This report focuses on adults diagnosed with severe mental illness (SMI) served by the public mental health system. It aims to identify and describe the range of self-directed care programs for this group currently being pursued by states and bring together existing evidence relating to the impact of these programs on individuals and on state resources. In doing so, it attempts to contribute to ongoing debate about effective strategies for improving the quality and outcomes of the public mental health system. It is early in the development of self-direction for individuals diagnosed with SMI and the number of consumers currently served by these programs remains very small. Therefore, the findings and conclusions presented here are preliminary and further investigation will be required before definite conclusions can be drawn. [56 PDF pages]