On January 20, President Luiz Inácio Lula da Silva established the Therapeutic Community Support Department, a government office that further legitimizes Brazil’s notorious forced-treatment institutions. The new department represents a massive blow to people who use drugs and to public health activists, who hoped Lula’s first drug policy move would dismantle harmful practices installed by the previous administration—not replicate them.
In 2019, former President Jair Bolsonaro installed drug policies that centered mass incarceration and involuntary commitment. This included the creation of the National Secretariat for Drug Treatment and Prevention (SENAPRED), which served as the official contact point between so-called rehab entrepreneurs and the federal government. In January 2023, Lula discontinued SENAPRED—and immediately faced pressure from the National Confederation of Therapeutic Communities. And now, voilà: A presidential decree quietly published in an extra edition of the Federal Register instituted a new department to serve as the official contact between rehab entrepreneurs and the federal government.
Public health and social assistance programs have suffered under years of underfunding and sabotage, by the Bolsonaro administration and that of Michel Temer before him. Lula’s new department will be housed under the Ministry of Social Development, Assistance, Family and Fight against Hunger. This means that private therapeutic communities—which are typically operated by conservative religious groups—are recognized as credible institutions alongside those that already exist in the national health system.
Under Bolsonaro, therapeutic communities became synonymous with drug treatment.
Therapeutic communities have been embedded in Brazilian drug policy for decades. These abstinence-only institutions are widely known for human rights abuses including physical and psychological violence, forced labor and religious freedom violations.
Under Bolsonaro, who funneled the majority of available federal funding to Christian organizations, therapeutic communities became synonymous with drug treatment. He reinstated involuntary commitment, even passing a decree allowing the commitment of children as young as 12 years old. During his term, the number of therapeutic community placements across the country grew from 2,900 to 17,300.
Lula is now facing criticism for cowing to pressure from evangelical lobbyists, among whom he has low popularity and who campaigned against him in the 2022 elections. The new department has been condemned by the Brazilian Association of Collective Health, which published an open letter demanding it be abolished. The Brazilian Association for Psychiatry did the same. The National Council for Human Rights called for an audit of all contracts between the Brazilian government and these institutions between 2019 and 2022.
Members of Lula’s own transition team advised against supporting therapeutic communities. In December 2022, the health policy transition team—a team that included Nísia Trindade Lima, who is now Brazil’s Minister of Health—formally recommended that Lula revoke all ordinance and decrees related to these institutions, on the grounds that their practices go against established public health guidance.
Therapeutic communities still retain broad public approval.
Therapeutic communities still retain broad public approval. We are taught at school, by the media and by law enforcement that people who use drugs are sick—spiritually, morally, mentally, physically—and dangerous if not forced to become “sober.”
Some are suggesting that the department be renamed to show that therapeutic communities are not its only focus. But what we desperately need is divestment from militarized policing and investment in harm reduction and affordable housing, in physical and mental health care that is accessible—not carceral.
Lula hasn’t publicly commented on the establishment of the new department, and isn’t really expected to. In the wake of his decree, the government has already extended the period of public funding for many of the institutions. Beyond that, what comes next is unclear.