title: Electroconvulsive therapy in Brazil after the "psychiatric reform": a public health problem--example from a university service.
abstract: OBJECTIVE
  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.
authors.affiliation: Institute of Psychiatry, King's College, London. rafael@usp.br
authors.forename: Rafael Bernardon
authors.initials: RB
authors.lastname: Ribeiro
authors.forename: Débora Luciana
authors.initials: DL
authors.lastname: Melzer-Ribeiro
authors.forename: Sérgio Paulo
authors.initials: SP
authors.lastname: Rigonatti
authors.forename: Quirino
authors.initials: Q
authors.lastname: Cordeiro
mesh_terms: D000328:Adult; D000368:Aged; D001290:Attitude; D001938:Brazil; D004565:Electroconvulsive Therapy / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D005260:Female; D018166:Health Care Reform / Q000331:legislation & jurisprudence*; D006291:Health Policy; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000523:psychology / Q000628:therapy; D011570:Psychiatry / Q000331:legislation & jurisprudence* / Q000639:trends; D011634:Public Health; D012424:Rural Population; D012559:Schizophrenia / Q000628:therapy; D014505:Urban Population