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It is basically a primarily legal philosophical and political problem whether or not mentally disordered persons “belong” in prison. Countries applying the construct of criminal responsibility or incompetence to stand trial can prevent mentally disordered persons from being imprisoned. Secure confinement can then be ordered in a forensic psychiatric institution, if necessary. Of course this principle does not prevent people from becoming mentally unwell when put in a prison environment, nor does the presence or a history of mental disorder automatically result in the absence of criminal responsibility. The still high prevalence of mental disorders in prisoners has been impressively demonstrated in more recent surveys. In a systematic review of 62 surveys from 12 different western countries including 22,790 prisoners (mean age 29 years, 81% men), 3.7% of the men had psychotic illnesses, 10% major depression, and 65% a personality disorder, while 4% of women had psychotic illnesses, 12% major depression, and 42% a personality disorder. In comparison to the general population, prisoners have an increased risk of suffering from a mental disorder that transcends countries and diagnoses. Psychotic disorders increase the risk of suicide, which as a rule is considerably higher in prisoners than in the general population. Suicide is the leading cause of death in penal institutions, especially during the early stages of confinement.