Launch in Chile of the "Transitions" project on the ethics and politics of psychiatric deinstitutionalisation in South America
At a seminar held on 18 August at the School of Public Health, University of Chile, the international Transitions project, funded by the Wellcome Trust and coordinated by King's College London, was officially presented in the country. The project seeks to comparatively study the processes of psychiatric deinstitutionalisation in Chile and Brazil, integrating academic, ethical, political and social activism perspectives.
The initiative is led by academic Cristian Montenegro and involves the participation of two postdoctoral researchers: Felipe Szabzon at the Institute of Social Medicine at the State University of Rio de Janeiro (Brazil), and anthropologist Sofía Bowen at the School of Public Health, University of Chile.
The project seeks not only to analyse psychiatric deinstitutionalisation as a public health policy, but also to understand it as a process fraught with ethical debates, social struggles and knowledge production. In the words of the organisers, the aim is to compare the trajectories of both countries and place their specificities in a broader international context, while also strengthening collaborative networks around mental health and human rights.
The director of the School of Public Health, Dr. Lorena Rodríguez Osiac, opened the conference by highlighting the importance of this milestone: ‘Transitions is a beautiful name for a project that invites us to recognise ourselves in our differences and to think about how to build community based on autonomy and human rights.’ In this vein, she added that the challenge is also to leave a mark: ‘What is important is that we can systematise not only the evidence, but also the experiences of those who have been part of a more humane approach to mental health.’
During the welcome ceremony, Dr Olga Toro, co-researcher on the project, emphasised the value of collaborative work and its transdisciplinary approach: ‘This is a project that contributes to international collaboration and places us in the Latin American context, where the Faculty of Medicine of the University of Chile has a special interest and responsibility.’ For the academic, this is an unprecedented opportunity: ‘The history of deinstitutionalisation has been written, but not from Latin America. This is the first effort to narrate it from the perspective of its own actors.’
At the beginning of the presentations, the principal investigator, Dr Cristian Montenegro, expressed his gratitude for the institutional support received in Chile and explained the scope of the study: ‘Although we are talking about a launch, we are also celebrating the fact that we have managed to create the conditions for the circulation of resources, knowledge and experiences between different countries.’ The academic emphasised that deinstitutionalisation remains a current issue: ‘In some places, it is thought of as a process of the past; however, current ethical and political tensions show that it is an open debate that requires the voices of patients, carers and health workers to be heard.’
Later in his speech, Montenegro stressed the importance of understanding the local in dialogue with the global: ‘Our interest is to observe how international debates were reinterpreted in specific contexts such as those of Chile and Brazil, which were marked by dictatorships, democratic transitions and neoliberal reforms.’ She added: ‘We want to highlight how these political and social realities shaped the course of psychiatric reform and how they are now straining the discussion on rights and reparation.’
From the Chilean perspective, Dr. Sofía Bowen, a postdoctoral researcher on the project and academic at the School of Public Health, argued that this is still a contentious process: ‘Unlike the international view, which tends to consider it a closed issue, in Chile deinstitutionalisation is still ongoing, with advances and setbacks that cannot be understood without their social and political context.’ In her presentation, she added: ‘Our objective is to provide a critical perspective that recovers the specificity of the Chilean case and highlights the current tensions in the implementation of policies.’
Bowen also detailed the methodology that will be applied in the country: ‘We are going to review archives, interview key actors, and ethnographically observe care spaces to understand how policies translate into practices and everyday experiences.’ In this context, she noted: ‘This project is also an effort to integrate diverse voices—users, professionals, family members—that are fundamental to rethinking the direction of mental health in Chile.’
The seminar also provided a space for activism and lived experience, with a presentation by Raúl Ariz Abarca, broadcaster for the Radio Diferencia group in Valparaíso, Master in Experimental Science Education from PUCV and PhD candidate in Science with a specialisation in Chemistry at the same university. With more than 40 years of experience as a mental health user, he recounted the group's history: ‘For almost two decades, we worked within the Valparaíso Psychiatric Hospital, providing psychoeducation, defending rights and building community.’ However, he also denounced situations of discrimination: ‘Deinstitutionalisation does not only occur in hospitals; we also face stigma and bad practices in society, which limit our voice and make us vulnerable.’
Finally, Dr. Carlos Madariaga, an academic at the School of Public Health, addressed the challenges from the perspective of collective mental health: ‘Psychiatric institutionalisation is not just a problem of the past, but an unresolved tension that persists in Chile.’ Inspired by the thinking of Franco Basaglia, he argued that structural change is necessary: ‘It is not enough to transform institutions; we need to build community and generate new paradigms for an emancipatory approach to mental health.’
Madariaga also warned of current risks: ‘Today we continue to see how even in community settings new forms of institutionalisation are emerging, linked to precariousness, bureaucratisation or welfare dependency.’ He therefore argued: ‘The solution cannot be purely technical; we need to rethink collective mental health, incorporating the social, political and historical dimensions of the processes of suffering.’
The seminar concluded with an open dialogue between attendees and an invitation to strengthen collaborative networks between researchers, professionals, and activists. The Transitions project will continue to develop in the coming years, generating comparative knowledge between Chile and Brazil and placing its findings within the framework of global mental health.
Audiovisual recording of the meeting: https://youtu.be/KFEXyP9HwFQ
All photographs credit: Escuela de Salud Pública, Universidad de Chile
