Experts from the UK and South America join forces for major new study of mental health reform

A major new research project will explore the impact of transformational changes to mental health treatment in South America.

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

This policy was promoted by the World Health Organization and the Pan America Health Organization and is considered a defining element of the modernisation of mental health systems. But in current analysis of this process the ethical, social and political tensions associated with it are generally concealed.

Experts will now examine the long-term impact of “psychiatric deinstitutionalisation” on communities and record the contemporary struggles for and against the policy. This work will add to a richer and more diverse international history of psychiatric reform beyond the USA and Western Europe.

Researchers will examine archives and conduct oral history interviews with leaders, practitioners and advocates in Brazil and Chile. The study is designed with the assistance of service-users and caregiver networks.

Findings will be relevant to contemporary challenges in mental health policy, such as poor access to community mental health services, the rise in mental health detentions 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 Centre for Cultures and environments of Health.

Dr Montenegro said: “Existing histories about mental healthcare around the world can ignore the debates, innovations and visions for transformation in South America. A comparative and historical perspective will show how therapeutic innovations and policy ideas have travelled in the past and this can help to promote respectful, reciprocal learning between Europe and South America.”

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

In many countries, the transition from centralised psychiatric institutions to services in the community is either stagnant or yet to begin. Between 2000 and 2021, Brazil and Chile produced legislation prohibiting the creation of new psychiatric hospitals, substituting this with community-based supports, upholding the legal capacity of persons with psychiatric disabilities and regulating coercive procedures. But debates have ensued about the responsibilities of the state and the prospect of abandonment, echoing failed experiences in the past. Challenges in access and quality of care have been aggravated by the Covid-19 pandemic. Researchers will develop recommendations for policymakers, service-users and other civil society organisations 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 with a focus on Chile and South America from the United Kingdom. This project not only reinforces the importance of transnational dialogue in mental health research but also allows for an enriching exchange of knowledge and perspectives between regions that have historically been unequal in terms of resources and representation in the global academic sphere.”