[Problems in the treatment of mentally ill offenders--a problem of general psychiatry?]

The special position of psychiatry among the various medical disciplines is determined not least by the phenomenon of violent behaviour of some of its patients and the possibility of coercive measures against patients. The worldwide process of deinstitutionalization since the last decades is characterized by a substantial reduction of inpatient treatment and the expansion and improvement of increasingly specialized community care offers. Yet, at the same time paradoxically we are confronted with an increasing neglect of the special care requirements of a certain group of difficult-to-place patients (mostly severely chronically ill with high rates of comorbidity). Despite different social and legal conditions this has uniformly led to an increasing shift of these patients into the forensic system which is illustrated by a comparison of international and Austrian data. Forensic psychiatry is hardly able to cope with this development because of structural and personal deficits existing and is in danger of being misused primarily as an instrument of social control. From the position of forensic psychiatry the limits of deinstitutionalization are set by the feeling of responsibility of general psychiatry for a subgroup of troublesome and difficult to treat patients.