The current literature surrounding the intersection of criminal justice and mental health is addressed. First, the history of overrepresentation of individuals with a mental health disorder in the criminal justice system is discussed, followed by a discussion of the current gaps in the literature. These gaps need to be addressed to inform better practices among public defenders and their decision making role with clients who have a mental health disorder. The lack of research is evident in ambiguous judicial guidance in ensuring that defendants with a mental health disorder are able to exercise autonomy relevant to their case. Social workers are professionally positioned to advocate for this population, in a way that public defenders are not.