Mental illness should be viewed as a neurobiological disorder, similar to such diseases as diabetes or arthritis, and as an equal opportunity illness that affects all social classes. Hospitalized mental patients should be treated in the same way as patients hospitalized for other medical conditions. In addition, jails and prisons should provide treatment for mental illness just as they provide treatment and medication for other illnesses. Distinctions should be made among the following four groups: (1) mentally ill who commit antisocial acts out of fear and paranoia caused by cognitive and volitional brain malfunction; (2) mentally ill who sometimes access shelter and food by behaviors designed to get themselves arrested; (3) career criminals who develop mental illnesses after they have chosen a career of crime; and (4) individuals who want to escape responsibility for their antisocial behavior by pretending to be mentally ill. Mentally ill offenders may need advocates, depending on the nature of their situations, and advocacy may be particularly important in the context of involuntary treatment. Issues to be decided by the courts involve whether offenders have mental disorders or impairments that substantially affect their cognitive or volitional functions, whether offenders pose a danger to themselves and others, competency to stand trial, burden of proof, and length of confinement.