Mental health courts (MHCs) have emerged as one option to address the needs of people with severe mental illness who enter the criminal justice system. Little is known about defendants having multiple referrals to MHCs or the outcomes of subsequent admissions. This study included a sample of 1,084 defendants referred to municipal MHC. During the 13-year study period, 14.3% of defendants had a second admission, with an estimated probability of readmission of 17.4%. Key factors associated with readmission included being eligible to participate in the court but choosing not to do so, being rearrested during court supervision, and having a negative termination from supervision. Defendants who had a second admission during the study period had poorer outcomes than those with one admission. When defendants are referred for readmission to MHCs, careful assessment is required to ensure that these courts are the best alternative for them.