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Despite the proliferation of mental health courts across the United States, virtually no attention has been paid to the criminal justice effects these courts carry for participants. This article provides the first empirical analysis of differential sentencing practices in mental health and traditional criminal courts. Using a case study approach, the article compares how Pennsylvania’s Erie County Mental Health Court and county criminal courts sentenced individuals who committed the same offenses and held the same average criminal history score. Information on the mental health court—including eligibility criteria, plea bargaining and sentencing procedure, sentencing policies, program length, graduation rates, likelihood of early discharge, and consequences of unsuccessful termination—derive from interviews with key mental health court professionals, five years of collected sentencing and dispositional data, and court materials. The Pennsylvania Commission on Sentencing provided the county-level data, which were disaggregated by offense and criminal history score. The article analyzes sentencing for twelve offenses spanning four offense grades.

The findings are striking. First, analysis reveals that anticipated mental health court sentences typically exceed—by years—the supervisory periods that offenders would otherwise receive in a county criminal court. Second, mental health court participants with multiple convictions were significantly more likely to receive consecutive, as opposed to concurrent, sentences than those sentenced by traditional courts. Third, the analysis suggests the mental health court usually does not divert individuals from jail or prison sentences—a primary justification for these courts—but instead merely extends state control over individuals with serious mental illnesses. Fourth, key mental health court actors appear unaware of likely sentencing disparities or the high rate of participant failures. Thus, offenders choosing between mental health and traditional courts may go uninformed about these fundamental differences. The article concludes with suggestions for future research.