While Buffalo City Court pioneered several such courts, major inconsistencies exist across the state, with only 41 of 62 counties offering mental health diversion. Racial disparities are stark: 83% of Buffalo’s Opioid Court participants have been white. The Treatment Not Jail coalition advocates for the Treatment Court Expansion Act to standardize eligibility, reduce jail use, and expand mental health diversion. Observations and interviews reveal a system often prioritizing punishment over recovery.

Local courts can also take immediate action without legislation by improving transparency through community advisory committees, public reporting, and third-party observation. Standardized training, equitable case distribution, and written clinical guidelines would further ensure consistency and fairness, while investment in community-based care remains essential to preventing legal system involvement in the first place.