From the asylum to primary care: problematisation and re-problematisations in the making of formal mental health care in Chile

In this paper, I examine key milestones in the expansion of mental health care in Chile, showing how it has evolved within the public health system and gained broader visibility and influence in society. To do this, I draw on historical primary and secondary sources, alongside scholarship from historians and other disciplinary specialists, and relevant official policy documents. I analyse how mental health care has changed in meanings, practices and places. From an explicitly coercive response, directed at groups of people seen as disrupting the social and classified using a limited set of medical labels, to a response increasingly framed around the professional responsibility to care for mentally ill persons, drawing on an ever-expanding range of diagnostic categories and experts. From being located in asylums and later in closed psychiatric institutions, to being situated within community-based institutions, and particularly within public primary health care. I argue that these different problematisations of mental health have contributed to the expansion of medical jurisdiction in everyday life. This has mainly occurred through the development and entrenchment of a top-down, expert-led strategy. Although reconfigured across changing normative frameworks, such epistemic, institutional, and clinical solutions have evolved and endured in Chilean policy and are reflected in formal mental health care provision. Consequently, there remains an ongoing risk that epistemological and cultural diversity may be marginalised or selectively reformulated in ways that align with a dominant framework – one that tends to absorb political contestation into an individualised, biomedical approach. Traces Chile’s shift from asylums to primary care in mental health provision. Examines how medicalisation shaped psychiatric expansion across historical phases. Shows how community psychiatry was reconfigured into expert-led policy frameworks. Reveals enduring top-down logics in Chile’s mental health policies and practices. Contributes a sociological analysis linking medicalisation to policy problem framings.