Transitions in Rio: Building Bridges, Preserving Memory, and Creating Space for User Voices

Earlier this month, from 12–14 August 2025, we were in Rio de Janeiro for the Brazilian launch of Transitions – The Ethics and Politics of Psychiatric Deinstitutionalisation in South America. Hosted at the Institute of Social Medicine (IMS-UERJ), the event brought together researchers, activists, service users, and policymakers to reflect on the ethics and politics of psychiatric reform in Brazil and Chile. Alongside the seminar, we visited key sites linked to the history and ongoing transformation of psychiatric care in Rio. What follows are some reflections from those days, on building institutional bridges, on the role of memory in promoting change, and on the centrality of service-user voices in shaping the conversation.

1. Building an Administrative and Political Bridge

The Brazilian launch marked the consolidation of a bridge — of trust, administrative alignment, and shared purpose — spanning three countries, three languages, and three distinct bureaucratic cultures.

Behind the morning’s programme lay more than a year of groundwork: negotiating contracts, translations, ethical reviews, and institutional agreements among King’s College London, the Institute of Social Medicine (IMS-UERJ), and the School of Public Health at the University of Chile. This was not mere “admin.” It was the construction of an operational infrastructure designed to sustain collaboration across North–South and South–South axes, grounded in a commitment to parity and reciprocity.

As Rossano Cabral Lima reminded the audience, the event was “both the beginning of a new stage and the culmination of an extended preparatory process” — one that drew on the strengths of each partner and on relationships cultivated over years of dialogue.

Brazil has developed a wide body of scholarship in the field of mental health, generating deep critical reflection on its reform process. This reflexivity has been both the fruit of, and the driving force behind, one of the most comprehensive psychiatric deinstitutionalisation experiences in Latin America and worldwide. Yet, for various reasons — from language barriers to the sheer size of the country — these debates have often remained inward-looking, with limited dialogue with international experiences. Building bridges for collaborative and comparative research therefore represents a promising path: one that allows us to learn not only about ourselves, but also from and with others.

To make such learning possible, the infrastructure forged in this preparatory work is indispensable.

2. Memory Before Culture: Visiting Sites of Transformation

During our stay in Rio, we visited two places that reframed how we think about change in psychiatric institutions: the Laboratório de Estudos e Pesquisas em Saúde Mental e Atenção Psicossocial (LAPS) and the Nise da Silveira Municipal Health Care Institute (IMASNS).

Though different in their immediate purposes, both institutions share a vision of the world that guides how they act, reflect, and promote change. LAPS is a research laboratory situated at Fiocruz, one of Brazil’s foremost centres of health research.

At LAPS, we encountered the “Memory of the Reform” project — a decades-long dream of Paulo Amarante -a leader of the reform process and its dissemination-  and colleagues. Unlike institutional histories that trace the linear life of a hospital or the biography of a figurehead, this archive focuses on the psychiatric reform movement itself: its agents, slogans, campaigns, and policy shifts. Its unit of observation is diffuse and collective, resisting easy boundaries. In doing so, it recognises that psychiatric reform is not simply a sequence of policy milestones but a shifting social and political constellation.

More than 30 years after the start of this process, there now exists a wealth of documents, promotional materials, photographs, laws, and ordinances, alongside the testimonies of individuals — both iconic figures and those less visible — who played a role in this history. The project has been cataloguing these diverse materials, telling the story of a deep social movement that has gained significant force in the country and resisted over decades, despite the changes in the political landscape faced by the country. The project is politically committed to affirming the identity of the Psychiatric Reform Movement in Brazil, ensuring that the history of this social struggle is not lost.

The Nise da Silveira Municipal Health Care Institute (IMASNS), by contrast, is a mental health institution with a strong historical legacy. Its best-known chapter is the pioneering work of Dr Nise da Silveira, beginning in the 1940s. Today, the institution bears her name in honour of the “rebel psychiatrist” who rejected the aggressive treatments of her time. Nise paved the way for others to consolidate the Anti-Asylum Movement, making the Institute a key hub for disseminating new ideas in psychiatry.

Since the 2000 and in line with the guidelines of Brazil’s National Mental Health Policy, IMASNS began dismantling its asylum system. Through deinstitutionalisation initiatives, the Institute expanded local services (including psychiatric emergency rooms and Psychosocial Care Centres) and repurposed its facilities for cultural, social, and income-generating projects that engage users, staff, and the wider community. Today, IMASNS continues to redirect hospital-based demand towards community mental health structures, strengthening its commitment to deinstitutionalisation.

At IMASNS, the lesson was distilled into a phrase from its director, Erika Pontes e Silva: “First there’s memory, then there’s culture.”

Since 2011, the former asylum complex has undergone not a sudden closure but a deliberate, reflexive deconstruction. The first step was to understand the institution and its transformations in detail. Professional archivists, museologists, and historians were brought in to document and interpret its trajectory before curating a museum. This process reframed transformation not as an administrative decree from above, but as a dialogue rooted in knowledge of the institution’s complexity.

As Érika noted, this approach is also a safeguard in an age of authoritarian threats: to defend the gains of reform, one must know their history rigorously and professionally. Here, memory itself becomes a transformative intervention — a way of stabilising the ground beneath a process of change.

Within this context, the IMASNS Documentation and Memory Centre plays a crucial role, fostering training and research in mental health while preserving memory and repurposing hospital spaces with new initiatives that reframe society’s relationship with madness.

3. Lessons from Latin America

In the launch seminar, Francisco Ortega captured a core ambition of Transitions:

“It is not what the Global North can teach the Global South in psychiatric deinstitutionalisation processes, but what we here in the Global South can teach them.”

This inversion matters. Too often, the histories of psychiatric reform in Brazil and Chile are read as local adaptations of European or North American models. Our project insists that these histories contain original contributions — conceptual, political, and practical — to global debates on care, community, and rights.

The Brazilian case, in particular, is marked by a set of characteristics that make it distinctive from Global North contexts, while also offering valuable lessons for many other countries in the Global South. Among these are: the scope and scale of the reform; the country’s geographic, social, and cultural complexity; the strong presence of social mobilisation; the integration with the values and principles of the Latin American Social Medicine and Collective Health — such as equity, universality, and social participation; as well as the alignment of ethical, clinical, and political endeavours. At the same time, Brazil is a country that, despite the advances of recent decades, has faced significant setbacks — which themselves also provide important lessons.

These specificities have often been overlooked or misunderstood in more universalising readings of deinstitutionalisation, reinforcing the importance of the project we are launching today. Transitions invites us to think of deinstitutionalisation not as a single or exportable model, but as a plural, situated, and constantly contested process.

4. Opening the Floor: Service-User Engagement

For us, the highlight of the launch was the way service-user voices shaped the conversation. Sociologist and activist Fabiane Valmore set the tone, both as a speaker and as a facilitator of user participation throughout the event. She moved beyond telling “what life is like after the asylum” to making space for claims, demands, and visions from users themselves to dominate the discussion.

Fabiane’s intervention was sharp:

“We still have in Brazil judicial asylums and therapeutic communities operating with legitimised asylum practices and public resources… these are expressions of the challenges we still need to confront.”

From the floor, users, artists, and activists spoke about dignity, about the politics of recognition (“We are crazy, but we have talent; all that’s missing is recognition”), and about art as a political force (“Aesthetics are very much linked to something political… the person’s emotion shapes a lot of what they see”).

Some professionals asked how individual complaints could be transformed into guarantees of rights and policy action, highlighting the risk of user participation being reduced to micro-level grievances. This is precisely where Transitions hopes to contribute: tracing how concepts like rights, community, and participation are navigated and redefined by different actors — and how they might connect to systemic change.

5. Moving Forward

Our days in Rio — the seminar, the visits, the conversations — reinforced a conviction: that psychiatric deinstitutionalisation is not merely a technical policy process but a living, contested, and deeply contextual movement. It requires bridges: between institutions and countries, between past and future, between research and activism. It requires memory: as a method for change and as a defence against regression. And it requires voice: the active protagonism of those most affected by psychiatric institutions, not as symbolic participants but as co-authors of the agenda.

The work in Brazil is only beginning for Transitions. In the coming months, our research will deepen into the histories and present struggles of Brazilian psychiatric reform, always in dialogue with our parallel work in Chile — whose own launch and field visits we will share in our next post.

Full video of the launch event: https://www.youtube.com/watch?v=Urr6ye6NYjw