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This report provides a review of available information on self-directed care (SDC) programs in mental health care settings and discusses potential policy implications of large-scale implementation of SDC programs serving persons with serious mental illness. Although SDC holds great promise to address deficiencies in mental health care, SDC also has the potential to re-invent within a new program setting some of these same problems. Building checks and balances into the design of mental health SDC programs is consequently needed to ensure that all consumers have an opportunity to participate and benefit from SDC.