A major new research project will explore the impact of transformative changes in mental health treatment in South America.
Community care for people with psychosocial disabilities began in the region in the 1960s and 1970s, when a minority of people were transferred from large and isolated psychiatric hospitals to alternative housing in the community.
This policy was promoted by the World Health Organization and the Pan American Health Organization and is considered a key element in the modernization of mental health systems. But in the current analysis of this process the moral, social and political tensions associated with it are generally obscured.
Experts will now examine the long-term effects of “psychiatric deinstitutionalization” on communities and chart contemporary struggles for and against the policy. This work will add to a richer and more diverse international history of psychiatric reform beyond the US and Western Europe.
Researchers will review records and conduct oral history interviews with leaders, practitioners, and advocates in Brazil and Chile. The study was designed with the help of networks of service users and carers.
The findings will relate to contemporary challenges in mental health policy, such as poor access to community mental health services, increasing mental health bookings and the unregulated use of coercion in psychiatric facilities.
The project, called “Ethics and Politics of Psychiatric Deinstitutionalization in South America. Innovations, Trajectories and Debates in Comparative Perspective” (EPPDISA) is funded by the Wellcome Trust. It is led by Dr Cristian Montenegro, from the University of Exeter’s Wellcome Center for Health Cultures and Environments.
Existing stories about mental health care around the world can ignore the conversations, innovations, and visions for transformation in South America. A comparative and historical perspective will show how therapeutic innovations and policy ideas have traveled in the past and this can help promote respectful, mutual learning between Europe and South America.”
Dr Christian Montenegro, University of Exeter Wellcome Center for Health Cultures and Environments
Researchers will examine the exchanges between local and international reformers and leaders, the intellectual and practical reworking of psychiatric deinstitutionalization, the influence of local conditions and processes in shaping a local critique of psychiatric institutions, and how these local developments shaped the incorporation of politics worldwide.
In many countries, the transition from central psychiatric institutions to services in the community is either stagnant or has not yet begun. Between 2000 and 2021, Brazil and Chile created legislation prohibiting the creation of new psychiatric hospitals, replacing it with community support, supporting the legal capacity of people with psychiatric disabilities, and regulating coercion procedures. But debates about the responsibilities of the state and the prospect of abandonment followed, echoing failed experiences in the past. Challenges to access and quality of care have been exacerbated by the Covid-19 pandemic. Researchers will develop recommendations for policy makers, 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 focusing on Chile and South America from the UK. This project not only reinforces the importance of transnational dialogue in mental health research, but allows also enriching the exchange of knowledge and perspectives between regions that have historically been unequal in terms of resources and representation in the global academic sphere.”
