Abstract
This paper summarises our own accumulated experience from developing community-orientated mental health services in England and Italy over the last 20-30 years. From this we have provisionally concluded that the following issues are central to the development of balanced mental health services: (a) services need to reflect the priorities of service users and carers; (b) evidence supports the need for both hospital and community services; (c) services need to be provided close to home; (d) some services need to be mobile rather than static; (e) interventions need to address both symptoms and disabilities; and (f) treatment has to be specific to individual needs. In this paper we consider ten key challenges that often face those trying to develop community-based mental health services: a) dealing with anxiety and uncertainty; (b) compensating for a possible lack of structure in community services; (c) learning how to initiate new developments; (d) managing opposition to change within the mental health system; e) responding to opposition from neighbours; (f) negotiating financial obstacles; (g) avoiding system rigidities; (h) bridging boundaries and barriers; i) maintaining staff morale; and (j) creating locally relevant ser-vices rather than seeking „the right answer" from elsewhere.