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Although courts routinely consider whether a criminal defendant's mental illness makes punishment unfair, the rules are very different for civil liability. When people with mental illness harm others, courts refuse to consider their mental states in determining civil liability. The justifications offered for this rule range from the difficulty of assessing the impact of mental illness on behavior to the desire to place the burden of loss on the person who caused the injury. Undeniably, though, mental disabilities are treated differently from physical impairments, and the law's resistance to change seems largely based on misunderstanding and prejudice against mental illness. (Psychiatric Services 63:308–310, 2012; doi: 10.1176/appi.ps.20120p308)