Dear Sir,It was with some dismay I read the article published on November 28 with the headline “MWI refuses to admit mentally ill man”. While I cannot discuss individual patient details, I feel it is important that the community understands that anyone in need of psychiatric inpatient services is admitted to MWI. No one has ever been refused care because of to overcapacity, or “convenience”.As a forensic psychiatrist, my training and experience is in working with those who suffer from mental illness and who are also in conflict with the law. I have more than 20 years of experience of working in both Britain and Bermuda. Until recently, it was widely assumed that those with mental illness who commit crimes did so because of their mental illness with the corollary that, if they only received better treatment, they would not reoffend. Research has shown that this is the case in a small minority of offenders with mental illness — 5 per cent to 10 per cent. The vast majority who commit crimes have the same risk factors as those who do not suffer from mental illness — low social class, poverty, living in an environment with widespread availability of illegal substances, chronic health problems, underemployment and unemployment, child abuse/neglect, domestic violence, family breakdown, unstable housing and neighbourhood crime. Because of their mental illness and associated impact on their day-to-day functioning, they often have even more of these factors.This leads to the second issue that is related to the prejudice held against people with mental illness, which is largely invisible and largely socially acceptable. However, this story made it visible in our courts and our media.That a person has had a mental illness diagnosed does not mean that this is all they are. The common reference to someone being “schizophrenic” is a case in point. While they may be a person who suffers from schizophrenia, they are also human beings with hopes, wishes, dreams and fears like the rest of us. Just because someone has a diagnosis does not mean that they need to be admitted to a hospital. Many people live every day with mental illness, with outpatient support and medication as required. While severe mental illness is a chronic condition, individuals have periods of stability — often helped by medication — but also times of relapse. When they cannot cope in the community or present a risk to themselves or others, a brief period of hospitalisation may be warranted. This is the job of psychiatrists and other mental health workers, working along with the patient, to use their experience and expertise to make this decision. For the courts and legal profession to presume they are better placed to decide these issues is of great concern to me.A final point is that the typical profile of an offender with mental illness is of someone with multiple needs, with mental illness being but one — and often the easier to treat and manage. Such needs include poverty, unemployment, under-education, homelessness, which was mentioned several times in the article, substance misuse, past trauma, social isolation, etc. These social determinants of health cannot be “fixed” by sending someone to a psychiatric hospital for “treatment”. Unfortunately, MWI is often seen as the place to send those whom no one else has been able to help — lock them up; out of sight, out of mind. I believe it is up to us as a community to address the increasing impact of these social determinants and not leave it up to an already stretched mental health service. It is sad to note that apart from a few, many in our community will not step up and provide support for those less fortunate and provide robust responses in the form of assisted employment, supported housing and just plain old kindness and understanding.SEBASTIAN HENAGULPH, MDConsultant Forensic PsychiatristMid-Atlantic Wellness Institute