Paper short abstract:

Since 2016, Peru is transitioning from a mental healthcare model based in asylums and psychiatric hospitals to Community Mental Health. In this paper, I argue that this transitional moment provides insight into the dynamics that arise in the community when total institutions start to fade away.

Paper long abstract:

Peru is currently undergoing an important institutional transition regarding mental health. Since 2016, the government has started transitioning state-sponsored treatment for several mental illnesses from an asylum/institutionalization model to a community mental health model. To effectively address mental health afflictions and other psychosocial conditions in the wake of de-institutionalization, the goal is to build at least one hundred community mental health centers around the country. Thus far, twenty-nine have been built. This reform also aims to place mental health in the public agenda and address the stigma surrounding mental illness. In this paper, I present the case of the community mental health center in Carabayllo, the “flagship” facility of the ongoing reform, located in a poor semi-urban district at the outskirts of Lima, Peru. Drawing from three months of fieldwork and interviews with psychiatrists, community mental health workers and residents of Carabayllo, I argue that this transitional moment provides insight into the dynamics that arise in the community when total institutions start to fade away. I explore residents’ reflections on this transition, considering in particular the anxieties they express over the proximity of mental illness and the symbolic and spatial dimensions they reveal of the relationship between clinic and community. With the asylum reconfiguring and the community-based model spreading in the city through its different agents, I signal the diverse challenges the residents of Carabayllo articulate against the closeness of mental illness and the extension of the clinic.