Transitions

About Transitions

The Ethics and Politics of Psychiatric Deinstitutionalisation in South America

Led by: Cristian Montenegro, Senior Lecturer in Critical Global Health at King’s College London's Department of Global Health and Social Medicine..

Contact: cristian.montenegro@kcl.ac.uk

Funded by: Wellcome Trust, through a Career Development Award.

Context: In South America, community-based care for people with psychosocial disabilities was pioneered in the 1960s and 1970s. Mainstream accounts of mental health reform in the region cite the "Initiative for the Restructuration of Psychiatric Care in the Americas" (1990), planned by the Pan American Health Organization (PAHO) to bring the principles of modern psychiatric care to the region, as the formal beginning of the transition. However, a policy narrative of modernisation towards an international standard ignores the debates, innovations, and visions for transformation developed in South America, concealing the influence of local conditions such as populist politics, authoritarianism, and the struggle for democracy and human rights in shaping the ethics and politics of psychiatric deinstitutionalisation (PDI) and mental health reform.

Transitions is an innovative research initiative examining the transformation of psychiatric care in South America since the 1960s. Funded by the Wellcome Trust, this project aims to reframe the global narrative of psychiatric deinstitutionalisation (PDI) by exploring its ethical and political dimensions in South America.

Research Questions:
Considering the cases of Brazil and Chile, the project will address the following sets of questions:

  1. What were the local debates, innovations, and visions for transformation in Brazil and Chile in response to the movement for PDI and reform in the USA and Western Europe in the second half of the 20th century? How were these debates, innovations, and visions shaped by specific social and political processes affecting these countries? How did these local developments influence the global mainstreaming of PDI?
  2. How did PDI move from a local movement to a global policy model? What role did international agencies such as the WHO and PAHO play in the international circulation of PDI ideas and policies, considering the cases of Brazil and Chile?
  3. What ethical and political tensions are involved in the contemporary struggle for and against PDI in Brazil and Chile? How do they differ from the initial debates?

Work Packages:

  • WP1: Debates and Innovations in South America (Months 3 to 20) WP1 explores the debates, innovations, and visions for transformation developed in South America vis-à-vis the movement for PDI and reform developed in the USA and Western Europe. Combining a literature review, documentary analysis, and oral history interviews, WP1 will explore the exchanges between local and international reformers and leaders, the intellectual and practical re-elaboration of PDI, and the influence of local conditions and processes in shaping a local critique of psychiatric institutions.
  • WP2: From Local Movement to Global Policy and Back WP2 will explore the transition of PDI from a situated anti-institutional revolt to a global policy model, asking how a process intimately tied with historical and political circumstances in Western Europe and the USA became a defining element of a "modern" MH system worldwide, embraced and promoted by international agents across health, disability, and human rights fields. Special attention will be given to how European and South American leadership was balanced in the process leading to and resulting from the Initiative for the Restructuration of Psychiatric Attention in the Americas. Documentary analysis will be combined with in-depth interviews following the role of PAHO, WHO, and other international organisations.
  • WP3: Contemporary Tensions Between 2000 and 2021, Brazil and Chile produced legislation prohibiting the creation of new psychiatric hospitals, calling for their substitution with community-based supports, upholding the legal capacity of persons with psychiatric disabilities, and regulating coercive procedures. These laws have mobilised a complex oppositional field. WP3 aims to trace the ethical and political tensions and the continuities and discontinuities around PDI in South America, exploring the policy and regulatory frameworks and the positions involved in the contemporary struggle for and against PDI in the region. An expanded literature review will be combined with in-depth interviews and focus groups, focusing on the debates and mobilisation leading to and initiated by PDI legislation in Brazil and Chile.

Impact Goals: Transitions seeks to:

  • Challenge prevailing narratives that overlook South America's contributions to psychiatric reform.
  • Provide nuanced insights into the regional dynamics that have shaped mental health policies.
  • Offer evidence-based recommendations to policymakers and stakeholders for improving mental health care systems globally.

International Collaboration: Transitions collaborates with top South American institutions to enhance the relevance and impact of its findings:

  • Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (IMS-UERJ): Hosts a postdoctoral researcher to lead the Brazilian component, offering rich local knowledge and extensive professional networks.
  • School of Public Health, Universidad de Chile (ESP-UChile): Leads the Chilean component, hosting a postdoctoral researcher, leveraging its significant role in national mental health policy development.

Join Us: We are committed to fostering robust academic exchanges and practical collaborations that can reshape mental health policies and practices. For inquiries about partnerships or participation in our research, please contact us: transitions@kcl.ac.uk