The epistemic dimensions of the brazilian mental health reform: Meanings assigned by mental health service managers, workers and users

Abstract

This study analyzes the epistemic dimensions of the Brazilian Mental Health Reform through the lens of mental health service managers, workers and users. We conducted a qualitative study with 33 respondents using semi-structured interviews and field observations in psychosocial care services in Vitória da Conquista, Bahia. We used an analytical framework consisting of three core dimensions: the concept of mental health/suffering; the purpose of care; and meanings of deinstitutionalization. The findings reveal a convergence of meanings framed within expanded and emancipatory knowledge, underpinned by the assumptions of the psychosocial model, and traditional psychiatric knowledge, consonant with the asylum model. Multiple meanings of deinstitutionalization emerged. Difficulties in implementing the ideals of the mental health reform and the persistence of asylum values demonstrate the need to reclaim and strengthen the ideology of the psychosocial model.