Although both adult and juvenile mental health courts have emerged in recent years, this publication pertains only to adult mental health courts. The 10 elements presented are planning and administration, target population, timely participant identification and linkage to services, terms of participation, informed choice, treatment supports and services, confidentiality, court team, monitoring adherence to court requirements, and sustainability. Each element contains a short statement that describes criteria that should be met by mental health courts, followed by several paragraphs that explain why the element is important and how courts can comply with it. Two key principles underlie the 10 essential elements. First, at the core of each element is collaboration among the criminal justice, mental health, substance abuse treatment, and related systems. Second, the elements make clear that mental health courts are not a panacea. Reversing the overrepresentation of people with mental illnesses in the criminal justice system requires a comprehensive strategy, with mental health courts being but one component of the strategy. The authors advise that the 10 elements are drawn largely from the experiences of existing mental health courts and are not based in evaluation and performance research. Only a few studies of the performance of mental health courts have been completed; however, more are underway. In the meantime, these elements provide guidance for communities interested in developing a mental health court or reviewing the organization and functions of an existing court program. This publication will be updated periodically to reflect innovative thinking from the field as well a benchmarks that mental health court administrators can use to assess their progress in implementing the essential elements in their courts.