A mixed-methods study examined these issues in Monroe and Bronx Counties in New York, which were selected because of their geographic and demographic diversity. The analysis used interview data to determine how public defenders and defendants made decisions related to the defendant's mental health needs, particularly in terms of raising the defendant's mental health in court and advocating for treatment-based alternatives to incarceration. Results showed a high degree of correlation between procedural justice measures, satisfaction with attorney's strategy, and satisfaction with case outcome. The client's mental health disorder, measured by self-reported impact on daily functioning, was not significantly associated with procedural justice measures, but did have a weaker association with the procedural justice scale and understanding of court appearance. During baseline interviews, defendants were asked whether they would accept diversion to treatment as part of a guilty plea. Seventy-eight percent said yes; 19 percent said no; and 4 percent did not respond. Of those that would accept treatment, 48 percent thought they needed treatment or other services; and 35 percent thought treatment was always better than jail. Of eligible cases, 23 percent were diverted. When attorneys were asked why potentially eligible defendants were not diverted to treatment, 20 percent of attorneys indicated they did not seek diversion to treatment. These results inform both the scientific and criminal justice communities about the unique needs of defendants with mental health disorders. 14 tables, 3 figures, and 12 references