Objective: Patient activation refers to one’s ability and willingness to manage their health and health care. Visit preparation, question formulation, and other elements of patient activation are core components of patient-centered care. However, they are inconsistently translated into clinical practice. Multiple factors have been shown to influence patient activation and associated activities, such as patients’ race and ethnicity, illness, and clinical settings. Because race and ethnicity are important factors in patient activation, and we know little about ethnic minority patients with respect to patient activation, the goal of this study was to examine the contexts, barriers, and facilitators influencing African American veterans’ involvement in visit preparation in mental health outpatient settings. Method: We conducted qualitative interviews with 49 African American veterans with mental illness receiving outpatient psychiatric care at a large, urban U.S. Department of Veterans Affairs (VA) Medical Center, and used a grounded theory approach to analyze the data. Results: Findings from this study identify patients’ beliefs about preparing for the clinical encounter, the patient–provider relationship, and lack of information about patient activation as barriers to engaging in visit preparation activities. Conclusions and Implications for Practice: Findings indicate the need for greater awareness of the challenges of visit preparation as well as the potential consequences of lack of preparation. Results suggest the incorporation of visit preparation as part of routine mental health visits, and as a tool to increase patient activation, especially among minorities. Findings also inform intervention studies by emphasizing the need to explore sociocultural factors that may impact patient activation programs.