Mental health is now seen as a major global problem. In recent decades acknowledgement of the global cost of mental illness has prompted mental health reforms in many countries. While there have been national differences in how the reforms have been played out, in virtually every case there has been an intensification of governmental interest in mental health, resulting in the adoption of deinstitutionalisation and community care as the officially sanctioned options for providing mental health services. At the same time, the new policy directions have been characterised by concern for the citizenship participation and human rights protection of mental health service users. This paper compares recent mental health reforms in four countries - Australia, the UK, Italy and Brazil, with particular emphasis on the relationship between deinstitutionalisation, citizenship and human rights. The paper concludes by arguing that the question of whether deinstitutionalisation has worked is best addressed using an international comparative approach.