New project to explore impact of psychiatric deinstitutionalization in South America

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A major new research project will explore the impact of transformative change in mental health treatment in South America.

Community-based care for people with psychosocial disabilities began in the region in the 1960s and 1970s, when minorities moved from large and isolated psychiatric hospitals to community residential options.

This principle was promoted by the World Health Organization and the Pan American Health Organization and is considered a defining element of the modernization of the mental health system. But the moral, social and political tensions associated with it are usually glossed over in current analyzes of this process.

Experts will now examine the long-term impact of “psychiatric deinstitutionalization” on the community and record contemporary struggles for and against the policy. This work will add to a richer and more diverse international history of mental reform outside the United States and Western Europe.

Researchers will examine archives and conduct oral history interviews with leaders, practitioners, and advocates in Brazil and Chile. The study was designed with the support of service-user and carer networks.

Findings will be relevant to contemporary challenges in mental health policy, such as poor access to community mental health services, increased mental health detention, and uncontrolled use of coercion in mental facilities.

The project entitled “Ethics and Politics of Psychosis in South America. Innovations, Trajectories and Debates in Comparative Perspective” (EPPDISA) is funded by the Wellcome Trust. It is led by Dr Christian Montenegro, from the University of Exeter’s Wellcome Center for Cultures and Environments of Health.

Existing histories of mental health care around the world may overlook the debates, innovations, and visions for change in South America. A comparative and historical perspective will show how therapeutic innovations and policy ideas have traveled in the past and can help promote respectful, mutual learning between Europe and South America.”

Dr Christian Montenegro, University of Exeter’s Wellcome Center for Cultures and Environments of Health

Researchers will examine exchanges between local and international reformers and leaders, the intellectual and practical re-elaboration of psychiatric deinstitutionalization, the influence of local conditions and processes in shaping local critiques of psychiatric institutions, and how these local developments have shaped mainstreaming. Global policy.

In many countries, the transition from centralized psychiatric institutions to community services has either stalled or not yet begun. Between 2000 and 2021, Brazil and Chile banned the creation of new mental hospitals, replaced them with community-based support, maintained legal capacity for people with mental disabilities, and regulated coercive procedures. But echoing the failed experiences of the past, the debate over the responsibility of the state and the possibility of abandonment has begun. Challenges to access and quality of care have been exacerbated by the Covid-19 pandemic. Researchers will develop recommendations for policymakers, service-users and other civil society organizations through publications and workshops in the UK, Brazil and Chile.

Dr Montenegro said: “It is a privilege to have the opportunity to lead an international project from the UK focusing on Chile and South America. This project not only reinforces the importance of international dialogue in mental health research but is also a privilege to be historically in terms of resources and representation in the global academic field. Enriching the exchange of knowledge and perspectives between regions that were unequal

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