The changes introduced by the mental health legislation of 1978 have not been accompanied by corresponding legal transformations. As a result, the mentally ill offender - not guilty by reason of insanity - is still regarded as a public threat and requires social security measures (basic condition for the survival of forensic psychiatric hospitals). Thus, at the present time, the treatment of mentally ill offenders remains extremely complex to put into practice, as it is burdened by the ‘custody/care’ antinomy. However, the abolition of the presumption of dangerousness enhances a new therapeutic approach in the implementation of the social security measures. This multifaceted process comprises: the assessment of the level of social dangerousness of the mentally ill offender, the choice of the appropriate place for treatment, the decision on the therapeutic benefit of targeting a patient’s violent behaviour and, last but not least, the definition of the psychiatrist’s duties and responsibilities.
Keywords: Social dangerousness of mentally ill patients, treatment, dilemma