Mentally disordered offenders are placed apart from other psychiatric patients by their offending, yet their mental disorder places them apart from other offenders. Moreover, individuals who become offenders within the context of a mental disorder are more likely than other psychiatric patients to have serious and longstanding mental health problems and unhealthy associations. The first issue to contend with in the treatment of mentally disordered offenders is to establish safety, while the second is to ensure that the treatment is appropriate to the diagnosis. A third consideration is that the complexity and length of time of the treatment are appropriate and that a realistic goal for treatment has been set. Patients should be encouraged to assist in developing their own treatment plans in order to promote cooperation with the plan and to keep coercion to a minimum. A written treatment plan agreed upon by all relevant participants is important because in some instances, a written treatment plan becomes a legal document. Secure hospitals and units should provide an element of security that does not detract from the therapeutic environment. The use of restraint and seclusion should be kept to a minimum and should occur under proper supervision and with high levels of skill to avoid injury and humiliation. One goal of therapy within secure settings is to offer a sense of community to the offender patient in order to help patients understand that they can have a positive influence on their environment. Medication should be viewed as complementary to psychological and social interventions; in some cases drug treatment is of limited value, while in other cases it can be used effectively in combination with cognitive behavioral approaches. Two case examples are presented to illustrate important points. References