The Criminally Insane is the largest scale in-depth follow-up study on mentally ill criminals yet to appear. This book challenges the assumption that inmates of maximum-security mental hospitals are extraordinarily violent and questions the necessity for maintaining maximum-security institutions which currently house some 15,000 persons in the United States.

In 1971, 586 patients were released from a Pennsylvania maximum-security hospital for the criminally insane. They were not considered officially "cured," but a federal court held that their commitments had been unconstitutional. Through exhaustive examination of hospital and police records and interviews with hospital administrators and the subjects themselves, Thornberry and Jacoby assess the processes by which the patients had been retained in confinement, the impact of their release upon their communities, and their ability to adjust to the freedom of community life.

The authors demonstrate that the patients did not display a significant level of violent behavior during confinement, nor did they pose a major threat to society after release. In fact, their social and psychological adjustment to community life is shown to have been comparable to that of non-criminal mental patients. Yet despite these findings the subjects had been retained in maximum-security confinement for an average of fourteen years because they were predicted to be violent and "dangerous" to society. The authors explain this inaccuracy by a process called "political prediction," in which clinicians avoid any potential risks to the community, the reputation of their hospitals, and their careers by consistently overpredicting dangerous behavior.

The Criminally Insane will stimulate response from professionals in a wide variety of fields, including law, criminology, psychiatry, and sociology, and from anyone concerned with society's responsibility to the mentally ill offender.

In courts across the country, judges depend on mental health experts to determine whether mentally disordered people are dangerous. But experts' ability to predict violence is severely limited, and they are wrong as often as they are right. This study reviews two decades of research on mental disorder and offers new empirical and theoretical work that will pave the way for more accurate predictions of violent behavior.

"Essential for all those who are interested in the study of risk assessment of violence. It is particularly important for the researcher in this area. . . . For the clinician who must make violence assessments it is important reading as well."—Stewart Levine, Bulletin of the American Academy of Psychiatry and the Law