25 anos da lei da reforma psiquiátrica: uma política sob dispura (2001-2025)

Abstract

Introduction: The Brazilian Psychiatric Reform has completed 25 years since the enactment of Law No. 10,216/2001, the landmark legislation that redirected the mental health care model and established the paradigm of community-based, freedom-centered care. Since its approval, mental health policy has coexisted with significant advances in the expansion of the Psychosocial Care Network and with setbacks stemming from ideological pressures, economic interests, and shifts across distinct political contexts. The non-linear trajectory of the Reform, marked by permanent tensions between the psychosocial paradigm and counter-reformist forces, constitutes the central object of this investigation. Objectives: To analyze the trajectory of the Brazilian Psychiatric Reform from 2001 to 2025, identifying advances and setbacks and correlating institutional initiatives, events, and positions to distinct contexts, conjunctures, and social actors. Specific objectives included: identifying regulatory milestones enacted during the period; systematizing timelines by governmental cycles; investigating contradictions between regulatory frameworks and legal guidelines; grounding the analysis in the categories of Law No. 10,216/2001; and identifying challenges and prospects for the consolidation of freedom-centered care as the central paradigm of mental health policy. Method: This is a qualitative study based on documentary analysis, guided by conjuncture analysis methodology. The time frame covered 2001 to 2025, encompassing the governments of Fernando Henrique Cardoso, Lula I and II, Dilma I and II, Michel Temer, Jair Bolsonaro, and Lula III. Documents were collected from official repositories of the Federal Government, Ministry of Health, and National Congress, as well as from civil society organization platforms. Regulatory measures were systematized into timelines for each period analyzed, according to the principles of Law No. 10,216/2001. Results: The timelines revealed that no federal government acted in a wholly reformist or wholly counter-reformist manner, configuring a permanent structural ambivalence. The Lula I and II governments expanded the Psychosocial Care Centers and advanced Harm Reduction strategies, but tolerated funding to Therapeutic Communities. The Dilma government established the Psychosocial Care Network through Ordinance GM/MS No. 3,088/2011, while the Temer government initiated the normative and budgetary dismantling of the psychosocial network. The Bolsonaro government issued Technical Note No. 11/2019 without revoking Law No. 10,216/2001. The Lula III government created the Department of Mental Health, Alcohol and Other Drugs and Decree No. 11,392/2023, but maintained public funding to Therapeutic Communities through the Ministry of Social Development. A persistent institutional hybridism was identified: the Ministry of Health invests in expanding the Psychosocial Care Network while the Ministry of Social Development funds segregation-oriented institutions operating outside the technical standards of the Unified Health System. The strengthening of the reformist field was evidenced by the strategic sophistication of social movements and by CNJ Resolution No. 487/2023, which brought the Judiciary as an allied actor in deinstitutionalization. Conclusions: The Brazilian Psychiatric Reform constitutes a singular laboratory of democracy. Law No. 10,216/2001 served as a legal barrier that no government managed to formally revoke, even as its content was circumvented through normative, budgetary, and administrative means. The structural pattern identified is one of dispute: the counter-reform has not disappeared but shifted tactically toward new institutional fields, revealing the financial hybridism that sustains isolation under new guises. It is concluded that overcoming this hybridism and definitively consolidating freedom-centered care may require constitutional-level budgetary protection, rendering the psychosocial model structurally irreversible.