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This institutional ethnography explored the work of adults receiving long-term treatment for serious mental health disorders through a lens of literacy. The 14-month long qualitative study involved 22 consenting client participants, 12 of whom participated, in interview sessions, in-depth observations and reading miscue analysis sessions. Pertinent staff members also participated in interviews. Findings indicate that certain ruling relations inhibited the recovery work of those clients with limited literacy skills. This study contributes to the paucity of research on the intersection of literacy and mental health as well as research on adult literacy. The presentation will discuss the value of institutional ethnography for literacy research, especially among adult research subjects and institutions that serve them.