Autonomy and contractuality: guiding axes for an ethical-political praxis in mental health

Abstract

This article emphasizes the importance of paying attention to the way mental health care is provided, stressing that it is not neutral, as it reflects different worldviews and also produces different effects. Two paradigms in mental health are contrasted: the asylum model and the community model. The effects of the institutionalization and medicalization promoted by the asylum model, which served as motivation for the psychiatric reform, in the hopes of creating a new ethically oriented model, are discussed. Furthermore, the reform’s guiding principles are explored, as well as the challenges that hinder its consolidation, such as the lack of knowledge regarding the historical process by which it occurred and its guiding norms and principles, as well as the new forms of institutionalization that arise within the psychosocial care network. Vulnerability is highlighted as a major obstacle to the right to health, as well as the concept of equity as an ethical guideline to overcome said obstacle. Finally, autonomy and contractuality are conceptualized and discussed as axes for the construction of an ethical-political praxis in mental health.