On May 28, the lower house of the National Congress of Brazil passed a bill that would allow parents to commit children as young as 12 to therapeutic communities to be treated for substance use. The bill, which had strong support from the evangelical caucus, now awaits transfer to the Senate. It represents the latest expansion of Brazil’s increasingly powerful therapeutic communities, which have subjected children to forced treatment in the past.
Under the proposed legislation, children would need to consent to be admitted, but of course this does not account for those who will be coerced into giving consent by their parents.
Therapeutic communities—private, usually faith-based residential drug treatment facilities where patients are subjected to forced labor and other abuses—are a historical feature in Brazil. But in recent years, political investment has created a massive, parallel care network that operates largely outside the official public health system. In 2025, the Federal Prosecution Office published a damning report on the human rights violations in these institutions, based on an investigation of 43 therapeutic communities across 25 states. It described facilities in remote locations where patients were physically and pharmacologically restrained, and prevented from contacting the outside world.
Though they are nonprofits, therapeutic communities receive substantial support from government contracts. Between 2017 and 2020, federal and local governments in Brazil spent more than $100 million USD on these shadowy, weakly regulated facilities.
In 2019, the first year of former president Jair Bolsonaro’s only term, the right-wing administration brought back involuntary commitment. In 2020, a resolution expanded that to minors between ages 12 and 18. That year the United Nations International Narcotics Control Board, noting that almost all of Brazil’s therapeutic communities use unscientific approaches, called upon “the Government of Brazil to implement voluntary, evidence-based treatment services with due respect for patients’ human rights,” in line with international standards.
The model built under right-wing Bolsonaro has largely persisted under left-wing Lula da Silva.
In 2021, a federal judge suspended the resolution that had expended involuntary commitment to minors. Seven former health ministers who had served under Bolsonaro and former presidents Dilma Rousseff and Luiz Inácio Lula da Silva (who was reelected as president in 2023) then signed an open letter calling for an end to the involuntary commitment of adolescents in therapeutic communities.
The letter argued that these institutions were not appropriate for children, and echoed broader concerns about human rights violations, family separation and the diversion of public resources away from the public health system. The ministers also called for releasing the hundreds of minors being treated in therapeutic communities, and suspension of federal funding for the placement of more minors in these settings.
The model built under right-wing Bolsonaro has largely persisted under left-wing Lula da Silva. Shortly after beginning his third term in 2023, Lula created a Therapeutic Community Support Department, against the advice of his health minister at the time. This move was criticized by the National Health Council and civil society organizations. Amid calls to invest in the country’s public health care system rather than faith-based institutions, the administration made the symbolic gesture of changing the name to the Department of Entities of Support and Welcoming Acting in Alcohol and Drugs.
In 2024, the National Council on Drug Policy (CONAD) approved a resolution revoking the Bolsonaro-era authorization of involuntary commitment of minors. However, for months the Ministry of Justice delayed it from taking legal effect. During the same period, the National Council for the Rights of Children and Adolescents (CONANDA) approved and promptly published a similar resolution. The episode exposed division within the administration.
Even as the government found ongoing abuses within the therapeutic community sector, the funding always continued.
While the Ministry of Health supported shifting away from the therapeutic communities, the Ministry of Social Development maintained close ties and continued funding them. Rather than dismantling the policies of Bolsonaro, as many voters had hoped, Lula’s government appeared caught between conflicting priorities.
In late 2024, researchers from the Federal University of Minas Gerais released the results of an oversight program—commissioned by the Ministry of Social Development—covering the 500-plus therapeutic communities receiving federal funding at that time. Its descriptions of overcrowding, restrictions on family contact and other harsh practices reinforced a recurring theme: Even as the government found ongoing abuses within the therapeutic community sector, the funding always continued.
That contradiction has become a defining feature of Brazilian drug policy. Public defenders, health councils, children’s rights groups and even federal prosecutors have repeatedly questioned the use of therapeutic communities, but each new administration continues to finance them.
Over the past several years, the National Health Council, National Human Rights Council, National Social Assistance Council, CONANDA and, eventually, CONAD, have all approved measures opposing therapeutic communities or the institutionalization of minors. Yet new federal contracts continue to be awarded, and Lula’s administration is now facilitating the likely reinstatement of adolescent treatment. Criticism has accumulated much faster than policy change.
Image of Luiz Inácio Lula da Silva in 2023 via Ricardo Stuckert PR/Palácio do Planalto/Flickr/Creative Commons 2.0