Conditional Release Programs

Conditional release programs for persons acquitted by reason of insanity (not guilty by reason of insanity or NGRI) are designed to maximize public safety while meeting the courts’ mandate that some individual liberties be protected. These programs developed as a result of the state and federal court decisions in the 1960s, which required that this population be provided with commitment procedures similar to civil commitment. Prior to these decisions, persons found NGRI were given an automatic, indefinite “life sentence” to maximum-security state psychiatric hospitals for crimes ranging from shoplifting to murder. Under the new laws, persons committed as NGRI had to meet the commitment requirements of civil patients—that is, mental illness and dangerousness. Their continued commitment had to be periodically reviewed, and if they no longer met the commitment standards, they were to be released. Concerned with releasing what were believed to be “dangerous” offenders with mental illness into the community, states created a new category of posthospitalization supervision—conditional release. Research suggests that both goals were met in that insanity acquittees no longer languished in hospitals with no hope of being released and those who remained dangerous and mentally ill remained in a secure facility.

The other major watershed event that affected the insanity defense, especially release procedures, was the NGRI acquittal of John Hinckley from the charge of attempting to assassinate President Ronald Reagan in 1981. Following Hinckley’s 1982 acquittal, the most common type of legal change in this area of law was in postacquittal procedures. Most states responded by providing shared responsibility between the trial court and the clinicians responsible for the day-to-day inpatient treatment of the committed population. Until then, hospital clinicians or the county court where the hospital was located had made the release decisions. Hinckley’s acquittal further decreased the already declining popularity of the insanity defense among the public. He eventually received a number of 1-day conditional releases under the supervision of his parents in 2003, more than 22 years after his actions. His release was widely opposed by the victims’ families, the Justice Department, and many others.

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Conditional release programs are often referred to as “mental health parole or probation,” but they significantly differ from traditional criminal justice aftercare supervision. The major differences between the two types of programs are in the length of the supervision period, the due process requirements for revocation, and the agency responsible for supervision. In most states, conditional release can be extended for any number of reasons, including clinical concerns, such as medication compliance; safety concerns; and lack of adequate community placement. For most parolees or probationers, their supervision time is finite. A few states limit the duration of conditional release to the maximum sentence that would have been given by the court had the defendant been convicted, reducing the utility of conditional release for less serious offenders. More often, conditional release is a relatively unrestrained and extensive period of community supervision and consequently makes the insanity defense a lesser plea and outcome.

Revocation of conditional release is less difficult than in the criminal justice system. Few states require a formal due process hearing to revoke conditional release, unlike criminal justice postrelease programs. Typically, conditional release can be revoked if the individual simply violates any term of the release. While some states have in place more procedural safeguards, they are still minimal compared with other aftercare programs. A final difference that highlights the special circumstances of the population acquitted NGRI is in the agency responsible for supervision. These programs often bisect the mental health and criminal justice systems due to the legal status of persons acquitted NGRI. Because an insanity plea is an affirmative defense, defendants admit to factual guilt but are legally not responsible due to lack of mens rea. Consequently, while their treatment and confinement are provided within the mental health system across all states, their release might be controlled to some extent by the criminal justice system, in particular the county’s criminal court of commitment. This dual responsibility can cause professional conflict and confusion, making the release of insanity acquittees a complex legal and procedural process. None of this confusion surrounds parole or probation.

While in most states an NGRI finding leads to an automatic inpatient evaluation, this is not the case in all states. A few states allow the judge discretion in bypassing an order for hospitalization. Following an NGRI commitment, periodic reviews are conducted at intervals designated by state law: commonly 30 days, 60 days, 90 days, 1 year, and then annually. At this review, the treating psychiatrist or patient advocate can recommend or request conditional release. This application sets in motion the state’s conditional release procedures, which range from a simple approval by a judge in the county where the acquittal was recorded to a complex, multilayered process in which hospital, state, and court officials are required to approve the petition. In some states, the county judge and/or district attorney have to approve even internal security changes, such as from closed to open unit, or grounds privileges. The complexity of the release procedures has an impact on the likelihood of release, who is released, and the length of time between approval and actual release. An important component of conditional release is the availability of community programs to provide services to this forensic population.

An innovative program developed in Oregon in 1978 and established in Connecticut in 1985 sought to gain greater control over persons found NGRI. The Psychiatric Security Review Board (PSRB) is a multi-disciplinary independent board with full responsibilities for persons found NGRI. Decision making is highly centralized, and this board grants and revokes conditional release and sets the terms of release. This model has never been attempted in states with large populations.

Most persons found NGRI and subsequently placed on conditional release draw little, if any, public attention, and the petitions are usually supported by the courts. Who supervises the persons on conditional release programs varies from state to state. Many states, in particular larger states with larger NGRI populations, have special intensive case managers who have experience or special training with forensic clients. Their caseload is often smaller than in traditional aftercare programs. This common model for conditional release leads to decentralized supervision and decision making once the person is released. In addition to possible revocation, conditional release can be extended by the court, or the person can be discharged from all supervision.


  1. Appelbaum, P. S. (1994). Almost a revolution: Mental health law and the limits of change. New York: Oxford University Press.
  2. Callahan, L. A., & Silver, E. (1998). Factors associated with the conditional release of persons acquitted by reason of insanity: A decision tree approach. Law & Human Behavior, 22, 147-163.
  3. Steadman, H. J., McGreevy, M. A., Morrissey, J. P., Callahan, L. A., Robbins, P. C., & Cirincione, C. (1993). Before and after Hinckley: Evaluating insanity defense reform. New York: Guilford Press.

Return to the overview of Sentencing and Incarceration in Forensic Psychology.