This paper analyzes the role of mental health in self-employment decisions. We find evidence of a relationship between psychological distress and self-employment for men that depends on type of self-employment and severity of psychological distress. Specifically, there is suggestive evidence of a causal link from moderate psychological distress to self-employment in an unincorporated business as a main job for men. Additionally, we find evidence that long term mental illness can significantly increase the probability of self-employment in an unincorporated business for both men and women. Our results suggest that individual difficulty in wage-and-salary employment is the likely mechanism for this connection.