Mary E. WiktorowiczKaitlin Marie Di Pierdomenico2024-11-072024-11-072024-07-122024-11-07https://hdl.handle.net/10315/42437This dissertation explores the trajectories of mental health reform in Canada, the United Kingdom, and Australia, examining how each state’s political and institutional contexts within universal healthcare systems have influenced these trajectories. Despite being parliamentary democracies, these states exhibit significant variations in mental health governance due to differences in government control and levels of privatization. Using a historical institutionalism framework, the research examines how state-based institutional configurations impact the use and outcomes of mental health policy levers. The research investigates the relationship between healthcare governance and government structure, financing and service system designs, and professional regulation and payment. Drawing insights from Postpsychiatry and Mad activism, the research employs archival documentary analysis, policy analysis, and feedback from community service agencies to assess the effectiveness and reach of mental health reforms. It highlights the need for a moral transformation in global mental health, advocating for person-centered, recovery-oriented care that respects and integrates the social and structural determinants shaping health. The dissertation’s comparative analysis reveals the strategic use of policy levers and their impact on mental health policy trajectories and outcomes. Part One examines historical opportunities for change and identifies key policy levers. Part Two discusses the use of policy levers and mental health policy trajectories and outcomes. Part Three compares the use of policy levers across the states to highlight differences in the scale and pace of reforms. The analysis highlights a difference in the scale and pace of mental health policy reforms, with Australia and the UK implementing larger scale and faster paced changes compared to Canada’s more conservative approach. These differences are shaped by the state’s institutional frameworks and historical legacies that influence how mental healthcare is governed, financed, and delivered. The research highlights the imperative to shift from traditional biomedical models to more inclusive, human rights-focused mental health practices. This research improves understanding of the dynamic interplay between policy levers and mental health reforms in varied institutional contexts. It emphasizes that future policies be co-produced with policy communities, prioritizing community-based care and moving beyond traditional biomedical approaches to address broader social determinants of mental health. The research adds to the literature by offering an examination of the intersections between mental health policy, social justice, and institutional change.Author owns copyright, except where explicitly noted. Please contact the author directly with licensing requests.Mental healthPublic policyElectronic Thesis or Dissertation2024-11-07