The voice of the consumer has often gone unheard in modern health care, particularly in the era of managed care. Consumers of mental health care have had additional difficulties being heard because of stigma, paternalism, cognitive impairments, or lack of self-confidence. In this issue's Managed Care column, in the fourth installment of a continuing series on strengthening the consumer voice in managed care, James E. Sabin, M.D., and Norman Daniels, Ph.D., describe the Leadership Academy, its origins, its program, and some of its achievements over the ten years since its founding as the Idaho Leadership Academy. With the help of funding from the Center for Mental Health Services (CMHS), the organization was formed in the early 1990s to improve the advocacy skills of mental health care consumers and their families. CMHS funding also helped in the forming of a second Leadership Academy in West Virginia in 1995 as well as of CONTAC (Consumer Organization and Networking Technical Assistance Center) in 1998, which has enabled the academy to maintain a presence in 16 states. The academy's skills development program, which involves three- to four-day training sessions, has produced several hundred graduates. Follow-up networking activities, a vital part of the program's model, are used in collaborative projects and for continued learning (see page 405).