John Hinckley, the would-be assassin of President Ronald Reagan, was recently allowed to have unsupervised visits with his family away from the psychiatric hospital. I know there are people in Missouri who have also committed crimes and been declared “not guilty by reason of insanity.” In our state, who decides whether or not a person is still dangerous and should be allowed access back into our communities?

When a person is found not guilty by reason of insanity (NGRI), the court commits them to the Department of Mental Health (DMH). These “forensic clients” are placed at a level of security appropriate to their NGRI crime and risk (e.g., maximum, minimum). Clients must work through the “forensic system” by making progress in treatment and demonstrating lower risk through their behavior over time. New dangerous behavior may mean transfer back to a higher level of security. There is no maximum time of commitment (like with a prison sentence).

When clients are clinically ready, a “trial release” or “conditional release” may be sought. Trial and conditional releases include rules about when and where clients may go, what clients must and must not do, and how clients are supervised in the community. Trial release involves living in the facility and taking passes for up to 96 hours total. This is like John Hinckley’s current release. Conditional release is a release greater than 96 hours. With a partial conditional release, clients live in the hospital and go into the community for assigned activities and/or passes. Full conditional release includes discharge to an approved setting. Conditionally released clients continue to be supervised by caseworkers and a psychiatrist who monitor treatment, behavior and compliance with the rules of the release. Failure to comply with these rules leads to revocation of the release and return to a secure facility. Finally, there is unconditional release, which is complete release from the court commitment. These are granted rarely and only when the client proves that supervision by the court and DMH is no longer necessary to protect public safety.

To obtain any type of release, the treatment team applies to the Forensic Review Committee, composed of senior clinicians at the client’s facility. If the committee approves, DMH leadership in Jefferson City reviews the request. If they approve, the release is sent to courts in those jurisdictions involved in the NGRI commitment and in the release plan. Prosecutors and victims have 30 days to object to the proposed release. For trial release, if there is no objection, the release is approved. For conditional release, if there is no objection, a judge will sign an order for release. In any case, if there is an objection from a prosecutor, a hearing is held and the decision to release the client is made by the judge after hearing testimony.

Rick Scott, Ph.D.
Unit Director, Forensic Evaluation Program
St. Louis Psychiatric Rehabilitation Center

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