According to the global report The Mental State of the World in 2023 by Sapien Labs, Brazil ranks third worst in mental health among 64 countries. The data were analyzed based on the impact of the COVID-19 pandemic on global mental health; however, Brazil already had the highest rate of anxiety disorders in the world in 2017.

According to the World Health Organization (WHO), 5.8% of the Brazilian population (around 11.5 million people) suffered from depression, and 9.3% (approximately 18.6 million individuals) experienced anxiety disorders during that period.

These rates are closely related to the conditions of social vulnerability that affect a large portion of the Brazilian population, as is the case in the Parelheiros region. Factors such as poverty, unemployment, hunger, violence, misinformation, and limited access to basic health care contribute to the emergence or worsening of mental disorders.

In response to the needs of this vulnerable population, the Sisters Hospitallers, in collaboration with the Municipality of São Paulo, provide free multidisciplinary mental health care through the Psychosocial Care Centers (CAPS). Below, we explain what CAPS is, how it works, and how the Sisters Hospitallers bring their charism and hospitality to benefit the population of Parelheiros.

CAPS and its Role in Mental Health Care

The Psychosocial Care Center (CAPS) is a Brazilian mental health service that is community-based and free, treating and socially reintegrating people with psychological issues. CAPS is an initiative of the Ministry of Health and operates through the Unified Health System (SUS), forming part of the country’s mental health care network.

The service promotes a more humanized approach, individualized treatment, psychosocial care, and the reintegration of individuals into society. Care is provided by a multidisciplinary team, which may include psychiatrists, psychologists, social workers, occupational therapists, nurses, and other professionals. There are different types of CAPS, classified according to the severity and needs of the population served.

CAPS Parelheiros

The CAPS Adult III Parelheiros has been operating since 2008, serving the adult population of the southern region of São Paulo. The service is aimed at people with severe and persistent mental disorders, offering comprehensive care 24 hours a day.

The unit offers individual care, group activities, and therapeutic workshops, such as conversation circles, crafts, dance, and writing. It also seeks to strengthen the role of users and their families through psychosocial rehabilitation and participation in community activities. Since its opening, CAPS Parelheiros has provided mental health assistance to approximately 11,400 people.

The Integration of the Sisters Hospitallers into CAPS

Although CAPS is a public initiative, its units can be managed in collaboration with entities and social organizations such as hospitals, NGOs, and religious organizations. These partnerships play a crucial role in strengthening and expanding the services offered and ensure that the needs of the communities are addressed more holistically, especially in areas of high social vulnerability.

The Sisters Hospitallers have managed different CAPS units, including Parelheiros, since 2008. The joint work with the public initiative goes beyond maintaining and operating the service.

We share a commitment to promoting comprehensive care, respecting human dignity, and offering compassionate hospitality to people in vulnerable situations.

Through this service, the Congregation extends the reach of its Hospitaller Mission and puts into action one of its greatest principles: to generate

 social transformation in the field of mental health.

In this way, the hospitaller charism is manifested whenever someone is welcomed with humanity, compassion, and respect for their individuality, regardless of their social condition. It is also revealed when a person, even within their limitations, is able to recover their role in society and receives treatment that promotes not only mental health but also the well-being of body and spirit.

The Impact of CAPS on the Mental Health of Vulnerable Populations

The region of Parelheiros is characterized by high levels of social vulnerability, with much of the population living in poverty and lacking basic infrastructure. This reality directly impacts the community’s mental health, as the lack of resources, violence, food insecurity, social exclusion, and the lack of educational and job opportunities contribute to the development and worsening of disorders such as anxiety, depression, and stress.

Additionally, Parelheiros is located in an area far from major urban centers and has extensive rural areas, where public transportation is scarce and the distances to health centers are long. These limitations significantly hinder the population’s mobility, making access to health services even more challenging. In this context, mental health often takes a back seat, being neglected both by the residents themselves and by conventional health services, which are often insufficient.

The work of CAPS in regions of social vulnerability, such as Parelheiros, is essential to ensure access to mental health care for populations that would otherwise struggle to receive proper assistance. In these areas, the lack of infrastructure, the scarcity of public services, and socioeconomic barriers make seeking assistance more difficult, worsening cases of anxiety, depression, and other psychological disorders. CAPS acts as an essential welcoming point, offering continuous, humanized treatment that is close to the reality of these territories, reducing the need for long travel and improving the users’ quality of life.

In addition to clinical care, the impact of CAPS goes beyond individual health, reflecting across the community. The unit promotes therapeutic activities and psychosocial rehabilitation efforts, strengthening social and family bonds, encouraging the reintegration of users into society, and combating the stigma associated with mental illness. Thus, CAPS not only treats but also helps prevent the worsening of mental disorders, contributing to the construction of a more welcoming society, aware of the importance of mental health.

Care for Indigenous Communities

Currently, CAPS Parelheiros also serves the Indigenous population living in preservation areas of the region. Care is provided through the Basic Health Units (UBS), located in the Tenondé Porã Indigenous Land, in collaboration with Primary Care teams.

The teams carry out home visits, individual care, and therapeutic groups, either at the UBS itself or in open spaces within the villages, on a biweekly basis. There is also an initiative to encourage the participation of Indigenous people in activities at the CAPS Parelheiros unit, although this integration is challenging due to the distance and travel difficulties between the reservation and the service.

To ensure more accessible and culturally sensitive service, CAPS relies on the support of Indigenous Community Health Agents, who play a crucial role in mobilizing the community for mental health care. In addition to facilitating access to services, these agents act as translators between Guarani and Portuguese, promoting clearer and more effective communication between health professionals and users.

Although the therapeutic approach follows the same principles applied to the general population, it is essential to respect cultural particularities so that the treatment is effective and takes into account the users’ individuality, beliefs, and specific challenges. In Indigenous culture, mental health and spirituality are deeply connected. Therefore, in addition to medical treatments and medication when necessary, it is common for Indigenous people to seek the help of the pajé — the spiritual leader of the village — and to attend prayer houses as part of the healing process.

This relationship between traditional care and mental health assistance was evident in a recent case. An Indigenous patient, facing a worsening mental health condition, was advised to undergo more intensive treatment at CAPS Parelheiros, which included the possibility of staying at the unit for a few days for closer follow-up — a first-time experience for her. However, before making a decision, she chose to temporarily withdraw to undergo healing rituals with the pajé.

Initially, this absence caused concern among health professionals, who were unable to contact the patient for several days. However, upon returning to CAPS, she showed a significant improvement in symptoms, highlighting the importance of spirituality in her therapeutic process. Over time, it became clear that understanding and respecting cultural differences is essential to promote more comprehensive and humanized care.

Thus, CAPS Parelheiros has sought not only to include traditional Guarani knowledge in the context of mental health but also to strengthen its presence in the territory, building connections and the trust necessary for truly welcoming care.

The work carried out by CAPS Parelheiros is an example of how psychological and social care can be humanized, adapted to local needs, and help improve the quality of life of those who need it most. Receiving appropriate treatment transforms lives, building a society increasingly aware of the role of mental health in overall well-being.