Community Systemic Approach (Abordagem Sistêmica Comunitária)

Community Systemic Approach (Abordagem Sistêmica Comunitária)

Project type:

To create new opportunities for communities through self-esteem strengthening.

Brief description:

A methodology to strengthen communities, by addressing the bio-psycho-social-spiritual dimensions of individuals.

Project status:


Innovation summary

After the Second World War an increase in Brazil’s population led to rapid urbanisation leading to an added burden on existing healthcare systems and social inequalities1. The Community Systemic Approach identified communities that exhibit psychological suffering, addiction, social fragility and lack of empowerment and responded with therapeutic exercises to empower members of those communities and help them develop processes necessary to improve their quality of life. This approach is being implemented as a public policy approach in Brazil and Bolivia and builds on the concept of ‘autopoiesis’2: the ability of a system to reproduce and maintain itself.

The Community Systemic Approach program aims to use this idea to:

  • Nurture the innate potential of individuals
  • Encourage personal development
  • Facilitate exchange between cultural and scientific knowledge
  • Offer educational programs:
    • Self-Esteem Therapy
    • Community Therapy
    • Drug Dependency Prevention and Mental Health

Impact summary

  • Over 14,500 people offered holistic services and support as part of the Community Systemic Approach including:
    • Employment training
    • Addition prevention and treatment
    • Therapeutic care and psychiatric support

“The Community Systemic Approach (ASC) gives MSMC the breath of life. ASC creates new pathways and fosters growth in self-esteem and the potential of community members.”

- Father Ottorino Bonvini, Psychiatrist and President Mental Health Community Movement (MSMC).

Abordaje Sistémico Comunitario (ASC)


Objetivo: Crear nuevas oportunidades para las comunidades a través del fortalecimiento de la autoestima.

Innovación: Una metodología para fortalecer las comunidades, abordando las dimensiones bio-psico-social-espiritual de los individuos.

Resumen de la innovación

Después de la Segunda Guerra Mundial, un aumento en la población de Brasil condujo a una rápida urbanización que dio lugar a una carga adicional para los sistemas de salud existentes y las desigualdades sociales1. El Abordaje Sistémico Comunitario identifica las comunidades que están experimentando sufrimiento psicológico, adicción, fragilidad social y falta de empoderamiento y responde con ejercicios terapéuticos para empoderar a los miembros de esas comunidades y ayudarlos a desarrollar procesos necesarios para mejorar su calidad de vida. Este enfoque se está implementando como un enfoque de política pública en Brasil y Bolivia y se basa en el concepto de "autopoiesis"2: la capacidad de un sistema para reproducirse y mantenerse a sí mismo.

El programa de Abordaje Sistémico Comunitario tiene como objetivo utilizar esta idea para:

  • Chuddar el potencial innato de las personas
  • Fomentar el desarrollo personal
  • Facilitar el intercambio entre el conocimiento cultural y científico
  • Ofrecer programas educativos:
    • Terapia de autoestima
    • Terapia comunitaria
    • Prevención de dependencia de sustancias y salud mental

Resumen de la innovación

Más de 14.500 personas ofrecieron servicios integrales y de apoyo como parte del programa de Abordaje Sistémico Comunitario, que incluye:

  • Capacitación laboral
  • Prevención y tratamiento de adiciones
  • Cuidado terapéutico y apoyo psiquiátrico

"El Abordaje Sistémico Comunitario le da a Movimiento de Salud Mental Comunitaria el aliento de vida. El Abordaje Sistémico Comunitario crea nuevas vías y fomenta el crecimiento en la autoestima y el potencial de los miembros de la comunidad ".


- Padre Ottorino Bonvini- Psiquiatra y presidente del Movimiento de Salud Mental Comunitaria (MSMC).


Innovation details

The Community Systemic Approach serves to expose people in the greater Bom Jardim area to new possibilities in overcoming internalized poverty. The approach is constructed through uniting popular community and scientific knowledge through social practices that promote self-actualization3. This multiple impact therapeutic approach addresses the whole human being, connecting the community, environment and the transcendent in a responsible and transformative manner.

In less than two decades, this socio-therapeutic technology has already transformed and improved thousands of lives in the greater Bom Jardim area in Fortaleza and in Maracanaú and Pacatuba with the Pitaguary indigenous people. Internationally recognized, Bolivia has expressed interest in applying the Community Systemic Approach as a public policy capable of reinvigorating and improving lives.

  • Self-Esteem Therapy: Self-Esteem Therapy develops intrapersonal and interpersonal communication by strengthening an individual's autonomy, dignity, and wisdom, which promotes active citizenship. A person’s self-esteem supports them to develop new skills to care for themselves, to assume their rightful place within the family, become an empowered and engaged member of society, and to positively transform their relationship with Mother Earth. Through various techniques, dynamics and complementary therapies, each participant improves their self-esteem, awakening their creative and participatory potential.
  • Community Therapy: In community therapy group participants collectively develop the skills to better manage and solve their problems by assuming the role of a true protagonist in their lives. The community therapy groups encourage participants to assume their proper place in the construction of a more just and united society. This form of therapy is based on the principle of circularity, in which there are no victims and no perpetrators because everyone shares responsibility. Today, there is a network of community therapy groups that serves thousands of people every month throughout Brazil. 
  • Yes to Life Project: The Yes to Life Project works on the Community Systemic Approach to serve high-risk children by preventing their initial exposure to drugs, violence, and human rights violations and developing their sense of agency as citizens. This project offers opportunities for youth to stimulate their multiple intelligences through involvement in arts, sports, and leisure activities. The Yes to Life Project encourages the full development of each person’s bio-psycho-social-spiritual dimensions. The Yes to Life Project has been recognized widely for its impact by the National Anti-Drugs Bureau (SENAD), and received honourable mention from the Queen of Sweden. The European Union, CBM International and the Federal University of Ceará are valued partners of this project.
  • Bom Jardim Community Center for Psycho-Social Assistance (CAPS): CAPS is co-managed by the implementing organisation and the Municipal Health Bureau and contributes to the Community Systemic Approach by offering treatment for people with severe psychiatric problems and family support. With the objective to promote care and social integration, it was developed as an alternative to psychiatric hospitalization and is the result of the autopoietic process of active community participation and co-responsibility in public policy.
  • Therapeutic Residence: Running since 2011 this approach serves psychiatric hospital patients who have been institutionalized for at least three years and have no contact with their families. Residents are welcomed into a new home where, with the support of community caregivers who are certified in the Community Systemic Approach, they find the opportunity to make ties and form friendships with their caregivers, their neighbours and the community at large. The residence offers its members care through various therapeutic activities, which encourage them to realize that it is possible to reconnect with their social and cultural reality and become integrated into their community. The Therapeutic Residence is also co-managed by the participating organisation and the Municipal Bureau of Health of Fortaleza.
  • Community Garden: The Community Garden offers the community contact with the earth, reviving its cultural roots, stimulating the communion between nature and humans and providing a transformative pedagogical perspective. This program builds upon the community’s existing knowledge of farming and gardening in order to teach all members of the community the skills needed to take care of the earth. In the garden, the community engages in occupational therapy activities and Live Pharmacy (Farmácia Viva), in which they produce medicinal syrups, soaps and shampoos. Community Garden partners with the Clóvis Beviláqua Forum, which is the Ceará Court System, to provide community service opportunities as an alternative to incarceration for judicial offenders.  Additionally, the Community Garden partners with the Pharmacy Department of the Federal University of Ceará (UFC) in growing lippia alba (lemongrass), which is the principal ingredient in natural antianxiety medications. This provides people with an alternative medication to avoid potential dependence on anxiolytic drugs. 
  • The Bishop Franco Masserdotti AME House: AME House (Art, Music, and Performance) welcomes those with a penchant for creative forms of expression. In 2008, AME House was designated by the Brazilian Federal Ministry of Culture as a Cultural Landmark. The House includes the Knowledge Exchange Reading Hub (Troca de Saberes) and provides the Bom Jardim community a dynamic space for meeting, listening, citizenship, leisure and culture. Workshops on handicrafts, typing, guitar, drums, piano, flute, percussion, violin, organic cardmaking, painting, mosaics, theater, cinema, and audiovisual tools are regularly offered. AME House offers art therapy to members of the greater Fortaleza region, as well as the Bom Jardim Community CAPS Program. The objective of the AME House is to expand community members´ multiple intelligences and increase their sense of agency and self-esteem through the development of marketable skills.
  • Culinary Arts School: The Self-Sustainable Culinary Arts School trains community members as professional chefs, furthering the MSMC´s mission of creating opportunities for socio-economic inclusion and the development of multiple intelligences for community members. The Culinary Arts School utilizes the alternative energy sources, such as solar and water power, to sustain the agroecological production of organic vegetables, fruits, poultry, fish, and eggs.

    El Abordaje Sistémico Comunitario ayuda a entregar a las personas nuevas posibilidades para superar la pobreza internalizada en el área metropolitana de Bom Jardim. El enfoque se construye mediante la unión de la comunidad y el conocimiento científico a través de prácticas sociales que promueven la auto-actualización3. Este enfoque terapéutico de impacto múltiple considera a todo el ser humano, conectado con la comunidad, el medio ambiente y lo trascendente de una manera responsable y de forma transformativa.

    En menos de dos décadas, esta tecnología socio-terapéutica ya se ha transformado y mejorado miles de vidas en el área metropolitana de Bom Jardim en Fortaleza y con los pueblos indígenas Pitaguary en Maracanaú y Pacatuba. Por su reconocimiento internacional, Bolivia ha expresado interés en aplicar el Abordaje Sistémico Comunitario como una política pública capaz de revigorizar y mejorar las vidas.

  • Terapia de autoestima: la terapia de autoestima desarrolla la comunicación intrapersonal e interpersonal mediante el fortalecimiento de la autonomía, la dignidad y la sabiduría individual, que promueve la ciudadanía activa. La autoestima de una persona los ayuda a desarrollar nuevas habilidades para cuidar de sí mismos, asumir el lugar que les corresponde dentro de la familia, convertirse en un miembro de la sociedad empoderado y comprometido y transformar positivamente su relación con la Madre Tierra. A través de diversas técnicas, dinámicas y terapias complementarias, cada participante mejora su autoestima, despertando su potencial creativo y participativo.
  • Terapia comunitaria: en grupos de terapia comunitaria, los participantes desarrollan colectivamente habilidades para gestionar de mejor forma y resolver sus problemas asumiendo el papel de un verdadero protagonista en sus vidas. Los grupos de terapia comunitaria alientan a los participantes a asumir su lugar en la construcción de una sociedad más justa y solidaria. Esta forma de terapia está basada en el principio de circularidad, en el que no hay víctimas ni autores porque todos comparten la responsabilidad. Hoy, existe una red de grupos de terapia comunitaria que sirven a miles de personas en todo Brasil.
  • Proyecto Sí a la Vida: El Proyecto Sí a la Vida trabaja en el Enfoque Sistémico de la Comunidad para ayudar a niños de alto riesgo a prevenir su exposición inicial a drogas, violencia y violaciones a sus derechos y desarrollar su sentido de agencia como ciudadanos. Este proyecto ofrece oportunidades para que los jóvenes estimulen sus inteligencias múltiples a través de la participación en artes, deportes y actividades de ocio. El Proyecto Sí a la vida alienta el desarrollo completo de las dimensiones biopsicosociales y espirituales de cada persona. El Proyecto Sí a la Vida ha sido reconocido ampliamente por su impacto por la Oficina Nacional Antidrogas (SENAD), y recibió mención honorífica de la Reina de Suecia. La Unión Europea, CBM International y la Universidad Federal de Ceará son socios valiosos de este proyecto.
  • Centro Comunitario de Asistencia Psicosocial Bom Jardim (CAPS): CAPS es cogestionado por la organización ejecutora y la Oficina Municipal de Salud y contribuye al Abordaje Sistémico Comunitario ofreciendo tratamiento para personas con trastornos psiquiátricos graves, además de apoyo familiar. Con el objetivo de promover el cuidado y la integración social, fue desarrollado como una alternativa a la hospitalización psiquiátrica y es el resultado del proceso autopoiético de participación comunitaria activa y corresponsabilidad en las políticas públicas.
  • Residencia terapéutica: funcionando desde el 2011, este enfoque sirve a los pacientes del hospital psiquiátrico que han sido institucionalizados durante al menos tres años y no tienen contacto con sus familias. Los residentes son bienvenidos a un nuevo hogar donde, con el apoyo de cuidadores comunitarios que están certificados en el Abordaje Sistémico Comunitario, encuentran la oportunidad de hacer lazos y formar amistades con sus cuidadores, sus vecinos y la comunidad en general. La residencia ofrece a sus miembros atención a través de diversas actividades terapéuticas, lo que los alienta a darse cuenta de que es posible volver a conectarse con su realidad social y cultural y se integren en su comunidad. La Residencia Terapéutica también es cogestionada por la organización participante y la Oficina Municipal de Salud de Fortaleza.
  • Jardín Comunitario: El Jardín Comunitario ofrece el contacto de la comunidad con la tierra, reviviendo sus raíces culturales, estimulando la comunión entre la naturaleza y los humanos y proporcionando una perspectiva pedagógica transformadora. Este programa se basa en el conocimiento existente de la comunidad sobre agricultura y jardinería para enseñar a todos los miembros de la comunidad las habilidades necesarias para cuidar la tierra. En el Jardín, la comunidad se involucra en actividades de terapia ocupacional y farmacia viva (Farmácia Viva), en el que producen jarabes medicinales, jabones y champús. El Jardín comunitario está asociado con el Foro Clóvis Beviláqua, que es el sistema judicial de Ceará, para proporcionar oportunidades de servicio comunitario como una alternativa al encarcelamiento de infractores de ley. Además, Community Garden se asoció con el Departamento de Farmacia de la Universidad Federal de Ceará (UFC) para el cultivo de lippia alba (limoncillo), que es el principal ingrediente de medicamentos naturales contra la ansiedad. Esto proporciona a las personas una alternativa de medicamentos para evitar la dependencia potencial de los fármacos ansiolíticos.

Key drivers

Partnership and collaboration

  • Scheduling weekly meetings with all members of the coordination group to review on going work and creating an integrated framework for making decisions
  • Healing the healer: Every three months, members on the implementation team spend a week engaging in therapeutic activities.
  • The autopoiesis process improves the network of national and international partner collaboration and helps to achieve sustainability.


Stigma and ideological challenges

  • Resistance to changing the paradigm of ideas and traditional approaches to mental health treatments
  • Stereotypes common negative beliefs in the community related to mental health 
  • Political situation and governmental issues that reduce the budget available for community mental health projects.
  • Religious fundamentalism; stigmatising attitudes towards people with mental health problems are widespread and commonly held, especially about the causes of mental health problems, such as demonic or spirit possession.


Stigma and ideological challenges

  • Resistance to changing the paradigm of ideas and traditional approaches to mental health treatments
  • Stereotypes common negative beliefs in the community related to mental health 
  • Political situation and governmental issues that reduce the budget available for community mental health projects.
  • Religious fundamentalism; stigmatising attitudes towards people with mental health problems are widespread and commonly held, especially about the causes of mental health problems, such as demonic or spirit possession.


  • Banco do Nordeste Foundation
  • CBM International
  • Comboni Missionaries
  • Federal University of Ceará (UFC)
  • Fortaleza Municipal Bureau
  • Maracanaú Municipal Bureau
  • State University of Ceará (UECE)


  • Prefeitura de Fortaleza Secretaria de Saúde (Health Department of Fortaleza Municipal Government)
  • Prefeitura de Maracanaú Secretaria de Saúde (Health Department of Maracanaú Municipal Government)
  • European Union
  • Global Giving Partnership
  • Private Donors
  • Northeast Citizenship Institute (INEC)
  • Moinho Dias Branco


Evaluation methods

A monitoring and evaluation specialist was contracted by the European Union to evaluate the program4. A Results-Oriented Monitoring (ROM) methodology was implemented through a qualitative research study to evaluate the innovation. 

.La Unión Europea contrató a un especialista en seguimiento y evaluación para la evaluación del programa4. Se implementó una metodología de Monitoreo Orientada a Resultados (ROM) a través de un estudio de investigación cualitativa para evaluar la innovación.

Cost of implementation

Since the Community Systemic Approach’s impact has significantly grown over the past several decades, the cost of implementation is currently estimated at $1.2 million annually for service delivery on around 14,500 beneficiaries. 

Los beneficiarios del del Abordaje Sistémico Comunitario provienen de un gran número de comunidades en Fortaleza y sus alrededores y su impacto continúa creciendo a un ritmo acelerado a nivel mundial. El enfoque contribuye a la humanización y desinstitucionalización de los servicios de atención de salud mental que históricamente han victimizado a las personas a través de una atención inadecuada, conceptos erróneos y prejuicios.

Impact details

The Community Systemic Approach’s beneficiaries come from a large number of communities in Fortaleza and its surrounding areas and its impact is continuing to grow globally at a fast pace. The approach contributes to the humanization and deinstitutionalization of mental health care services that have historically victimized people through inadequate attention, misconceptions and prejudices.

Los beneficiarios del Abordaje Sistemático Comunitario vienen de un alto número de comunidades en Fortaleza y sus zonas aledañas y su impacto continúa creciendo globalmente a un ritmo rápido. El abordaje contribuye a la humanización y desinstitucionalización de los servicios de salud mental que históricamente han victimizado a las personas a través de una inadecuada atención, ideas erróneas y prejuicios.


1. De Jesus Mari, J. (2014). Mental healthcare in Brazil: modest advances and major challenges. Advances in psychiatric treatment20(2), 113-115.

2. Maturana H & Varela F. (1997). De máquinas e seres vivos - autopoiese: a organização do vivo. 3.ed. Porto Alegre: Artes Médicas.

3. Bonvini O et al (1996). Healing the illness or Cure the Disease? Toward a Bio-Psycho-Socio-Spiritual approach in a multi-ethnic context. World Congress of Psychiatry, 2(10), 132.