Despite numerous advantages, the shift from hospital based to community mental health care has caused problems as well. To analyse whether or not the process of de-institutionalisation might have gone too far, studies are needed that cover general psychiatry, forensic psychiatry, and penitentiaries and analyse the interdependencies between them.

We combined epidemiological and service utilization data from three recent European studies that explored legal frameworks and practices of involuntary treatment in general mental health care, the care of mentally disordered offenders in forensic care and the care of mentally ill inmates in the European prison systems.

Time series from several EU-Member States suggest that civil detention rates remained more or less stable during the 1990s, though on rather different levels internationally. Admissions to forensic psychiatric facilities have increased during the same period. Data on the mental state (or on rates of psychiatric morbidity) in European prison populations are not available - aside from the prison suicide rate. Data from selected countries are likely to suggest that changes to the legal framework in one sector may considerably affect admission rates in others.

Much more national studies are needed to analyse the linkage between sectors and to identify inappropriate patient shifting, as this is strongly affected by the varying national health care and criminal justice systems.