Drawing on research conducted in British Columbia, Ontario, and Quebec it is argued that tension exists between mental health reforms born out of concern for the well-being and care of people and those that are being driven by costcontainment and efficiency. Contributing to this tension are competing discourses about mental health and mental illness. It is argued that progressive change requires the meaningful engagement of mental health care recipients in policy decision-making processes and ongoing analysis about the interconnections between economic globalization, social welfare state restructuring and mental health reform.

Despite increased interest in the concept of recovery, not enough is known about the challenges of implementing recovery models in mental health care settings. Findings are presented from a 3-year feminist ethnographic study that followed recently deinstitutionalized women and men as they moved into psychiatric tertiary care facilities in British Columbia where a psychosocial rehabilitation model based on recovery principles was implemented. We found that inconsistent staff training and stretched community supports have resulted in uneven implementation that does not yet maximize opportunities for people's recovery. Further, care is organized and delivered in ways that emphasize individual needs as opposed to social and collective needs based on factors such as gender, ethnicity, and culture. These findings indicate that greater political will, as measured in commitments to community-based mental health services, is required to fully realize the philosophy of recovery and equitable mental health care.