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Mental health courts are a type of specialty court designed to reduce the arrest and incarceration of offenders with severe mental illness. Recent literature has generated support for the theory of procedural justice, which posits that when a defendant perceives court processes as fair and that they are treated with respect, they are more likely to be compliant and have positive outcomes associated with graduation from mental health court. The present study uses longitudinal survey data from a mental health court in a midsized urban town. Surveys administered at intake and three-month follow up measure perceived procedural justice as it pertains to the mental health court judge and the case manager as well as perceptions of coercion and social support. We analyze if perceptions of procedural justice are associated with compliance during the court process, and if perceptions of procedural justice remained static while under supervision of the court. In addition, we examine if variations in procedural justice result from sanctions and incentives administered by the treatment team. Our results suggest that perceptions of procedural justice vary significantly across individuals. This variation is explained by differing experiences during the mental health court process.