Mental health treatment courts have expanded significantly across the United States. These courts serve individuals living with serious mental illness, or SMI, and operate within a treatment-court framework that has developed through adult treatment court and mental health court best practices.
Guidance from those best practices provides a foundation for mental health treatment courts. However, practitioners increasingly report challenges applying the existing frameworks to individuals living with SMI. To examine those challenges, the National Center for State Courts surveyed statewide treatment court coordinators and conducted follow-up interviews with local practitioners.
Findings from the review
- Mental health courts are expanding rapidly
- Many courts rely on adult treatment court standards
- Few states provide SMI-specific guidance
- Local courts are adapting standards to meet participant needs
- Housing and treatment shortages remain the largest barriers
The findings indicate that mental health courts are operating in a setting where broad treatment-court standards remain important but do not address every need identified by practitioners. Local courts are adapting those standards to meet participant needs, while states vary in the extent to which they provide guidance specific to serious mental illness.
The review identifies housing and treatment shortages as the largest barriers facing mental health courts. These shortages affect the ability of courts and practitioners to respond to the needs of participants living with SMI, according to the findings presented by NCSC.
The findings reveal a growing consensus: the field is not rejecting existing standards. Instead, practitioners are identifying areas where additional guidance is needed to address the realities of serving individuals with serious mental illness. NCSC presented these findings in “Myths, Realities & Emerging Practices in Mental Health Courts,” dated July 14, 2026.