Self-direction options have existed in Medicaid-funded long-term services and supports since the early 1970s. Today, every state in the US has at least one program with self-direction and many states have several. Self-direction has led to improved quality of life for individuals and caregiver satisfaction, and reduced nursing home and institution utilization in programs across the country. This session examined how self-direction delivers promise when utilized in new and innovative ways and for populations previously not formally served by self-direction, particularly persons with serious mental health conditions. A mental health services researcher and current self-directing participant shared their perspectives on mental health self-direction’s impact on individuals and systems. Further, this session examined the critical role of stakeholder engagement in designing services that meet the needs of the people they serve, providers of services, Managed Care Organizations, and states.