This article is based on a study, inspired by institutional ethnographic methods, of a mental health court (MHC) situated in Montréal, Canada. The focus of this article is on the qualitative results of the project, namely, the perceptions and experiences of accused (N=20) who were involved in the court as well as key actors (N=10) who make up the multidisciplinary team. In addition, findings from participant observation and a quantitative review of court files are drawn upon to flesh out the data. We argue that MHCs promote a special form of social exclusion based on othering that considers accused to be deviant, dangerous, or fragile. In an effort to control risk, MHCs target risky behaviours and reward individual mobilization efforts through their promotion of autonomy and self-regulation and their emphasis on psychiatric interventions. These new “socio-medico-juridical practices” bridge two systems of domination, psychiatry and the law, in an effort to “de-marginalize” mentally ill accused along three axes of intervention —juridical, therapeutic, and individualization and responsibilization efforts.