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can they be excused

can criminals who commit violence and abuse be excused if they have underlying mental issues

does that cause it?
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It depends on their ability to understand their crime at the time they committed it.

Just like a baby doesn't understand that hitting is wrong... some illnesses affect an adult in a way where they black out and have no knowledge of what they did. In this case, they can't be held criminally liable - but they can be forced to go to hospital and get whatever treatment they need to get better.