Caracas Declaration

Caracas Declaration, Conference on the Restructuring of Psychiatric Care in Latin America within the Local Health Systems, Pan-American Health Organization [PAHO]/World Health Organization [WHO], Venez., Nov. 14, 1990.
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Year of adoption: 1990
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1. That conventional psychiatric services do not allow for the attainment of objectives compatible with a decentralized, participatory, integrated, continuing, and preventive community-based care; and

2. That the mental hospital, when it is the only mode of psychiatric care provided, hampers the fulfillment of the above-mentioned objectives in that it:

a) isolates patients from their natural environment, thus generating greater social disability;

b) creates unfavourable conditions that imperil the human and civil rights of patients;

c) absorbs the bulk of financial and human resources allotted by the countries for mental health care; and

d) fails to provide professional training that is adequately geared to the mental health needs of the population, the general health services, and other sectors.


1. That Primary Health Care is the strategy that has been adopted by WHO and PAHO and endorsed by all the Member States as the means for attaining the goal of Health for All by the Year 2000;

2. That the Local Healthy Systems model has been implemented by the countries of this Region to reach that target through the provision of better conditions for the development of programs that are based on the health needs of the population and that are characterized by decentralization, social participation, and a preventive approach; and

3. That mental health programs must adopt the principles and guidelines on which these strategies and models of health care delivery are based.


1. That the restructuring of psychiatric care linked to Primary Health Care and within the framework of the Local Health Systems model will permit the promotion of alternative service models that are community-based and integrated into the social networks;

2. That the restructuring of psychiatric care in the Region implies a critical review of the dominant and centralizing role played by the mental hospital in mental health service delivery; and

3. That the resources, care, and treatment provided must:

a) Invariably safeguard personal dignity and human and civil rights,

b) be based on rational and technically appropriate criteria; and

c) strive to ensure that patients remain in their communities.

4. That the national legislation must be redrafted so that:

a) the human and civil rights of mental patients are safeguarded; and

b) promote the organization of community-based services that guarantee the enforcement of these rights;

5. That training in mental health should rely on a service model that is community-based and encourages psychiatric admissions in general hospitals, in accordance with the principles that underlie the restructuring movement; and

6. That the organizations, associations, and other participants in this Conference hereby undertake to jointly and individually advocate and develop programs in the countries that promote the restructure of psychiatric care, and to monitor and defend the human rights of mental patients in accordance with national legislations and international agreements.

To this end, they call upon The Ministries of Health and Justice, the Parliaments, the Social Security systems and other health care providers, professional organizations, consumer associations, universities and other training facilities, and the media to support the restructuring of psychiatric care, to assure its successful development for the benefit of the populations in the Region.