Local jurisdictions are increasingly implementing mental health courts to more appropriately determine the disposition of individuals with mental illness who are accused of minor crimes. To date, North Carolina has 6 such courts in 5 counties. I interviewed eight key stakeholders in the legal and health care systems to determine what barriers exist for these courts and what elements are important for their success. The results of these interviews suggest broad support for the expansion of mental health courts, but identify lack of community mental health resources as a major limitation on their potential effect. Until improvements can be made to the mental health system in North Carolina, existing mental health courts should collaboratively collect data to facilitate new court development, quality improvement, future research, and political advocacy.