Objective-This study identified ways that consumers of mental health services are active participants in psychiatric treatment.Methods-Self-reported activity in treatment and observations of audio recorded psychiatric visits were examined. Four providers (3 psychiatrists and one nurse practitioner) and 10 of their consumers with severe mental illness (40 total) were recruited. Consumers completed questionnaires on patient activation, illness self-management and medication attitudes on the day of a psychiatric visit. The visit was audiotaped, transcribed, and thematically analyzed. Providers reported diagnosis, substance abuse, and medication adherence.Results-Self-reported patient activation was positively related to illness self-management and negatively related to substance abuse. Consumers were active in partnership building, seeking and displaying competence, and directing treatment; however, there was little relationship between selfreported activation and observed behaviors.Conclusions-Consumers are active in a variety of ways; but, similar to other populations, the relationship to self-reported desire for involvement is not direct.Living successfully with chronic health conditions requires active collaboration in managing illness --consumer and health care provider working together to identify problem areas, set goals, learn self-management skills, and participate in follow-up (1). An active partnership is critical because the majority of time spent managing chronic illnesses takes place when the consumer is on his/her own in the community rather than in the provider's office. Further, NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript reviews have shown that positive, relationship-centered approaches translate into higher levels of trust, satisfaction, reduced emotional burden, and improved biomedical markers such as blood pressure and blood sugar control (2). Relationships in which patients are activated to take greater control in treatment appear to be particularly important predictors of physical health (3).National policy supports an active role for consumers of mental health services, and research indicates that people with severe mental illnesses such as schizophrenia want to take a role in making decisions about their care (4). Shared decision-making is gaining more attention (5) and interventions are being developed to improve activation and shared decision-making in this population (6). Unfortunately, tools to assess active participation are lacking (5).In the general medical field, the Patient Activation Measure (7) has been successfully used in a variety of chronic health conditions including diabetes, arthritis, and high blood pressure. The scale assesses an individual's knowledge, skill, and confidence for actively managing illness and has been associated with a variety of self-management behaviors including diet, exercise, nutrition, self-monitoring, and reading about medications. Patient activation has also been associated with service utilization, medicatio...