This article discusses, temporally, the Brazilian psychiatric reform since its initial formulation to the present time – that is, from the organization of the anti-asylum struggle movement, even under the military dictatorship, until now – a time of neoliberalism marked by an offensive conservatism. It argues about the need to fight conservatism and neoliberalism, as both walk in the opposite direction to the principles of the Unified Health System and psychiatric reform (such as universality, integrality, equity, care in freedom, the non-commodification of madness and the end of asylums). It demonstrates the importance of territorially based services, the work of social workers and multidisciplinary teams in the field of mental health, as opposed to biomedical-psychiatric and hospital-centred. It discusses, therefore, the relationship between mental health and social issue. In addition, this article presents the contributions of Brazilian psychiatric reform, considering the socio-historic context to identify the main advances, challenges and limitations, and to contribute to the consolidation of the reform principles.