Iana Raíssa is a 21-year-old psychology student, but her skills and training are already being put to use in a highly responsible professional setting.
Every Thursday afternoon Raíssa treats suicidal patients at Walter Cantídio University hospital in Fortaleza, a city in north-east Brazil.
“It’s a lot of pressure for a student,” she says. “Sometimes when a patient calls saying they will miss a session, my heart jumps because I’m worried they may kill themselves. I don’t want that to happen, I’m here to help them.”
The work is voluntary, but counts towards Raíssa’s university degree. Along with other students, she does it as part of a programme called Pravida, which aims to raise awareness of mental health problems and relieve some of the pressure on two hospitals in the city, as well as provide support for those desperately in need of help.
Pravida runs every Thursday afternoon for adults at high risk of suicide, as measured by a screening tool. It was set up by psychiatrist Prof Fábio Souza in 2004 as part of his work at the Federal University of Ceará. He now runs it alongside a second resident psychiatrist, Prof Luisa Weber Bisol, with a team comprising the students, as well as nurses, social workers and psychologists. Everyone works on a voluntary basis.
The team sees between 24 and 30 patients each week for individual 30-minute sessions. Patients attend for about three months, depending on need. Some people are referred by healthcare professionals to the programme, while others hear about it via social media channels.
Students undertake two months’ training before they see patients, and have 20 minutes with a qualified professional after the half-hour is up, before returning to their patients to talk about what to do over the coming week.
Over its 15 years, more than 500 future health professionals have participated in the programme. Pravida has supported more than 1,500 patients, most of whom have completed the 12-week programme. None have gone on to kill themselves. Once patients are no longer acutely suicidal, the programme signposts them to other services if necessary to continue treatment.
In 2019, Pravida was set up at a children’s hospital in the city to support the sole psychiatrist there. Souza and Bisol want to expand further, as the service is more important than ever.
Brazil is one of the world’s worst-hit Covid-19 hotspots, with more deaths than Italy and more cases than Russia and the UK. The mental health effects of the virus are only just starting to be seen.
Pravida has been continuing to provide treatment during the pandemic so far, and Souza predicts that the toll of the virus and everything associated with it on mental health may be huge. “We are still navigating in this unknown sea of Covid-19,” he says. “We are forecasting that we will have a lot of trouble after this acute phase is passed.”
Even before the pandemic, mental health services in Brazil were struggling. According to a survey by the World Health Organization, Brazil leads the world in prevalence of anxiety disorders and ranks fifth in depression rates. That Pravida is held up as a paragon of providing effective treatment when it’s run by volunteers and students illustrates the lack of effective mental health care provided by the state.
Carlos Jurior, chief executive of Hospital Universitário Walter Cantídio, admits that mental health care is severely underfunded and not prioritised. “Mental health is not seen as it should be,” he says. “Psychiatry is a hidden area and there is a lot of mental illness in our population. We should have more programmes to help before people feel suicidal. It shouldn’t be done by volunteers, but thank God we have them.”
Those who pass through Pravida at perhaps the most difficult time in their lives are also supremely grateful that the service exists. Ana Oliveira (not her real name), 26, is one such person. After growing up in a household where she witnessed domestic violence, she also suffered emotional and physical abuse at the hands of former partners. In the middle of 2019, she was raped and the event sent her spiralling into despair. She turned to the maternity services at the hospital for help and was referred to Pravida.
At first she didn’t go and instead started planning to take her own life. She was on the way home to kill herself when she found herself walking past the hospital when Pravida was on. She went in and the person who greeted her saw she had a referral letter. Oliveira was given an appointment immediately.
“There were a million things going around in my head,” she recalls. “There was too much pain and too many thoughts in a short time. I wanted to end it.”
She was diagnosed with bipolar disorder and put onto medication. She talked about what had happened and learned coping strategies. “It’s hard to believe that things will get better when you’re in crisis, but everything goes away and leaves space to see,” says Oliveira.
“Now, my life is really good,” she adds. “The medication and therapy have really helped.”