Issues of mental health and mental illness inform the current crisis in the criminal justice system and inspire calls for reform. Specialized mental health courts (MHCs) address the growing problem of defendants with mental illness cycling through the criminal justice system. As a part of the broader problemsolving court movement, they represent an important innovation. This chapter provides a comprehensive account of MHCs from their inception to the present. Placing MHCs within a historical context, their development is described, and then key features that characterize these treatment courts are detailed. The chapter concludes with an exploration of the effectiveness of MHCs and specific recommendations for the next generation of MHCs are offered.