For nearly twenty years, legal and mental health professionals have created mental health courts (MHCs) for responding to the increasing numbers of criminally involved people with severe mental illnesses (PSMI) who are entering the criminal justice system. This article presents findings from qualitative analysis of survey and ethnographic data collected at nine MHCs established in a Midwestern state between 2004 and 2008, exploring how professionals who operated the MHCs organized the programs and conducted roles at the work sites. Findings revealed that professionals established very similar models of mental health court organization at each of the nine sites. The data supported three forms of institutional isomorphism—coercive, mimetic, and normative—that occurred as professionals introduced MHC programs in various jurisdictions. However, the data also revealed some variances of structure, professional belief, and practice when comparing the MHCs. Some of these variations are explained by local organizational cultures, while others are due to organizational dependence on available resources.