Two research reports in this month's issue focus on ensuring that treatment decisions are driven by the preferences of persons with mental illness—a key feature of a transformed system. In a two-year study of 106 outpatients who had completed a psychiatric advance directive, Debra S. Srebnik, Ph.D., and Joan Russo, Ph.D., examined whether their crisis care was consistent with their expressed preferences. Across 90 crisis events in which directives were accessed, the average rate of care consistent with directive instructions was 67%. Clients who had a surrogate decision maker who accessed the directive were more likely to receive directive-consistent care (page 1157). In a brief report Jared R. Adams, B.S., and colleagues present the results of a pilot study in which they interviewed 30 adults with severe mental illness about their preferences in regard to shared decision making. About three-quarters preferred an autonomous or shared role in treatment decisions, especially in regard to medications; however, only 37% rated their current roles as more than passive (page 1219). In a related commentary Marvin S. Swartz, M.D., and Jeffrey W. Swanson, Ph.D., highlight the importance of these empirical studies, which provide support for a recovery orientation and point to opportunities for improving care (page 1164).