The beginning of the new millennium coincided with the start of a new phase in the reform of mental health services in Latin America and the Caribbean. This new phase has imposed new priorities and prompted new technical cooperation strategies at the international level. This piece points out the main characteristics of the first phases in the reform of mental health services in Latin America and the Caribbean, discusses the factors that led to the phase that started in 2001, and describes the strategies and the technical cooperation activities of the Pan American Health Organization to deal with the challenges that have arisen in the current stage of reform. The piece also considers the prospects for international cooperation in this field, as well as the advantages of establishing a program for the reform of mental health services in the Americas that would contribute to the combined efforts of governments and international organizations in an action plan with defined objectives. The piece recommends taking advantage of the celebration of the 15th anniversary of the Declaration of Caracas in order to launch an action plan that gives new impetus to mental health services reform in the Americas.