Trabalho, Educação e Saúde - TES (Work, Education and Health) is an open access scientific journal, edited by the Joaquim Venâncio Polytechnic School of Health, from Oswaldo Cruz Foundation.
The goal was to analyze the trajectory of mental health policies in Brazil. We systematize historical
periods based on the analysis of socio-political contexts, the organization of the health system and
the characteristics of mental health care. We identified seven periods from the institutionalization of
madness, in the imperial period, until 2019. The trajectory of politics reveals a process of dispute of
epistemological and symbolic conceptions about madness and mental illness, which in interaction with
other contextual factors influence the care models and care practices. Subsequently, we discussed the
plurality of approaches to deinstitutionalization in the international scenario and the influences on the
mental health model proposed by the Brazilian Psychiatric Reform. We present a synthesis of the idea of
deinstitutionalization considering the various dimensions that involve the comprehensive perspective
of the term. Finally, we reflect on the advances and challenges of the Brazilian Psychiatric Reform.
Despite the significant achievements, problems related to financing, stigmatization, fragile intersectoral
articulation and the reproduction of asylum logic in substitute services persist. In addition, the current
changes in the National Mental Health Policy are the main threats to the deinstitutionalizing model.
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