Legislation passed in 1993 makes sweeping administrative structural changes in Georgia's mental health system. Underlying these changes is the core value that consumers and families should be empowered to participate in the design, contracting, and evaluation of services. The key structural component is the creation of regional boards, comprised of at least 50% consumers and family members, which have the capacity to plan and contract for services and to evaluate the outcomes of those services. This paper describes Georgia's mental health system before these changes, the development of the initiative for reform, the process and problems associated with the passage of the legislation, and the current status of the implementation of the legislation.