نبذة مختصرة : The Custody and Psychiatric Treatment Hospital (CPTH) is ambivalent and ambiguous in its essence, because it gathers not only the characteristics of a mental institution, but also those of a prison – epitomized by the security system. By analyzing this context, one can perceive the importance of implementing some knowhow able to attend the real needs of the individuals hospitalized in this type of institution. This interpretation of their needs must be done in association with a work in mental health based on the principles of the Brazilian Psychiatric Reform and Psychosocial Field Practice. The objective of this study is to reflect on the real possibilities of implementing mental health work based on the Brazilian Psychiatric Reform, inserted in the Psychosocial Field, in institutions such as CPTHs. This reflection occurs from the conflicts arisen in the beginning of Occupational Therapy service in a CPTH located in the state of Sao Paulo, Brazil, as well as through the analysis of the reality in which this Custody Hospital is inserted. When studying the Psychiatric Reform Law, ordinance 28.195/1988, which deliberates on the functions of Occupational Therapy in the CPTHs of the state of Sao Paulo, and the Penal Execution Law, the reality was analyzed from its dimensions, to conclude that the institutional forces ruled the work process of occupational therapists. Therefore, the structural, particular, singular dimensions that rule the CPTH were understood and, after that, the “nodes” that hinder the implementation of mental health work in the Psychosocial Field in this type of institution were revealed.
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