreams and meaning of life”.

Alternatives to mental health care were only possible after the psychiatric reform in Brazil, which developed laws and policies of regulation for humanized treatment. Before the reform, people were limited to their conditions. Thanks to the anti-asylum movement, patients became the focus.

This does not diminish the value that we must give to care. The Maré Minds project, for example, inspired similar initiatives in the Complexo do Alemão and Rocinha, other mega-favelas in Rio de Janeiro.

Among the challenges, Neves cites prejudice. “Poor people suffer from mental disorders, too, they are not reserved for rich people. Work demands more from us, life demands more from us. And the idea is that [patients] should find comfort in knowing that there is someone who cares close to them.”

The practice of valuing life comes from health professionals, residents and local institutions, although with little investment. It comes from online initiatives and actions, from the distribution of basic hygiene items and basic food baskets, and from other care practices extended to each Maré resident. With the streets once again full, the fight continues to come from within.

Free mental health support initiatives in Maré:

Telemedicina SAS Brasil – Online psychological care

WhatsApp: 21 99272-0554
Espaço Normal – Harm reduction space

Telephone: 21 3105-4767
Instituto Yoga na Maré – Online yoga classes

Instagram: @yoganamare
Mentes da Maré – Online psychological care

WhatsApp: 21 98635-7575

Thaís Cavalcante is a Brazilian Journalist from the Maré favela in Rio de Janeiro. Follow @tcavalcantes

This article appeared originally in Open Democracy – https://www.opendemocracy.net/

The Maré neighborhood, in the northern part of the city, is home to approximately 140,000 people who live in 16 different communities. Because it’s located along three of the city’s main expressways – the Avenida Brasil, Linha Amarela and Linha Vermelha – all international travelers drive past it, or past the wall that hides Maré from tourist eyes, on their way to the Galeão airport.

When the students gathered at their meeting point in the Parque União area, spirits were high. In neighborhood shops and squares, locals were getting ready for a sunny Saturday and setting up for a yellow fever vaccination campaign.

Some students had mentioned that their families were concerned about them working in Maré. Armed gangs operate openly in this informal settlement, and in one seven-day period this year, a series of five conflicts left six people dead and three wounded, according to the community group Redes da Maré, which monitors public safety in the neighborhood.

But the women felt confident. They were told that they would only enter the favela if it was safe, the walk to the Casa das Mulheres was uneventful and they were warmly greeted by the staff.

About 90 minutes into a lively meeting, shots rang out nearby. The locals seemed calm, but WhatsApp messages pinging on mobile phones alerted Casa staff of a surprise police raid in Parque União.

The Special Operations Battalion of the military police (known by their Portuguese acronym, BOPE), arrived at around 11 am. Now gun shots were replaced by bursts of machine gun fire and explosions.

The group tried to stay calm and continue the meeting, despite frequent interruptions. When the gunfight got most intense, they took shelter under the stairs and in the back of the newly installed industrial kitchen.

Upon leaving the community center safely at 3 pm, the group passed several tanks, which locals call the caveirão (or “big skull”), and 30 heavily armed men in uniform: BOPE officers.

When they got home, they learnt that four Maré residents had died that day, not far from the Casa das Mulheres.

I was one of the two professors and I was distraught. But March 25 was just an ordinary day for the thousands of people who live in the conflict zones of Brazil’s second-largest city.

According to the Forum Brasileiro de Segurança Pública, a public safety research group, 4,572 people were murdered in the state of Rio de Janeiro in 2016, an increase of almost 20% over the year before. In February 2017 alone, the state registered 502 murders, which was 24.3% higher than February 2016.

Brazil’s national homicide rate is ninth in the Americas, according to a 2016 World Health Organization report, with 32.4 deaths per 100,000 inhabitants. That’s worse than Haiti (26.6), Mexico (22) and Ecuador (13.8) but better than homicide-beset Honduras (103.9), Venezuela (57.6), Colombia (43.9) and Guatemala (39.9).

But in this country of 200 million, the sheer numbers are staggering. More people were murdered in Brazil in the five-year period from 2011 to 2015 (279,567 victims) than those killed in the war in Syria (256,124 victims). Also notable is the profile of the people dying: in 2015, 54% of Brazilian homicide victims were young people between the ages of 15 and 24, and 73% were black or brown.

Police violence figures are even more stunning. Between 2009 and 2015, law enforcement killed 17,688 people. Figures from the Forum Brasileiro indicate that in 2014, 584 people died as a result of “resisting a police intervention”.

In 2015, 645 out of a total 58,467 violent deaths were at the hands of police. And last year, 920 people were killed by the same forces that, in theory, are supposed to protect them.

In the Maré neighborhood, law enforcement’s death toll last year was 17, the result of 33 police operations. This rate of 12.8 deaths per 100,000 is eight times higher than in the rest of Brazil and three times that of Rio de Janeiro state.

Safe for Whom?

This year, Maré has already seen 12 brutal police operations similar to the one on March 25. So far, 11 people have been injured and five killed, including four residents and a police officer, according to the group Redes da Maré. These figures do not include results from yet another raid that happened while this article was in production.

Like the university professors and students who witnessed that day of violence in March, the residents of Maré and other Rio de Janeiro favelas are terrified by the city’s spike in violence.

Rio police are clearly not helping. Research shows that warlike invasions of places like Maré – primarily carried out by the military police – do not provide any positive or sustainable results. Instead, the raids create widespread fear, injure or kill innocent bystanders, and kill people: both suspects and police officers.

The day after the invasion, the old “order” is restored. Nothing changes, it only deteriorates.

Such raids leave not only a trail of blood in their wake, but also create hatred, resentment and a deep distrust of government institutions. Little by little, the image of the Rio police has become dissociated from the notions of justice and protection.

Brazil has been trying unsuccessfully to quell crime with militarized law enforcement for decades, but governments remain immune to criticism from the local population and international human rights organizations.

Of course, there is no easy solution. Definitive change in Maré would require profound socioeconomic and cultural changes across Brazil. This involves addressing the country’s structural racism, abysmal inequality and social stigma that all but justifies abusive state treatment of its poorest.

As the author Luiz Eduardo Soares has pointed out “police brutality wouldn’t exist if society didn’t allow it”. Public opinion and the media sanction these killings, otherwise the government could not keep deploying its resources against its own people. The same holds for prosecutors and justice officials who let police violence go unpunished.

Will the children of Maré get vaccinated safely this Saturday? Will the interns return to the Casa das Mulheres next weekend without fear? At this point, we can only hope.

Miriam Krenzinger is a Criminal Science Professor and Researcher on Crime Prevention and Human Rights at Universidade Federal do Rio de Janeiro.

This article was co-authored by Eliana Sousa Silva, PhD, executive director of the community organization Redes da Maré.

Disclosure statement:

Miriam Krenzinger does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.

This article was originally published in The Conversation. Read the original article here: http://theconversation.com/with-tanks-grenades-and-guns-police-wage-war-on-rio-de-janeiros-poorest-73182