Ideas and theories relevant to the discussions around mental health reform in Italy, the UK and Germany are described. Referring to papers identified in a 2024 search of the literature, descriptive outlines of the general course of mental health service development in the three countries are presented. There have been parallel trends of deinstitutionalisation and orientation towards community mental health care in all three countries but changes have followed different patterns: early and enduring orientation towards mental hospital closure and community mental health care in the UK, later and radical orientation towards mental hospital reform, mental hospital closure and community mental health care in Italy and slow but enduring mental hospital reform, general hospital psychiatry and a relatively late flourishing of community care and integrated care models in Germany. Patterns of service development were shaped by the foundations of National Health Service in Britain (1948) and Italy (1978), while developments in (West) Germany have been influenced by a regionalised purchaser- (health insurance-) provider system with a mixed economy of care. Theories and ideas ranging from Michel Foucault’s theoretical approach and Erving Goffman’s institutional analysis to phenomenological and existential philosophy have been important in contributing to (i) a strong person- and rights-focus in Italy, (ii) a combination of institutional critique and surviving institutional paradigm in Germany, and (iii) a tradition of institutional critique, empiricism and rights-based psychiatric reform for the UK.