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Mental health courts (MHCs) are a growing component of the U.S. criminal justice system's response to individuals with mental illness. Yet, key aspects of contemporary MHC practices, such as eligibility criteria, assessment of risk-need-responsivity principles, integration of trauma-informed care, use of sanctions and incentives, and access to community resources, remain understudied. In response, we conducted a survey study of 70 U.S. adult MHCs to explore these domains. Our findings indicate broadened eligibility criteria, with increases in acceptance of violent offenses and greater inclusion of non-traditional primary diagnoses (e.g., developmental disabilities and traumatic brain injuries). Fewer than a quarter of respondents reported bilingual MHC staff and translated program materials. Most MHCs employed at least one risk assessment tool. Just over 90% of MHCs included jail sanctions on their menu of options, with the majority incarcerating participants for 6 days or less on average. Tailored sanctions and incentives were perceived as being most effective, but expansion of available incentives is hindered by lack of funding. MHCs identified housing, inpatient psychiatric units, and co-occurring disorders resources as the most needed resources for participants. Our findings highlight the differences across MHCs that persist across jurisdictions.