Care in Freedom! May 18, Anti-Asylum Day in Brazil
The National Health Council, at its 378th Regular Meeting, hosted the Department of Mental Health, Alcohol, and Other Drugs (DESMAD/SAES/MS). In 2026, Brazil’s anti-asylum movement will mark an important legal milestone, the result of extensive mobilization that reshaped the mental health care model in Brazil. It has been 25 years since the enactment of Law 10.216/2001, better known as the […]
National Health Council, at its 378th Ordinary Meeting, received the Department of Mental Health, Alcohol and Other Drugs (DESMAD/SAES/MS)
In the year 2026, the Brazilian anti-asylum movement celebrates an important legal milestone, the result of extensive mobilization, which redirected the mental health care model in Brazil. It has been 25 years since the enactment of Law 10,216/2001, better known as the Psychiatric Reform Law, whose proposal runs counter to the asylum-based model, prioritizing care in freedom.
To achieve this accomplishment, it took years of intense coordination by an organized political movement that demanded a break with traditional psychiatry. Considered the starting point for the Psychiatric Reform, the year 1978 marks the beginning of an alliance between the popular movement and the organized working class, with the creation of the Mental Health Workers Movement (MTSM). Alluding to the 48th anniversary of this milestone, the National Health Council (CNS) addressed the agenda last Wednesday (05/06) during the 378th Ordinary Meeting of the council (378th RO/CNS), held in Brasília (DF).
Reports of mistreatment and violence committed against patients, as well as precarious working conditions, were the driving force behind a mental health professionals' strike in April 1978. The mobilization was further strengthened later that same year with the 5th Brazilian Congress of Psychiatry, which culminated in the creation of the Mental Health Workers Movement.
Organized activism demanded a new mental health care model, to the detriment of the asylum model, which was marked by long-term hospitalizations and recurring violations of human rights. Psychiatric Reform, as a popular organization of the working class, is closely related to the Brazilian Sanitary Reform (BSR). The joint effort for redemocratization, as well as the notion of the universal right to health consolidated at the 8th National Health Conference in 1986, drove the anti-asylum movement to seek its inclusion in the constitutional text and demand specific legislation.
Moving on to 1987, the 1st Meeting of Mental Health Workers, held in Bauru (São Paulo), consolidated the Brazilian anti-asylum movement. Denouncing the horrors committed at the Barbacena Colony Hospital (Minas Gerais), where more than 60,000 people were killed, the MTSM (Mental Health Workers Movement) propelled the closure of the institution, demanding a society without asylums.
A more recent achievement was the creation of the Psychosocial Care Network (RAPS), in 2011, based on Ordinance 3,088/2011, with its main guidelines being care in freedom, the territorialization of care and continuous reception, in the search for comprehensive and humanized assistance, to the detriment of isolationist practices. The Psychosocial Care Network (RAPS), in the Brazilian context, contributes to the rejection of institutional exclusion and violence supported by the asylum logic.
Despite concrete changes in the care model—which enabled a reduction in psychiatric institution incarceration and the expansion of community-based services—the current scenario still carries a high degree of complexity. Budget disputes, gaps in care, and the reconfiguration of isolationist models with public funding are present-day challenges in the anti-psychiatric asylum struggle.
During the 378th RO/CNS meeting, Fernanda Magano, a psychologist and President of the National Health Council, representing the National Federation of Psychologists (Fenapsi) in the Council’s Plenary Session, Fernanda Magano, began her opening remarks at the panel by quoting Franco Basaglia—a leading figure in the Italian psychiatric reform, which also dates back to 1978. In her citation, Magano highlights the notion that mental hospitals are built to control and repress workers who no longer serve capitalist interests of production.
Even after years of the anti-asylum movement, the global escalation of neoliberalism is rearranging the asylum-based and hospital-centric logic in mental health care as a tool of control. Cultural, political, and social changes have been altering, from the perspective of Brazilians, the subjective perception of suffering.
The proliferation of mental health content in virtual environments has included more people in the debate. There is, however, a tendency toward the pathologization and medicalization of life, as pointed out by the Director of the Department of Mental Health, Alcohol, and Other Drugs (DESMAD/SAES/MS), Marcelo Kimati, who spoke on the panel during the 378th RO/CNS. Marcelo explains that this tendency masks deep-seated social problems, including capitalist exploitation itself: “Work overload becomes depression; racism, LGBTphobia become mental health problems.”.
New forms of labor precarization, the epidemic of ludopathy – a disorder linked to gambling addiction – as well as other contemporary exploratory dynamics, generate serious public health problems and have an undeniable impact on the mental health and well-being of Brazilians. Marcelo Kimati argues that “several phenomena related to mental suffering are based on social phenomena,” and therefore, it is necessary to “intervene within these social phenomena.”.
Therapeutic Communities – the new asylums
The neoliberal bias brings a new guise to the asylum model through therapeutic communities. During her speech at the 378th Ordinary Meeting of the National Health Council (RO/CNS), the President, Fernanda Magano, undertakes the exercise of defining them: “private entities, often of a religious nature, therapeutic communities promise to “cure” the abusive use of alcohol and other drugs through work therapy (treatment of psychological distress through work) and conversion to faith. Their “residents,” in general, are not allowed to leave their premises, to prevent them from being “tempted” by the outside world.”.
Report of the National Inspection in Therapeutic Communities, released in November 2025 by the Federal Public Prosecutor's Office (MPF) and the Labor Public Prosecutor's Office (MPT), which verified the reception conditions, the treatment offered, and the respect for human rights in therapeutic communities across the five regions of the country, points to serious violations in the inspected institutions. The report warns of practices of involuntary commitment, isolation of residents, imposition of religious practices, and poor accommodation conditions. The isolationist logic, combined with labor therapy, intensifies the potential for abusive situations toward residents, opening the door to exploitative practices such as conditions similar to slavery.
Although they are not part of the Unified Health System (SUS) or the Unified Social Assistance System (SUAS), therapeutic communities are taking up an increasingly larger share of the public budget. In 2025, the Federal District Government (GDF) allocated 100% from the Anti-Drug Fund (Funpad-DF) —more than R$ 2.460 million—to therapeutic communities, according to a survey conducted by the group Mental Health and Activism in the Federal District (SMM-DF) at the University of Brasília (UnB). The situation is exacerbated by the difficulty of oversight and the lack of transparency regarding the work carried out by these private institutions.
Various instruments of RAPS, which have a real impact on mental health care within territories, are underfunded. The Deputy Coordinator of the Intersectoral Mental Health Commission (Cism/CNS), Vanilson Torres, who also sat on the panel regarding the anti-asylum struggle at the 378th Ordinary Meeting of the CNS (RO/CNS), stated, echoing several male and female councilors present at the Plenary, that the CNS is against the funding of therapeutic communities. In fact, the end of therapeutic communities was a social control recommendation approved at the 5th National Mental Health Conference (5th CNSM), held in December 2023.
At the end of the debate, at the 378th Ordinary Meeting of the National Health Council (RO/CNS), the Plenary decided to draft a Resolution, through a dialogue between the Intersectoral Commission on Mental Health (Cism/CNS) and the Intersectoral Commission on Budget and Finance (Cofin/CNS), aimed at banning public funding for therapeutic communities, as well as funding via parliamentary amendments. National Health Councilor Shirley Morales added to the proposal the suggestion that the budget portion directed toward these private institutions be redirected to the Psychosocial Care Network, enabling the network's expansion to meet new demands.
There are still many challenges for Brazil to achieve complete care in freedom, in a human, dignified, and comprehensive manner, but the 48 years of the Brazilian anti-asylum movement reinforce the hope for a country where comprehensive, universal, and equitable care for people experiencing psychological distress is a full reality.
Source: National Health Council
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