Title 18 › PART III — PRISONS AND PRISONERS › CHAPTER 313 — OFFENDERS WITH MENTAL DISEASE OR DEFECT › § 4243
When someone is found not guilty only because they were insane at the time of the crime, the court must send them to a suitable hospital until they can be released under the rules below. Before the release hearing, the court will order a psychiatric or psychological exam and report. The hearing must happen no later than 40 days after the verdict. If the crime involved bodily harm, serious property damage, or a big risk of those things, the person must prove by clear and convincing evidence that releasing them would not create a substantial risk of harm. For other crimes, they must prove that by a preponderance of the evidence. If the court is not convinced, it sends the person to the Attorney General. The Attorney General must try to get the person’s home state to take responsibility for custody, care, and treatment. If no state will take them, the Attorney General will keep them in a hospital until either a state agrees or their mental condition improves enough that release (or conditional release with a treatment plan) would not create a substantial risk—whichever happens first. The hospital director must file a certificate when the person has recovered enough, and the clerk will notify the lawyers. The court will then order a discharge or hold a hearing. If released conditionally, the person must follow the court-approved treatment plan. If they fail to follow it, the director tells the Attorney General and the court, the person can be arrested, and a hearing will decide if they must be returned to a hospital. Temporary leaves are limited: allowed only with court approval after notice and chance for a hearing, in an emergency, or when escorted by a federal officer. Special rules let the Attorney General take certain District of Columbia patients into federal custody after notice and up to 15 days to respond; the same release and review rules then apply.
Full Legal Text
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
Sep 22, 2026
Release point: 119-110