We Need To Talk About Mental Health In Rio’s Favelas

By Felipe Araujo

Three people, three favelas, three journeys.

Stray bullets. Those have been Yuri Ibraim’s biggest fear since he was a child and, according to him, one of the root causes of his mental disorders. The social sciences and cinema student describes himself as “pathologically anxious” and “severely depressed,” but it’s only recently that he has become palpably aware of how serious his condition truly is.

I met Yuri at a popular shopping mall on a hot Sunday afternoon in São Gonçalo, Niterói — the city that stares back at Rio de Janeiro from the other side of Guanabára Bay. Cordial and soft-spoken, his answers were short, his gaze vacant. I couldn’t say for sure if it was his personality, or if his demeanor was a product of the medication he takes daily.

Ten minutes in, the 21-year-old told me — in an eerily casual manner — that he had tried to take his own life the previous night by overdosing on pills. Had it not been for his mum arriving home just in time, we probably wouldn’t be here having this conversation.

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Yuri was born and raised in Boassul, a favela with about 10,000 inhabitants not far from where we were. As far as he can remember, Boassul was always plagued by crime. These days, the criminal faction in charge is the Red Command, a vicious group of glorified gangsters that exert control over a number of such communities across Rio and beyond.

The shopping mall we chose as a meeting point could be anywhere in North America or Europe; families mill about eating chocolate sundaes from McDonald’s, little kids run all over the place, couples are window-shopping while holding hands. I remember thinking it was quite surreal that just a short bus ride from this idyllic suburban setting, thousands of people were living under the rule of a criminal organization which doesn’t even allow them to have an internet connection in their own homes.

Although Yuri has never been involved with any type of criminal activity himself, he says he’s seen many things he wishes he hadn’t. As much as he tried to stay away, crime and violence have always been a part of his everyday life.

“My first memory [of violence in the favela] was this criminal faction taking over the neighborhood while I was leaving school as a little boy,” he said. “I just saw all this commotion on the main road.”

Everyone I spoke to for this story — from local journalists with extensive experience covering the city’s favelas, to mental health experts who treat patients suffering from a number of mental disorders — kept referring to one thing: the normalization of violence.

Over the last 50 years, favelas have become the epicenter of the government’s vicious war on drugs. In the process, the law-abiding residents of those communities came to be seen as “collateral damage” in the daily battles between the police and local drug gangs.

Over the last 50 years, favelas have become the epicenter of the government’s vicious war on drugs.

Caught in the middle of it all, people like Yuri are forced to keep things in for fear of reprisals. It’s something I myself have experienced while covering stories in favelas — people seldom want to have their picture taken, or go on record to tell their version of events.

According to Dr. Kenia Okounhona, a psychologist with 15 years experience working in a number of Rio favelas, this culture of silence stifles people’s emotions, which in turn greatly affects their mental state.

“They know who it was, they know what happened, but if someone comes and asks, they say, ‘I don’t know anything, I haven’t seen anything.’ Emotionally, the price they pay for that type of response is very high.”

Unlike many Brazilians in similar circumstances, Yuri has family he can rely on. His mother buys the medication he needs every month out of her meager wages. When I mention to him that there’s a government-sponsored program that provides medical and social assistance to people in his situation, he seems to have no clue what I’m talking about.

This gap in knowledge is indicative of the chasm between the haves and the have-nots in Brazil. Yuri has no doubt that had he been born in a different neighborhood, under slightly better circumstances, his mental health would not dominate his life the way it does.

“People [in the favela] are very prejudiced when it comes to mental health, it’s just not something that’s talked about.”

“There are a lot of people needing professional help, but if you tell them to go see a psychologist, or a neurologist, or a psychiatrist, they think you are calling them crazy.”

Anyone who has spent some time in a Rio favela will quickly understand why the mentality of, “if you aren’t bleeding, you don’t have anything” is so pervasive. People in these communities are living day to day, literally dodging bullets from the criminals and those who are supposed to protect them — the police.

“I leave the house and I’m already anxious to return as soon as possible,” Yuri explains. “I’m really scared of being hit by a stray bullet. On many occasions, I have arrived home and minutes after, a shootout starts.”

And then there’s police violence. According to a 2014/2015 Amnesty International report titled “You Killed My Son: Homicides by Military Police in Rio de Janeiro,” of 1,275 registered cases of killings by on-duty police between 2010 and 2013, 99.5% of the victims were men, 79% were black, and 75% were aged between 15 and 29. Young, black, and poor, Yuri has a target on his back.

“I have never been stopped by either police or a drug trafficker, but if I had to choose, I would probably choose the trafficker,” he tells me.“For the police, I’m already a criminal. The trafficker might think that we are in this together, that we are equals in a way.”

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Although Yuri is on regular medication and better informed about what’s happening to his mind, his life today is still “confusing,” as he puts it, and in the favela there are not a lot of people he can turn to.

“I can’t have a dialogue with my family about the way I feel because at the end of the day no mother wants to hear from her son that he is thinking about suicide.”

In a favela, there are two other ways people have of forgetting about their daily struggles: churches and bars.

In the ultra-macho culture of these places, a lot of men see the bottle as the easiest way to deal with the stresses of daily life.

“Men generally turn to alcoholism,” Dr. Okounhona explains. “They usually have their own crew they can go to the nearest bar with and that’s how they vent.”

For Yuri’s family, the church is their rock. Brazil is the world’s largest Catholic country, but over the last decade the Protestant movement has made significant strides, especially among the poor.

“They [the church] provide lots of social services that the state doesn’t. My psychologist and neurologist were being subsidized by them at one point.”

‘Mental health disorders are still demonized.’

These days, however, Yuri no longer attends services regularly. As he became better informed about his mental disorders, the 21-year-old realized how his church’s approach could in fact be impeding his cure, instead of enabling it.

“Mental health disorders are still demonized. If I’m out on the street suffering from a panic attack or even epileptic seizures, they think the devil has taken over my body. Some people, instead of taking their family member to a hospital, prefer to take them to the nearest church.”

In spite of feeling suicidal, Yuri still plans for the future. He dreams of graduating from college and starting a social project in his community that would teach locals kids about film and the art of cinema.

There’s also something else.

“Hopefully next year I’ll move out of the house. I still need to prepare my mum for that day. She doesn’t want me to go.”

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Throughout the five years she stayed with the father of her children, Danielle Soares was beaten on a regular basis, even while pregnant.

The 31-year-old has attempted suicide twice in the space of a month, unable to cope with the constant verbal and physical abuse from her ex-partner while having to raise two kids on her own. In the process, she lost 44 pounds in two weeks.

“I just wanted to stay in bed crying the whole day, not wanting to eat anything and just do nothing,” she says. “I wanted to end it all and take my kids with me. I wanted to kill my own children.”

Danielle’s youngest daughter, 3-year-old Ana Luiza, is severely disabled. She was born healthy, but a day later came down with respiratory complications that left her unable to walk and caused serious brain damage. Her condition is yet to be diagnosed, but she will need extensive medical care for the rest of her life. For now, though, she clutches to her mother’s chest.

The family lives in the Pica-Pau favela, a community of around 7,000 residents in the north of Rio. Unlike Yuri’s neighborhood, shootouts between drug traffickers and police are not as common, but the president of the residents’ association had to notify the favela boss of my arrival. Down here, the Red Command still calls the shots.

Danielle doesn’t have a history of mental disorder. Her story, however, is not unique. In Brazil’s male-dominated society, domestic violence is endemic, and more often than not its victims are unable to seek the help of official government bodies.

“I don’t know if you know this, but before we call the police we need to go to them first.” By “them” she means the drug traffickers, or “the movement” as they call it, who control Pica-Pau.

More often than not, Brazil’s victims are unable to seek the help of official government bodies.

“I went to them, they heard me out, and said they would call my ex-partner in for a chat.”

Still, the harassment continued. The young mother kept receiving death threats via text messages until she was finally given permission to take him to court. Today, the father of her children is prohibited by law to contact her in any way, shape, or form.

Danielle’s state of mind is fragile. She says she no longer thinks about ending her life, much less her children’s, but she knows she needs professional help, which she is reluctant to get.

“I’m scared. I’m a very private person and it’s really hard for me to open up to people. I still feel deeply depressed some days. I start thinking about how it’s all on me, how I don’t have the support from their father or his family. I need to hustle to pay the rent, I need to hustle to feed my kids, and that really affects me.”

Women like Danielle represent the starkly gendered difference between how men and women in favelas cope with mental health issues. With the men either out working, in prison, or pursuing a life of crime, it falls on the women to stay home looking after the children.

“Women in general are a lot more neglected,” Dr. Okounhona says. “The man can go out and meet his friends, but the woman tends to stay at home, suffering in silence. It’s a lot harder to access those women.”

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More than an hour away from the center of Rio, Pica-Pau is a desolate place, and the negligence of the state is visible everywhere — houses half demolished or unfinished, garbage strewn all over the streets. The smell of raw sewage is so pungent I had to start breathing through my mouth.

And it’s precisely people living in these communities — which lack just about everything — that the government seems unable to help. When it comes to mental health, there is a universal system in place, but its tentacles just don’t stretch far enough.

“There are mechanisms in place [to help treat people’s mental disorders] but the demand is far too great,” says Dr. Okounhona. “Some people really are losing their minds and they just don’t have the access to the medication they need.”

Medication seems to be far down on Danielle’s list of priorities, however. Dependent on government allowances to cover her basic needs, she told me how just a few days ago she found herself with no money to feed her children; she had to ask her aunt to buy her a bag of rice and beans. Danielle’s daily existence is precarious.

‘I never thought of leaving this place.’

But in spite of all the difficulties, she insists that life wouldn’t be better, or easier, if she decided to up and leave. Born and raised in Pica-Pau, here she has a support network she believes she wouldn’t be able to find elsewhere.

“I never thought of leaving this place. My family is here and even though I can’t rely on them for everything, it’s good to know they are close by.”

For now, Danielle’s biggest concern is her disabled child. At a time when Rio just finished hosting the Paralympic Games — the biggest legacy of which was supposed to be a new awareness of the plight of the disabled community in Brazil — she worries how her baby girl will be treated by society.

“I think about it every day. How she will be treated, how life will be for her as a young woman. At this point, I don’t want to send her to school because I’m afraid of how people will see her.”

As for her mental health, Danielle plans to start seeing a psychologist soon, but her children take up all of her time.

“Right now, my children are my life. I can’t just leave them with anyone.”

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Regina Celia lost her only son in 1995 in a tragic, but not uncommon, case of mistaken identity.

Marcio Antonio, 25, was not a favela resident, but his girlfriend and mother of his children was.

One day Marcio went up to the Salgueiro favela, in the north of the city, to see his partner; he whistled when he got to her door, as he usually did.

Police officers passing by thought the whistling was Marcio’s way of warning drug traffickers of their arrival. In spite of the young man insisting he was no drug dealer and was just there to see his family, one of the officers put a bullet in his head, claiming later that Marcio tried to resist arrest.

It turns out the man the police were looking for was a known criminal — he just wasn’t Regina’s son.

Rio de Janeiro has one of the deadliest police forces in the world. From January to May of 2016, 322 civilians were killed as a result of police interventions in the state, a 13% increase over the same period the previous year, according to the state’s Institute for Public Security. And the problem goes way back.

When I met Regina in downtown Rio on a cloudy Wednesday afternoon, the 70-year-old seemed to be in good spirits. But as soon as talk turned to her son, tears started rolling down her face. The conversation was stopped. She needed to go to the toilet. When the bereft mother returned, she told me how a corrupt police force not only killed her son, but made her quest for justice a living nightmare, causing her to go into a deep depression.

From January to May of 2016, 322 civilians were killed as a result of police interventions in the state.

“In the beginning, when I started to fight for justice, they tried to intimidate me,” she said. “Men in unmarked vehicles would park at my door and stay there the whole day. It got to a point where I just felt completely alone. My depression got so bad, I spent 34 days on nothing but coffee and milk.”

It was Regina’s three daughters who slowly brought her back to life. A trained psychologist, she told me candidly that all her training could never have prepared her for such a devastating loss. And the government either didn’t want to or wasn’t willing to step in.

“Society stigmatizes you [when it comes to mental health], no matter if you are a mother from a favela or from a more affluent area.”

The stigmatization Regina talks about should be on the wane, at least according to government policy. Over the last 20 years, there has been a complete overhaul in the way people who suffer from mental disorders are treated in Brazil. Locking them up in mental health institutions, isolated from the outside world, is no longer standard procedure, although those facilities still exist.

Today, the standard are the Centres for Psycho and Social Assistance (CAPS) — a one-stop-shop that looks after patients’ physical and mental state while enabling them to be productive members of the community.

Days after the Olympic Games, I found myself in one of those centers in Rocinha, Rio’s largest favela.

For all the horror stories I have heard about the city’s public health system, this particular clinic, paid for by the Brazilian taxpayer, seemed like the model every public hospital and health center in the country should aspire to.

Clean, well staffed, and well equipped, patients from all over Rocinha and surrounding areas suffering from a variety of mental ailments find in the Maria do Socorro Santos clinic a safe harbor.

Still, when people have to deal with violent crime and everything else that comes with it on a regular basis, whatever mental disorder they are already suffering from tends to get worse, not better, regardless of the health facilities in place.

“For sure living in a favela, where crime and access to drugs is a constant, only tends to aggravate the patients’ mental disorders,” Fabiana Gaspar, director of the CAPS in Rocinha told me one afternoon.

The government seems unable to reach people like Regina Celia. Today, more than 20 years after Marcio’s death, she is one of the women at the vanguard of the struggle to bring justice to mothers in the same situation. Her activism is also the way she found to deal with her own pain.

‘Living in a favela, where crime and access to drugs is a constant, only tends to aggravate patients’ mental disorders.’

As if to show me proof of her body of work, she pulled a portfolio out of her bag containing newspaper clips. In the pictures Regina can be seen attending conferences, giving speeches, and even meeting presidents — there are photos of her meeting with Dilma Rousseff and her predecessor, Lula da Silva.

But the pride she feels about what she has accomplished since the worst day of her life is just not enough to mask the still raw pain of losing a son in such a sudden and brutal way.

“I cry myself to sleep every night. I just can’t understand why a mother should have to go through something like that. When I see Marcio’s grandkids graduating from college and I’m there as great-grandmother, and he’s not there to experience it all, it hurts so much.”

In the first decade of the 2000s, Brazil’s economic boom and the staging of two of the world’s biggest sporting events — the World Cup and Olympics — meant politicians put a new focus on improving the lives of favela residents, even if just for appearances.

In came the police pacifying units (UPPs) with the sole purpose of ridding Rio’s most notorious favelas of the stranglehold of the criminal factions which for decades have exerted control over those communities.

The UPP project was initially well received by locals, who thought the establishment of law and order would usher in other basic services such as sanitation, health, and education. But by and large those never came.

The state health secretary denied to be interviewed for this piece, even when I made it clear my aim was not to name and shame anyone.

Public servants who work in the city’s health department denied to go on the record, but admitted that especially now that the state’s finances are in dire straits, looking after the mental and psychological state of favela residents is “definitely” not a priority.

For people like Regina, all the activism in the world and goodwill messages from public officials will be in vain until the government decides to adopt concrete policies to safeguard the mental and psychological well-being of favela residents.

“We are not seen as normal people, we become ETs,” she said. “If we don’t create a service that tells people ‘you do matter, you are important, I need you,’ we will continue to die, just like we have been over the years.”

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