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Electroconvulsive Therapy in Brazil After the “Psychiatric Reform”: A Public Health Problem—Example From a University Service

Ribeiro, Rafael Bernardon MD*†; Melzer-Ribeiro, Débora Luciana MSc; Rigonatti, Sérgio Paulo MD, PhD; Cordeiro, Quirino MD, PhD

doi: 10.1097/YCT.0b013e31824d2889
Original Studies

Objectives The Brazilian public health system does not provide electroconvulsive therapy (ECT), which is limited to a few academic services. National mental health policies are against ECT. Our objectives were to analyze critically the public policies toward ECT and present the current situation using statistics from the Institute of Psychiatry of the University of São Paulo (IPq–HCFMUSP) and summary data from the other 13 ECT services identified in the country.

Methods Data regarding ECT treatment at the IPq–HCFMUSP were collected from January 2009 to June 2010 (demographical, number of sessions, and diagnoses). All the data were analyzed using SPSS 19, Epic Info 2000, and Excel.

Results During this period, 331 patients were treated at IPq–HCFMUSP: 221 (67%) were from São Paulo city, 50 (15.2%) from São Paulo’s metropolitan area, 39 (11.8%) from São Paulo’s countryside, and 20 (6.1%) from other states; 7352 ECT treatments were delivered—63.0% (4629) devoted entirely via the public health system (although not funded by the federal government); the main diagnoses were a mood disorder in 86.4% and schizophrenia in 7.3% of the cases.

Conclusions There is an important lack of public assistance for ECT, affecting mainly the poor and severely ill patients. The university services are overcrowded and cannot handle all the referrals. The authors press for changes in the mental health policies.

From the *Institute of Psychiatry, King’s College, London; †ECT Service, Institute of Psychiatry, Clinics Hospital, University of São Paulo Medical School; and ‡Department of Psychiatry at Santa Casa Medical School, São Paulo, Brazil.

Received for publication October 13, 2011; accepted January 26, 2012.

Reprints: Rafael Bernardon Ribeiro, MD, Ovídio Pires de Campos, 785, Instituto de Psiquiatria, ECT, 3.o andar, São Paulo, SP, Brazil 05403-010 (e-mail:

Dr Rafael Bernardon Ribeiro had his MSc funded by “Associação Beneficente Alzira Denize Hertzog Silva (ABADHS)” in cooperation with Fundação Faculdade de Medicina and received a grant from King’s College Santander Scholarship.

The authors have no conflicts of interest to declare.

© 2012 by Lippincott Williams & Wilkins