Violence risk assessment in release decisions for NGRI acquittees: Awareness of practical realities

When a criminal defendant is found not guilty by reason of insanity and committed to a state forensic hospital, the hospital bears the responsibility of treating the offender to decrease the risk for future violence. Principles of risk management and risk-reduction are the cornerstones of effective treatment in such contexts. Although traditional violence risk assessment may be useful in identifying static risk factors that contribute to a patient's violence risk status, dynamic risk factors relevant to a patient's risk state are the focus of risk-reduction interventions. When a release decision must be made, evaluators should utilize information about both the patient's risk status relative to others and present risk state on dynamic factors. A structured professional judgment model of violence risk assessment may be most useful in this process. However, even when evaluators use the most current and comprehensive methods to conduct a violence risk assessment, the ultimate release decision is in the hands of others, including judges, district attorneys, and outpatient program directors, who may be balancing competing considerations when making their decisions.