Romania is currently making efforts to deinstitutionalize residents of its mental health hospitals and initiate a system of community-based mental health care. Many lessons can be learned from the challenges faced by the United States in its respective deinstitutionalization efforts. Recognition of the various pitfalls may help Romania preventing the adverse consequences associated with such efforts in the United States. This article begins with an examination of the various challenges associated with the efforts in the United States to deinstitutionalize individuals who have been hospitalized for mental illness. The discussion first focuses on the various cycles of reform in the field of mental health care. It then proceeds to define deinstitutionalization and to identify the forces that have underlain such efforts in the U.S. The article then explores the requirements for deinstitutionalization and the consequences of deinstitutionalization efforts in the absence of an adequate attention to these prerequisites. The article concludes with an examination of the critical policy, ethical, and legal issues and associated challenges facing Romania in its efforts to depopulate its mental health institutions and the strengths that can be leveraged in its efforts to do so.