The article by Large et al describes the rise and fall in homicides attributed to mental disorders in England and Wales over the past 50 years. ^{Reference Large, Smith, Swinson, Shaw and Nielssen1} Since 2000, the rate of homicide due to a mental disorder in England and Wales has been 0.07 per 100 000 or lower. Encouraged by the authors, we examined the rate of homicides due to a mental disorder in The Netherlands. Dutch law considers responsibility for crimes to be diminished if there is a causal relationship between a mental disorder and the crime committed. Five degrees of responsibility are defined (i.e. complete responsibility, slightly diminished, diminished, considerably diminished, and total absence of responsibility). A severe psychiatric disorder, usually of a psychotic nature, is a necessary condition for a ‘total absence of responsibility’ finding.

From 1212 cases of homicide between 1 January 2000 and 31 December 2006, 1020 (84.2%) defendants were psychiatrically assessed pre-trial. Of these, 58 (5.7%) were considered to have total absence of responsibility. Furthermore, 63 (6.2%) were found to have considerably diminished responsibility, 239 (23.4%) diminished responsibility, 309 (30.3%) slightly diminished responsibility, and 259 (25.4%) complete responsibility. A psychotic disorder was diagnosed in 115 (11.3%) people, which is in line with earlier studies. ^{Reference Taylor and Gunn2} The rate of homicide due to mental disorder would be 0.11 per 100 000 when individuals with a total absence of or strongly diminished responsibility are included. If individuals with a diminished responsibility are also included, this would be 0.32 per 100 000.

The difference between England and Wales and The Netherlands may be explained by a different view on the issues of a diminished responsibility. ^{Reference Dell3} This may also explain the rise and fall of homicides due to mental disorders in England and Wales over the past 50 years.