Although Italian mental health (MH) services are community based, user and relative participation in service evaluation lagged behind until lately. We here review three recent studies involving stakeholder participation in service evaluation: two were quantitative studies, one on 204 users in an MH service in Pistoia (Central Italy) and the other on 2259 relatives, conducted with the National Union of Associations for Mental Health. The third (supported by The Centro per il Controllo delle Malattie, the ministerial Center for Disease Control) was a qualitative study in seven MH services, involving users, relatives, and professionals together, which collected interviews from 136 users, 119 relatives, and 79 professionals. In the quantitative studies, positive evaluations outnumbered negative ones. The qualitative study explored negative aspects in greater depth. Common findings were insufficient information, underinvolvement of users-relatives in planning, no choice of clinician, psychiatrist domination, and limited helpfulness of interventions. With stakeholder participation in service evaluation, the present medical framework will need reshaping.