Brazil faces a major disparity in public healthcare as northern and northeastern states record the lowest ratio of psychologists per resident in the Unified Health System.
According to a survey conducted by CNN Brasil based on National Registry of Health Establishments (CNES) data, the national gap exists despite the Federal Council of Psychology (CFP) counting more than 600,000 registered professionals across the country. Only a small fraction of these registered psychologists actually work within the public health network, known as SUS.
The research revealed that the shortage of public network psychologists is most severe in Pará, where there is one SUS psychologist for approximately 5,769 residents. In Amazonas, the ratio stands at one public psychologist for about 5,724 inhabitants, while Maranhão records one for roughly 4,476 people.
By contrast, southern and southeastern states maintain significantly lower ratios of residents per public psychologist. Santa Catarina has one SUS psychologist for roughly 2,482 residents, Minas Gerais records one for 2,557, and Rio Grande do Sul has one for approximately 2,646 inhabitants.
Despite the low availability of psychologists in the public system, data shows these northern and northeastern states have larger numbers of professionals registered with the Federal Council of Psychology. Pará has 9,235 active registered psychologists, representing one professional for every 943 residents. Amazonas accounts for 6,812 registered psychologists, or one per 634 residents, while Maranhão has 7,408 active professionals, representing one per 947 inhabitants.
State Rankings for Public Healthcare Disparity
Out of the ten states with the worst ratio of SUS psychologists per inhabitant in Brazil, eight belong to the North and Northeast regions. Pará ranks worst with one SUS psychologist per 5,769 residents, followed by Amazonas at one per 5,724, and the Federal District at one per 5,167.
Acre ranks fourth with one SUS psychologist for 4,559 residents, followed by Maranhão with one per 4,476, Ceará with one per 4,055, and Bahia with one per 4,030. Rondônia records one per 3,991, Mato Grosso stands at one per 3,817, and Roraima completes the list with one per 3,731 inhabitants.
Ana Carolina Freire, a federal councillor at the CFP, stated that the discrepancy between registration databases and public health records occurs because most psychologists work in clinical practice. Freire noted that the council's latest census indicated around 70 percent of psychologists work in the clinical field, with many balancing private practices alongside roles in public policy.
Impact of Staffing Gaps on Mental Healthcare
Freire stated that growing psychological distress in recent years, particularly following the COVID-19 pandemic, makes expanding psychology within SUS a sanitary necessity rather than a luxury or an expense. She highlighted that the council is in dialogue with the Ministry of Health and municipal managers to expand job positions, noting that the council launched a tool to assist municipalities in calculating the ideal number of psychologists based on population size.
Strengthening the presence of psychologists in primary care can prevent mental health conditions from worsening, reduce referrals to specialists, and decrease unnecessary hospitalizations, according to Freire. She added that complete teams at Psychosocial Care Centers (CAPS) can build therapeutic projects, work with families, and conduct group sessions, whereas a lack of professionals leads to excessive medication and indiscriminate referrals.
Freire also evaluated that geographic distribution is not the sole cause of inequality, pointing to a process of precarious work conditions within the public network. She explained that there is currently no national law establishing a 30-hour workweek or a minimum salary floor for psychologists, which drives the workforce away from public policy, even though some individual states and municipalities have established 30-hour schedules.
Rise of Online Therapy and Care Limitations
As access to in-person care remains difficult, demand for online therapy has increased. Caroline Macarini, psychologist and founder of the Unolife platform, reported that the company recorded a growth of more than 70 percent in demand for psychological consultations between 2023 and 2025.
In the North and Northeast regions, demand grew by 77 percent, reflecting a search for alternatives amid lower local availability of professionals. Macarini stated that remote consultations expand patient reach, lower costs for both users and professionals, and allow individuals who previously could not afford psychotherapy to access services, emphasizing that online therapy must be conducted with a psychologist rather than artificial intelligence.
The Federal Council of Psychology considers online therapy an important and regulated resource but cautions that it cannot fully replace in-person care. Freire pointed out limitations regarding internet access and population profiles, particularly in Indigenous territories, quilombola communities, and isolated areas where screen-mediated therapeutic bonds may not be suitable.
The comparison between professional registrations and public sector roles demonstrates that the primary issue in states with low coverage is not a total lack of psychologists, but their low participation within SUS.
Surge in Psychosocial Care Center Visits
The volume of consultations conducted at Psychosocial Care Centers across Brazil more than doubled between 2015 and 2025. Data from the Ministry of Health shows national consultations rose from 13.8 million in 2015 to 28.4 million in 2025, representing an increase of approximately 106 percent over ten years.
This growth was non-linear, experiencing a sharp drop in 2020 during the start of the COVID-19 pandemic, which marked the only national retraction in the ten-year series before attendance resumed growth in 2021. Expansion occurred across all regions, with the North rising from 467,900 consultations in 2015 to 1.64 million in 2025, while the Northeast grew by roughly 104 percent, from 3.63 million to 7.4 million sessions.
Lucas Modesto, a psychologist at CAPS Amazônia in Pará, stated that public health consultations humanize care and deliver mental health as an essential right. Modesto emphasized that psychology in SUS functions to democratize access and treat individuals experiencing severe psychological suffering, adding that mental health and citizenship are inseparable and must be provided with quality alongside education, housing, and food.
Government and State Responses to Disparities
In response to inquiries from CNN Brasil, the Ministry of Health stated that it has been expanding the Psychosocial Care Network (RAPS) to strengthen mental health care nationwide. Between 2023 and July 2026, the ministry authorized 867 new services, bringing the total number of network care points to 6,488, including CAPS units.
The ministry noted that 6,200 multiprofessional teams operating in SUS include psychiatrists and psychologists. It added that SUS provides monthly telehealth services through the Meu SUS Digital app for individuals facing gambling or betting issues, women experiencing violence, and youth aged 13 to 24 across all Brazilian regions.
CNN Brasil contacted the ten states with the lowest public psychologist ratios per habitant, but Amazonas, Acre, Ceará, and Rondônia did not provide comments. Pará's State Secretariat of Health (Sespa) reported a ratio of roughly one SUS psychologist per 5,769 inhabitants, close to the national average of about one per 5,556, stating that expanding and qualifying mental health care remain permanent guidelines.
The Federal District Health Secretariat (SES-DF) stated that its psychologists are deployed across all public care levels, including Primary Health Care multiprofessional teams, hospital teams, CAPS, and violence response services. Maranhão's State Health Secretariat (SES) clarified that RAPS operates under tripartite management among federal, state, and municipal governments, noting that the state network maintains 500 psychologists across various units.
Bahia's health authorities stated that assessing offer sufficiency requires evaluating territorial distribution, workload, and population demand alongside absolute numbers, noting the state invested over 23 million reais between 2024 and 2026 into RAPS. Mato Grosso reported 46 CAPS units operating across different modalities, with the state government directly managing two specialized units for youth and substance abuse while municipalities administer the rest. Roraima's Health Secretariat reported having 147 psychologists in its state network, emphasizing that psychological care requires continuous follow-up rather than isolated consultations, while acknowledging that geographic distribution remains a national challenge in remote areas.
