Involvement with the juvenile justice system may be the first time that a youth is identified as needing mental health intervention, creating an interesting assessment and treatment dilemma. This CCB outlines the professional role of a child and adolescent psychiatrist as a consultant to the court and highlights the differing roles of a treating physician, consultant physician, and an expert for the court. In addition, possible sources of conflicts and professional dilemmas, as well as ethical responsibilities of the consultant, are examined. For example, a conflict may arise based on the legal system’s mandate for containment of the youth and a physician’s ethical responsibility for assessment and treatment. Conflicts also may arise around the psychiatrist’s recommendations with regard to medications, hospitalization, or diagnosis when they are not in line with expectations of the court or other parties. Understanding the concepts of informed consent, as well as ensuring that one does not contribute to the adjudication of a youth, is essential. In the discussion of case examples, participants share experiences and solutions.