Brazil is a federation that possesses national laws, which are hierarchically superior, and state laws. Only legally sane people can be found guilty. The concept of criminal insanity requires the accused to present with some mental disorder at the time of the crime such that he or she would not be able to understand that the action was wrong or would be incapable of behaving according to his or her understanding. In Brazil, incarcerated people present high levels of psychopathology. The number of mentally ill prisoners has been growing due to the stressors and poor prison conditions and to changes in psychiatric service models resulting in a consequent reduction of psychiatric beds in the community. Attention given to the mental health of prisoners is very inconsistent and presents huge regional differences. The penitentiary conditions in Brazil are precarious and need to be improved.