It is a tragic reality that many individuals in the criminal justice system suffer from a mental illness. As a result, both mental health programs and mental health courts have been developed in response to the increasing number of individuals in the criminal justice system that are suffering from a mental illness. The first objective of this review is to discuss the background on mental illness as it relates to the criminal justice population, and to understand the common causes of incarceration amongst the mentally ill, including the deinstitutionalization movement of the 1960s, the unavailability of intermediate and long-term hospitalization in state hospitals, more formal and rigid criteria for civil commitment, a lack of adequate support systems and access to mental health treatment in the community, and the high recidivism rates by these types of offenders. Considering these causes, another objective of this review is to compare and contrast the United States' first mental health courts, including those in Broward County, Florida, King County, Washington, San Bernardino, California, and Anchorage, Alaska, by ultimately focusing on the origins of each court, the stages of intervention, methods of entry, competency evaluations, treatment approaches, and disposition of charges. From there, this review considers the differences between the courts and proceeds with a synthesis of the common and recurring themes between them, and then ends with recommendations specific to the mental health court system on practices that can be implemented or altered in order to encourage a more effective form of justice for the mentally ill, and a discussion of the policy solutions that have already been proposed to address the problem.