Critical reasons for frustration and circularity in the formulation and implementation of mental health policy are analyzed. The primary reason proposed is the lack of equal, systematic and structurally-reinforced participation of mental health services consumers and their communities in the planning and implementing of policy and programs. This is why mental health policy and services are often ineffective, inefficient and irrelevant to those who need them. A proposal for a two-year strategy for service acquirer participation is made to avoid some of the typical difficulties encountered in facilitating consumer involvement. (BN)