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This paper deals with the situation of mentally ill patients in the prison system. In particular, aspects of the high prevalence of mentally ill inmates as well as care problems are discussed.There are regional differences in the number of mentally ill individuals in the penal system, although the majority of inmates with severe mental illness can be returned to the community, sometimes even after years of inpatient psychiatric care. Considering all countries and diagnoses, prisoners tend to have a considerably higher prevalence of mental disorders than the general population. Care structures are frequently rated as being inadequate even inside penal institutions.The large number of mentally ill inmates necessitates the further development of person-centered and need-oriented care structures inside and outside the criminal justice system for the purpose of prevention. It is important for research to compare all state systems that examine not only care aspects but also legal constructs such as criminal liability and the competence to stand trial.