People with severe mental illness (SMI) traditionally have been perceived by themselves and others as powerless (Carling, 1995; Williams, 1995). This perception occurred in part as a result of the provision of psychiatric treatment in large institutional settings, particularly before the 1970s, and the dominance of the medical model of psychiatric treatment, which minimized clients’ roles in decision making (Bassman, 1997; Goffman, 1961). This is changing, however. Psychiatric treatment is being provided in less restrictive community-based settings. Psychosocial rehabilitation has emerged as a complement to medical treatment of mental illness, and a mental health consumer movement has taken hold, both of which emphasize client involvement in decision making in all aspects of their lives (Carling; Chamberlin, 1978, 1990; Cook & Hoffschmidt, 1993). One aspect of this change is that people with SMI have increased their involvement in organizational decision making. They now are serving on boards of directors, task forces, and committees in agencies, as well as operating consumer-run programs (Carling, 1995; Pratt, Gill, Barrett, & Roberts, 1999; Vandergang, 1996). Despite this involvement, some argue that a lack of opportunity still exists for most people with SMI to participate in organizational decision making (Beeforth, Conlan, Field, Hoser, & Sayce, 1990). In addition, few examples exist in the literature that detail efforts of mental health programs to involve clients in decision making (Vandergang). We address this void in the literature by describing the participation of clients in organizational decision making at a public psychiatric hospital and offering guidelines for mental health agencies that wish to increase such participation.