This article focuses on a court innovation for criminally involved people who are afflicted with serious mental illnesses, such as schizophrenia, bipolar disorder, or major depression. It describes a recently developed strategy for dealing with the challenges of working with mentally ill individuals during the pre- and post-adjudication stages of the criminal justice process: mental health court (MHC). The article also discusses the historical and legal underpinnings of these courts, their growth, and the defining elements and operations of the earliest MHCs, which are best viewed as evolving models of practice. Finally, the article reviews studies of MHC operations and effectiveness and suggests future directions for MHCs.