Twenty Years after the Caracas Declaration (1990-2010)

On November 14, 1990, the “Conference for the Restructuring of Psychiatric Care in Latin America” adopted the Caracas Declaration. Since then, the Declaration, which was supported by all ministers of health of the Americas, has become a guide for the reform of mental health care services based on scientific evidence, respect for human rights, and with absolute commitment to humanitarianism.  

What is the background? On the one hand, there were technical aspects, such as the insufficiency of care when provided only in mental hospitals, alongside successful experiences supporting the viability of community-based care in Argentina, Brazil, Chile, Honduras, Panama, and Peru. On the other hand, there were ethical elements and issues related to the protection of human rights of people with mental disorders; for example, military regimes, which had a reputation of violating human rights, were replaced by democratic systems, however, though many countries with democratic systems claimed that they honored human rights, they continued to violate them by keeping people with mental disorders in asylums.

Who participated? The call for participation by PAHO and many regional and international professional associations was wide and included: professionals, health authorities, lawmakers, judges, politicians, international experts, users, and the media.

What does the Caracas Declaration say? Simply, that mental health care should be provided in the community and that all actions should be performed within the framework of human rights.

What has happened since then? The Declaration was supported by the Directing Council of PAHO in 1997 and 2000. The strategy to restructure psychiatric services in Latin America was extended to the English-speaking Caribbean. The Declaration was incorporated as a technical instrument in many laws on mental health as well as into world literature on the subject. Above all, the Declaration continues to be a mechanism of advocacy for developing equitable, high quality health services in the community that are adapted to each culture and accessible to everyone.

Twenty years after the Caracas Declaration, all countries, in all sectors, should reflect on the changes still needed in mental health care, strengthen what has been accomplished, and engage without delay in what has not yet been achieved.