Title 18 › Part PART III— - PRISONS AND PRISONERS › Chapter CHAPTER 313— - OFFENDERS WITH MENTAL DISEASE OR DEFECT › § 4243
If a person is found not guilty only because of insanity, the court must send them to a suitable hospital or facility until the rules below are met. Before a release hearing, the court must order a psychiatric or psychological exam and a written report. A hearing must be held no later than 40 days after the special verdict. At that hearing the person must prove their release would not create a substantial risk of bodily harm to someone else or serious property damage because of a current mental disease or defect. If the crime involved bodily injury or serious property damage (or a big risk of those), the person must prove safety by clear and convincing evidence. For other crimes, the person must prove it by a preponderance of the evidence. If the court does not find the person met that standard, the court must send them to the custody of the Attorney General. The Attorney General must try to get the state where the person lives or was tried to take responsibility. If the state will not, the Attorney General must hospitalize the person until the state accepts them or until the person’s condition improves so release or conditional release would not create a substantial risk. When the hospital director thinks the person has improved, the director must tell the court. The court will then order discharge, or hold a hearing and may order full discharge or conditional release with a court-approved treatment plan that the person must follow. If the person breaks the treatment plan, the director must tell the Attorney General and the court, and the person can be arrested and returned to the hospital after a hearing. Temporary leave from the hospital is allowed only with court approval after notice and chance for a hearing, in an emergency, or when a federal law enforcement officer accompanies the person. For certain D.C. patients, the Attorney General may ask a court to transfer them to federal custody, must give written notice and up to 15 days to respond, and the same discharge and compliance rules apply after transfer.
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Crimes and Criminal Procedure — Source: USLM XML via OLRC
Legislative History
Reference
Citation
18 U.S.C. § 4243
Title 18 — Crimes and Criminal Procedure
Last Updated
Apr 6, 2026
Release point: 119-73