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The 2001 Washington State Legislature directed the Institute to “conduct a longitudinal study of long-term [mental health] client outcomes to assess any changes in client status at two, five, and ten years.” Every year, the state’s public mental health system serves about 120,000 individuals. To follow changes over time, this paper focuses on a cohort of 38,668 adults who received public mental health services in January 2004. At the end of five years, mental health consumers were classified into those who 1) received services continually (every month), 2) regularly utilized mental health services (every quarter), 3) had intermittent use of mental health services (breaks longer than three months), and 4) clients who received services and did not return (“leavers”). After profiling these four categories of clients, we examine outcomes for each related to employment, housing, hospitalizations, and involvement in the criminal justice system.