[Bad or mad? Thinking in terms of 'bad or mad' and the (possible) prosecution of offenses committed by the mentally ill].

BACKGROUND: Psychiatrists working for the outreach emergency services of mental health institutions are regularly asked to assess whether a suspect being held at a police station should be charged and later prosecuted or be admitted to a mental institution. In other words, is the suspect 'suited for detention'. Often the representative of the judicial system and the psychiatrist from the emergency services then discuss whether the suspect would be better served by care under the mental healthcare system or under the criminal judicial system. Compulsorily admission to a mental health institution often leads to exemption from prosecution.

AIM: To determine what procedure (prison or clinic) will provide the suspect with appropriate care; to find out how to ensure that mentally-ill perpetrators of offences are not assigned erroneously to psychiatric care (i.e. they are 'psychiatricised') and thereby exempted from prosecution, and to determine whether the term 'suited for detention' is applicable to such a person.

METHOD: Data were derived from semi-structured interviews with experts from the acute mental health services, the forensic psychiatric services and the criminal justice system. All topics were based on a literature review and on study of case histories.

RESULTS: A decision by the emergency services to admit a suspect to a mental health institution influences the views of the representative of a criminal judicial system with regards to the possible imprisonment of the suspect. Thinking in terms of 'bad or mad' can influence the judicial system to give a psychiatric slant to offences or crimes committed by psychiatric patients. Psychiatrists' interpretation of proper care and often their lack of knowledge about the current care facilities available in prisons meant that psychiatrists were more likely than their forensic colleagues to assign suspects to mental health care. According to forensic psychiatrists, their colleagues from mental health care services should not be concerned about whether a suspect is 'suited' or 'unsuited' for detention; their main concern should be what kind of care and treatment the suspect urgently requires.

CONCLUSION: The role of the representative of the emergency services present at the police station is to decide what type of care is required at that particular moment. Care within the judicial system is an important option; that type of care can be obtained by involving forensic colleagues in the decision. Awareness of the importance of a dual track policy (conviction/punishment or care) should help to prevent unjustified 'psychiatrisation', of both minor and serious offenses.