Empowering individuals with serious mental health problems includes providing services which they themselves identify as needs. This paper reports on a study which examined needs for rehabilitation services from the perspectives of consumers with chronic mental health problems, their significant others, and case managers. In most instances far greater needs for services were expressed by consumers and significant others than by case managers, indicating that case managers pay insufficient attention to what consumers want. Professional control and power imbalance between case managers and consumers likely contribute to this situation. Study findings have been used to initiate change at the organizational level and at the level of individual professionals.