In this presentation, I argue that patient agency is an essential goal for mental health care integrated into the primary care management of chronic disease. This model of integrated care was developed by my colleagues Wayne Katon and Jurgen Unutzer. It is now widely disseminated throughout primary care systems nationwide. But it can be implemented in many different ways, with different goals. This presentation uses the example of a patient with diabetes to argue that integrated mental health care should focus on enhancement of patient agency.