Court Opinion

ID: 9429315
Source: CourtListenerOpinion
Date Created: 2023-08-02 23:26:25.074386+00
Date Added: 2024-06-11T17:23:18.770101
License: Public Domain

*371Justice Brennan,
with whom Justice Marshall and Justice Blackmun join, dissenting.
The Court begins by posing the wrong question. The issue in this case is not whether petitioner must be released because he has been hospitalized for longer than the prison sentence he might have served had he been convicted, any more than the question in a motion to suppress an allegedly coerced confession at a murder trial is whether the murderer should go free.1 The question before us is whether the fact that an individual has been found “not guilty by reason of insanity,” by itself, provides a constitutionally adequate basis for involuntary, indefinite commitment to psychiatric hospitalization.
None of our precedents directly addresses the meaning of due process in the context of involuntary commitments of persons who have been acquitted by reason of insanity. Petitioner’s argument rests primarily on two cases dealing with civil commitments: O’Connor v. Donaldson, 422 U. S. 563 (1975), and Addington v. Texas, 441 U. S. 418 (1979). O’Connor held that a mentally ill individual has a “right to liberty” that a State may not abridge by confining him to a mental institution, even for the purpose of treating his illness, unless in addition to being mentally ill he is likely to harm himself or others if released. 422 U. S., at 573-576; see id., at 589 (Burger, C. J., concurring). Then, in Addington, we carefully evaluated the standard of proof in civil commitment proceedings. Applying the due process analysis of Mathews v. Eldridge, 424 U. S. 319, 335 (1976), *372we held that “due process requires the state to justify confinement by proof more substantial than a mere preponderance of the evidence,” 441 U. S., at 427, specifically “clear and convincing evidence,” id., at 433.2
The core of both cases is a balance of three factors: the governmental interest in isolating and treating those who may be mentally ill and dangerous; the difficulty of proving or disproving mental illness and dangerousness in court; and the massive intrusion on individual liberty that involuntary psychiatric hospitalization entails. Petitioner contends that the same balance must be struck in this case, and that the Government has no greater interest in committing him indefinitely than it has in ordinary civil commitment cases governed by the standards of O’Connor and Addington. While conceding that the Government may have legitimate reasons to commit insanity acquittees for some definite period without carrying the burden of proof prescribed in Addington,3 *373he argues that he cannot be confined indefinitely unless the Government accords him the minimum due process protections required for civil commitment.
A
The obvious difference between insanity acquittees and other candidates for civil commitment is that, at least in the District of Columbia, an acquittal by reason of insanity implies a determination beyond a reasonable doubt that the defendant in fact committed the criminal act with which he was charged. See Bethea v. United States, 365 A. 2d 64, 93-95 (D. C. 1976); D. C. Code §24-301(c) (1981). Conceivably, the Government may have an interest in confining insanity acquittees to punish them for their criminal acts, but the Government disclaims any such interest, and the Court does not rely on it.4 In any event, we have held that the Govern*374ment may not impose psychiatric commitment as an alternative to penal sentencing for longer than the maximum period of incarceration the legislature has authorized as punishment for the crime committed. Humphrey v. Cady, 405 U. S. 504, 510-511 (1972). Once Congress has defined a crime and the punishment for that crime, additional confinement can be justified only by proof beyond a reasonable doubt of additional facts, subject to the limits of the Double Jeopardy Clause, and upon notice to defendants that they are subject to such additional punishment. See Specht v. Patterson, 386 U. S. 605, 610 (1967); In re Winship, 397 U. S. 358, 361-364 (1970).
B
Instead of relying on a punishment rationale, the Court holds that a finding of insanity at a criminal trial “is sufficiently probative of mental illness and dangerousness to justify commitment.” Ante, at 363. First, it declares that “[t]he fact that a person has been found, beyond a reasonable doubt, to have committed a criminal act certainly indicates dangerousness.” Ante, at 364. Second, the Court decides that “[ijt comports with common sense to conclude that someone whose mental illness was sufficient to lead him to commit a criminal act is likely to remain ill and in need of treatment.” Ante, at 366. Despite their superficial appeal, these propositions cannot support the decision necessary to the Court’s disposition of this case — that the Government may be excused from carrying the Addington burden of proof with respect to each of the O’Connor elements of mental illness and dangerousness in committing petitioner for an indefinite period.
*3751. Our precedents in other commitment contexts are inconsistent with the argument that the mere facts of past criminal behavior and mental illness justify indefinite commitment without the benefits of the minimum due process standards associated with civil commitment, most importantly proof of present mental illness and dangerousness by clear and convincing evidence.5 In Addington itself, the petitioner did not dispute that he had engaged in a wide variety of assaultive conduct that could have been the basis for criminal charges had the State chosen to prosecute him. See 441 U. S., at 420-421. Similarly, the petitioner in Jackson v. Indiana, 406 U. S. 715 (1972), had been charged with two robberies, yet we required the State to follow its civil commitment procedures if it wished to commit him for more than a strictly limited period. Id., at 729-730. As the Court indicates, see ante, at 364, n. 12, these cases are perhaps distinguishable on the ground that there was never proof that a crime had been committed, although in Addington the petitioner’s violent acts were before the jury. That objection, however, cannot be leveled at Baxstrom v. Herold, 383 U. S. 107 (1966), or Humphrey v. Cady, supra.
The petitioner in Baxstrom had been convicted of assault and sentenced to a term in prison, during which he was certified as insane by a prison physician. At the expiration of his criminal sentence, he was committed involuntarily to a state mental hospital under procedures substantially less protective than those used for civil commitment. 383 U. S., at *376108-110. We held that, once he had served his sentence, Baxstrom could not be treated differently from other candidates for civil commitment. Id., at 112-113. The principal difference between this case and Baxstrom is petitioner’s admission, intrinsic to an insanity plea in the District of Columbia at the time of his trial, that his crime was “the product” of his mental illness. Humphrey, however, indicates the limited importance of that distinction.
In Humphrey, the petitioner had been convicted of contributing to the delinquency of a minor, the court had determined that his crime was “probably directly motivated by a desire for sexual excitement,” and the State had established his “need” for psychiatric treatment by a preponderance of the evidence at a special hearing. 405 U. S., at 506-507. He was committed for treatment for the maximum period for which he could have been incarcerated as punishment for his crime — as in this case, one year — and at the end of that period his commitment was renewed for five more years after a judicial hearing on his present mental illness and dangerousness. See id., at 507. Thus, the situation was almost precisely identical to that in this case after petitioner’s February 1977 hearing — the defendant had been found to have committed a criminal act beyond a reasonable doubt, a connection between that act and a mental disorder had been established by a preponderance of the evidence, and he had been confined for longer than the maximum sentence he could have received. If anything, Humphrey had received more protections than Michael Jones; the State had borne the burden of proof by a preponderance of the evidence at his “release hearing,” ibid., and his recommitment was for a strictly limited time. Nevertheless, we held that Humphrey’s constitutional challenge to the renewal order had substantial merit, because Humphrey had not received the procedural protections given persons subject to civil commitment.6
*3772. The Government’s interests in committing petitioner are the same interests involved in Addington, O’Connor, Baxstrom, and Humphrey — isolation, protection, and treatment of a person who may, through no fault of his own, cause harm to others or to himself. Whenever involuntary commitment is a possibility, the Government has a strong interest in accurate, efficient commitment decisions. Nevertheless, Addington held both that the government’s interest in accuracy was not impaired by a requirement that it bear the burden of persuasion by clear and convincing evidence, and that the individual’s interests in liberty and autonomy required the government to bear at least that burden. An acquittal by reason of insanity of a single, nonviolent misdemeanor is not a constitutionally adequate substitute for the due process protections of Addington and O’Connor, i. e., proof by clear and convincing evidence of present mental illness or dangerousness, with the government bearing the burden of persuasion.
A “not guilty by reason of insanity” verdict is backward-looking, focusing on one moment in the past, while commitment requires a judgment as to the present and future. In some jurisdictions, most notably in federal criminal trials, an acquittal by reason of insanity may mean only that a jury found a reasonable doubt as to a defendant’s sanity and as to the causal relationship between his mental condition and his crime. See Davis v. United States, 160 U. S. 469 (1895). As we recognized in Addington, “[t]he subtleties and nuances *378of psychiatric diagnosis render certainties virtually beyond reach in most situations.” 441 U. S., at 430. The question is not whether “government may not act in the face of this uncertainty,” ante, at 365, n. 13; everyone would agree that it can. Rather, the question is whether — in light of the uncertainty about the relationship between petitioner’s crime, his present dangerousness, and his present mental condition— the Government can force him for the rest of his life “to share equally with society the risk of error,” 441 U. S., at 427.7
It is worth examining what is known about the possibility of predicting dangerousness from any set of facts. Although a substantial body of research suggests that a consistent pattern of violent behavior may, from a purely statistical standpoint, indicate a certain likelihood of further violence in the future,8 mere statistical validity is far from perfect for purposes of predicting which individuals will be dangerous. Commentators and researchers have long acknowledged that even the best attempts to identify dangerous individuals on the basis of specified facts have been inaccurate roughly two-thirds of the time, almost always on the side of overprediction.9 On a clinical basis, mental health profes*379sionals can diagnose past or present mental condition with some confidence, but strong institutional biases lead them to err when they attempt to determine an individual’s dangerousness, especially when the consequence of a finding of dangerousness is that an obviously mentally ill patient will remain within their control.10 Research is practically nonexistent on the relationship of nonviolent criminal behavior, such as petitioner’s attempt to shoplift, to future dangerousness. We do not even know whether it is even statistically valid as a predictor of similar nonviolent behavior, much less of behavior posing more serious risks to self and others.
Even if an insanity acquittee remains mentally ill, so long as he has not repeated the same act since his offense the passage of time diminishes the likelihood that he will repeat it.11 Furthermore, the frequency of prior violent behavior is an important element in any attempt to predict future violence.12 Finally, it cannot be gainsaid that some crimes are more indicative of dangerousness than others. Subject to the limits of O’Connor, a State may consider nonviolent misdemeanors “dangerous,” but there is room for doubt whether a single attempt to shoplift and a string of brutal murders are equally *380accurate and equally permanent predictors of dangerousness.13 As for mental illness, certainly some conditions that satisfy the “mental disease” element of the insanity defense do not persist for an extended period — thus the traditional inclusion of “temporary insanity” within the insanity defense.
Close reading of the Court’s opinion reveals the utter emptiness of the legislative judgment it finds so unproblematic. Today’s decision may overrule Humphrey by implication. It does not, however, purport to overrule Baxstrom or any of the cases which have followed Baxstrom.14 It is clear, therefore, that the separate facts of criminality and mental illness cannot support indefinite psychiatric commitment, for both were present in Baxstrom. The Court’s careful phrasing indicates as much: “someone whose mental illness was sufficient to lead him to commit a criminal act is likely to remain ill and in need of treatment.” Ante, at 366 (emphasis added). The Court relies on a connection between mental condition and criminal conduct that is unique to verdicts of “not guilty by reason of insanity.” Yet the relevance of that connection, as opposed to each of its separate components, is far from a matter of obvious “common sense.” None of the available evidence that criminal behavior by the mentally ill is likely to repeat itself distinguishes between behaviors that were “the product” of mental illness and those that were not.15 It is *381completely unlikely that persons acquitted by reason of insanity display a rate of future “dangerous” activity higher than civil committees with similar arrest records, or than persons convicted of crimes who are later found to be mentally ill. The causal connection between mental condition and criminal behavior that “not guilty by reason of insanity” formulations universally include is more a social judgment than a sound basis for determining dangerousness.
Given the close similarity of the governmental interests at issue in this case and those at issue in Addington, and the highly imperfect “fit” between the findings required for an insanity acquittal and those required under O’Connor to support an indefinite commitment, I cannot agree that the Government should be excused from the burden that Addington held was required by due process.16
3. In considering the requirements of due process, we have often inquired whether alternative procedures more protective of individual interests, at a reasonable cost, were likely to accomplish the State’s legitimate objectives. See, *382e. g., Mathews v. Eldridge, 424 U. S., at 335; Stanley v. Illinois, 405 U. S. 645, 657-658 (1972); Bell v. Burson, 402 U. S. 535, 542-543 (1971). There are many ways to take into account criminal behavior and past mental condition, and thereby to vindicate the government’s legitimate interest in accurate commitment decisions, without depriving insanity acquittees of the Addington protections. Certain aspects of the District of Columbia’s commitment procedures already embody less restrictive alternatives: all insanity acquittees are committed automatically for 50 days before an initial release hearing, § 24-301(d), and the testimony of mental health professionals at all hearings may be informed by their experience with mentally ill patients and by their familiarity with current research. The fact of an insanity acquittal and the evidence on insanity adduced at trial are clearly admissible in all commitment and release hearings.
In addition, an insanity acquittal might conceivably justify commitment for a reasonably limited period without requiring the Government to meet its Addington burden. See United States v. Brown, 155 U. S. App. D. C. 402, 408, 478 F. 2d 606, 612 (1973); American Psychiatric Assn., Statement on the Insanity Defense 15 (1982); cf. Jackson v. Indiana, 406 U. S., at 738; McNeil v. Director, Patuxent Institution, 407 U. S. 245, 249 (1972). In this case, petitioner submits that such a reasonable period extends no longer than the maximum sentence that could have been imposed had he been found guilty of the crime charged. But at some point the Government must be required to justify further commitment under the standards of Addington. 17
*3834. If the Government’s interests were the only ones at stake, an insanity acquittal would furnish a reasonable basis for indefinite commitment. Under the Constitution, however, the Government’s interests must be considered in light of the liberty interests of the individual who is subject to commitment. In the final analysis, the Court disregards Addington not on the ground that the Government’s interests in committing insanity acquittees are different from or stronger than its interests in committing criminals who happen to be mentally ill, or mentally ill individuals who have done violent, dangerous things, but on the theory that “there is good reason for diminished concern as to the risk of error” when a person is committed indefinitely on the basis of an insanity acquittal. See ante, at 367.
The “risk of error” that, according to the Court, is diminished in this context subsumes two separate risks. First, the Court notes that in Addington we were concerned, at least in part, that individuals might be committed for mere idiosyncratic behavior, see 441 U. S., at 427, and it observes that criminal acts are outside the “ ‘range of conduct that is generally acceptable.’” Ante, at 367, quoting 441 U. S., at 426-427. O’Connor, however, requires that a person be proved dangerous, not merely “unacceptable,” before he may *384be subjected to the massive curtailment of individual freedom and autonomy that indefinite commitment entails. In Addington itself, the State had clearly proved by a preponderance of the evidence that the petitioner had engaged repeatedly in conduct far beyond the pale of acceptable behavior, yet we did not regard that level of proof as furnishing adequate protection for the individual interests at stake.18
Second, the Court reasons that “[a] criminal defendant who successfully raises the insanity defense necessarily is stigmatized by the verdict itself,” and therefore that committing him does not involve the same risk of stigmatization a civil commitment may entail. Ante, at 367, n. 16. This is perhaps the Court’s most cynical argument. It is true that in Addington and in Vitek v. Jones, 445 U. S. 480 (1980), we recognized that individuals have an interest in not being stigmatized by society at large on account of being labeled mentally ill. 441 U. S., at 426; 445 U. S., at 492. Avoiding stigma, however, is only one of the reasons for recognizing a liberty interest in avoiding involuntary commitment. We have repeatedly acknowledged that persons who have already been labeled as mentally ill nonetheless retain an interest in avoiding involuntary commitment. See, e. g., O’Connor v. Donaldson, 422 U. S., at 575; Baxstrom v. Herold, 383 U. S. 107 (1966). Other aspects of involuntary commitment affect them in far more immediate ways.
In many respects, confinement in a mental institution is even more intrusive than incarceration in a prison. Inmates of mental institutions, like prisoners, are deprived of unrestricted association with friends, family, and community; *385they must contend with locks, guards, and detailed regulation of their daily activities. In addition, a person who has been hospitalized involuntarily may to a significant extent lose the right enjoyed by others to withhold consent to medical treatment. See Youngberg v. Romeo, 457 U. S. 307, 321 (1982) (involuntary committee’s due process right to freedom from unreasonable restraint limited to a guarantee that professional medical judgment be exercised). The treatments to which he may be subjected include physical restraints such as straightjacketing, as well as electroshock therapy, aversive conditioning, and even in some eases psychosurgery. Administration of psychotropic medication to control behavior is common. See American Psychiatric Assn., Statement on the Insanity Defense 15 (1982) (“Greater emphasis is now placed upon psychopharmacological management of the hospitalized person”). Although this Court has never approved the practice, it is possible that an inmate will be given medication for reasons that have more to do with the needs of the institution than with individualized therapy.19 See Mills v. Rogers, 457 U. S. 291, 303 (1982); Rennie v. Klein, 653 F. 2d 836, 845 (CA3 1981) (en banc). We should not presume that he lacks a compelling interest in having the decisions to com*386mit him and to keep him institutionalized made carefully, and in a manner that preserves the maximum degree of personal autonomy.
Therefore, I cannot agree with the Court that petitioner in this case has any less interest in procedural protections during the commitment process than the petitioners in Addington, O’Connor, or Baxstrom, and I cannot agree that the risks of error which an indefinite commitment following an insanity acquittal entails are sufficiently diminished to justify relieving the Government of the responsibilities defined in Addington.
C
Indefinite commitment without the due process protections adopted in Addington and O’Connor is not reasonably related to any of the Government’s purported interests in confining insanity acquittees for psychiatric treatment. The rationales on which the Court justifies § 24-301’s departures from Addington at most support deferring Addington’s, due process protections — specifically, its requirement that the Government carry the burden of proof by clear and convincing evidence — for a limited period only, not indefinitely.
The maximum sentence for attempted petit larceny in the District of Columbia is one year. Beyond that period, petitioner should not have been kept in involuntary confinement unless he had been committed under the standards of Addington and O’Connor. Petitioner had been in custody for 17 months at the time of his February 1977 hearing, either in St. Elizabeths or in the District of Columbia Correctional Center. At that time he should have received the benefit of the Addington due process standards, and, because he did not, the findings at that hearing cannot provide constitutionally adequate support for his present commitment. I would therefore reverse the judgment of the District of Columbia Court of Appeals.

 If we were to determine that the standards under which petitioner was committed did not satisfy the Due Process Clause, he would be “released” only in the most formalistic sense of the word. Realistically, he would probably be recommitted, assuming that the Government could carry its burden of proof at a regular civil commitment hearing. The facts that the Court discusses ante, at 365, n. 14, would certainly be relevant at such a hearing. But they are irrelevant to the question before us because they have never been assessed under the “clear and convincing” evidence standard.

 We held that a “preponderance of the evidence” standard was not sufficient to preserve fundamental fairness to candidates for civil commitment in light of their strong interest in avoiding involuntary confinement and psychiatric treatment. See 441 U. S., at 427; cf. Santosky v. Kramer, 455 U. S. 745, 766-770 (1982). Yet to require as a constitutional matter more than clear and convincing evidence — i. e., proof beyond a reasonable doubt — would unduly impair governmental efforts to protect both the mentally ill and society at large. See 441 U. S., at 427-431.

 Petitioner does not dispute that the Government may commit him solely on the basis of his insanity acquittal for a definite period — as long as he could have been incarcerated had he been convicted on the criminal charges against him rather than acquitted by reason of insanity. The issue, therefore, is not whether due process forbids treating insanity acquittees differently from other candidates for commitment. Petitioner is willing to concede that they may be treated differently for some purposes, and for a limited period of time. The dispute before us, rather, concerns the question whether the differences between insanity acquit-tees and other candidates for civil commitment justify committing insanity acquittees indefinitely, as D. C. Code § 24-301 (1981) provides, without the Government ever having to meet the procedural requirements of Addington.
*373A number of our decisions have countenanced involuntary commitment without the full protections of Addington and O’Connor, but for the most part these have involved persons already in custody and strictly limited periods of psychiatric institutionalization. E. g., Jackson v. Indiana, 406 U. S. 715, 738 (1972) (acknowledging that the State’s interest in determining whether an accused would become competent to stand trial in the foreseeable future justified commitment “for a reasonable period of time”); McNeil v. Director, Patuxent Institution, 407 U. S. 245, 249-250 (1972) (accepting the legitimacy of short-term commitment of a convicted criminal for psychiatric evaluation); Humphrey v. Cady, 405 U. S. 504, 510 (1972) (commitment of convicted sex offender, limited to duration of sentence); Baxstrom v. Herold, 383 U. S. 107, 111 (1966) (commitment of prison inmates who are determined to be mentally ill during their prison term). See also Parham v. J. R., 442 U. S. 584, 617-619 (1979) (wards of the State); Note, 31 Stan. L. Bev. 425 (1979) (burden and standard of proof in short-term civil commitment).

 Punishing someone acquitted by reason of insanity would undoubtedly implicate important constitutional concerns. It is questionable that confinement to a mental hospital would pass constitutional muster as appropriate punishment for any crime. The insanity defense has traditionally been viewed as premised on the notion that society has no interest in punishing insanity acquittees, because they are neither blameworthy nor the appro*374priate objects of deterrence. See A. Goldstein, The Insanity Defense 16 (1967). In addition, insanity and mens rea stand in a close relationship, which this Court has never fully plumbed. See Powell v. Texas, 392 U. S. 514, 536-537 (1968) (opinion of Marshall, J.); Leland v. Oregon, 343 U. S. 790, 800 (1952); cf. Mullaney v. Wilbur, 421 U. S. 684 (1975).

 Many of these decisions rely on the Equal Protection Clause of the Fourteenth Amendment as well as, or instead of, the Due Process Clause. As in Bearden v. Georgia, 461 U. S. 660, 665 (1983), “[d]ue process and equal protection principles converge in the Court’s analysis of these cases,” and under our current understanding of the meaning of these Clauses it is perhaps more appropriate to focus primarily on due process considerations. With the exception of petitioner’s argument that he should receive a jury trial, see n. 17, infra, there is no difference between the forms of relief he seeks under the separate theories. Cf. ante, at 362-363, n. 10.

 In Humphrey, we held only that the petitioner had raised a substantial constitutional claim and that the Court of Appeals had erred in refusing to certify probable cause for an appeal from the District Court’s dismissal of *377his habeas corpus petition. See 405 U. S., at 506-508. We remanded for an evidentiary hearing. Under today’s ruling, however, it is difficult to see how a constitutional claim like the one made in Humphrey could conceivably have merit, unless there is somehow a constitutional difference between Colorado’s pre-1972 “mentally disordered sex offender” statute and the District of Columbia’s “not guilty by reason of insanity” statute. Both statutes were designed to authorize involuntary commitment for psychiatric treatment of persons who have committed crimes upon a finding by a preponderance of the evidence that the crime was the product of a mental condition appropriate for psychiatric therapy.

 Indeed, the District of Columbia’s commitment scheme for insanity acquittees, unlike the civil commitment statute applied in Addington, permanently places the burden of persuasion on petitioner, thus forcing him to bear the lion’s share of the risk.

 J. Monahan, The Clinical Prediction of Violent Behavior 71, 80-81 (NIMH 1980) (Monahan); see, e. g., Cocozza, Meliek, & Steadman, Trends in Violent Crime Among Ex-Mental Patients, 16 Criminology 317 (1978) (Cocozza); Pasewark, Pantle, & Steadman, The Insanity Plea in New York State, 51 N. Y. St. B. J. 186, 221-222 (1979).

 See American Psychiatric Assn., Task Force Report on Clinical Aspects of the Violent Individual 24 (1974) (APA Task Force Report); Monahan 44-61; Diamond, The Psychiatric Prediction of Dangerousness, 123 U. Pa. L. Rev. 439, 447 (1974); Note, Rules for an Exceptional Class: The Commitment and Release of Persons Acquitted of Violent Offenses by Reason of Insanity, 57 N. Y. U. L. Rev. 281, 298-299 (1982). See also Megargee, The Prediction of Dangerous Behavior, 3 Crim. Justice & Behavior 3, 11 (1976) (“Whatever the behavior sample the clinician selects, *379it is no secret that the validity of our assessment techniques is less than perfect, and too often less than satisfactory”).

 See APA Task Force Report 25; Monahan & Cummings, Prediction of Dangerousness as a Function of its Perceived Consequences, 2 J. Crim. Justice 239 (1974). The record of this case strongly suggests that petitioner has been the victim of such bias. At petitioner’s first post-commitment hearing, a St. Elizabeths staff psychologist first testified that “because his illness is still quite active, he is still a danger to himself and to others,” then explained that “[w]e would like to keep him still at the hospital and work with him.” Tr. 9 (May 25, 1976).

 Monahan 52, 72; Rubin, Prediction of Dangerousness in Mentally Ill Criminals, 27 Archives of General Psychiatry 397, 401-406 (1972). See also Quinsey, The Baserate Problem and the Prediction of Dangerousness: A Reappraisal, 8 J. Psychiatry & Law 329 (1980).

 See Monahan 107. The Cocozza study showed that ex-mental patients with a single prior arrest were slightly less likely than members of the general population to be arrested for a violent crime.

 The. Court responds that “crimes of theft frequently may result in violence.” Ante, at 365, n. 14. When they do, that fact may well be relevant to, or even dispositive of, the dangerousness issue at a proper commitment hearing. In this case, however, petitioner’s attempt to shoplift involved neither actual violence nor any attempt to resist or evade arrest. It is difficult to see how the Court’s generalization justifies relieving the Government of its Addington-O’Connor burden of proving present dangerousness by clear and convincing evidence.

 E. g., Jackson v. Indiana, 406 U. S., at 723-730; Waite v. Jacobs, 154 U. S. App. D. C. 281, 475 F. 2d 392 (1973); United States v. Brown, 155 U. S. App. D. C. 402, 478 F. 2d 606 (1973). See also McNeil v. Director, Patuxent Institution, 407 U. S., at 249-250.

 See generally the sources cited in nn. 8-10, supra. To date, no one has established a connection between violence and psychiatric disorders. *381APA Task Force Report 30; Cocozza 330; Rabkin, Criminal Behavior of Discharged Mental Patients: A Critical Appraisal of the Research, 86 Psych. Bull. 1 (1979).

 Note that extended institutionalization may effectively make it impossible for an individual to prove that he is no longer mentally ill and dangerous, both because it deprives him of the economic wherewithal to obtain independent medical judgments and because the treatment he receives may make it difficult to demonstrate recovery. The current emphasis on using psychotropic drugs to eliminate the characteristic signs and symptoms of mental illness, especially schizophrenia, may render mental patients docile and unlikely to engage in violent or bizarre behaviors while they are institutionalized, but it does not “cure” them or allow them to demonstrate that they would remain nonviolent if they were not drugged. See American Psychiatric Assn., Statement on the Insanity Defense 15-16 (1982). At petitioner’s May 1976 hearing, the Government relied on testimony that petitioner was “not always responsive in a positive way to what goes on” and was “not a very active participant in the informal activities on the Ward” to support its contention that he had not recovered. See Tr. 7-9. The amount of medication he was receiving, however, made it unlikely he could be an active participant in anything. See n. 19, infra.

 The Court asserts that the Government has a “strong interest” in avoiding a de novo commitment hearing after an insanity acquittal. Ante, at 366. There appear to be several reasons for this. First, the Court mentions that a jury would be available at such a hearing. Petitioner, however, has not argued that the Due Process Clause requires that a jury be provided when an insanity acquittee is committed. If a jury were required in this case, it would only be because, lacking a constitutional basis to keep petitioner under confinement beyond the period he has already *383spent in jail or in St. Elizabeths, the Government had to turn to the existing civil commitment process to justify further commitment. Second, the Court apparently believes that the Government’s “strong interest” extends to avoiding the “clear and convincing evidence” standard. While it might often be convenient for the Government to accord individuals fewer protections than the Due Process Clause requires, constitutional standards of due process reflect individual interests as well as governmental efficiency. See infra, this page and 384-386. Finally, the Court states that “the new proceeding likely would have to relitigate much of the criminal trial.” Ante, at 366. In this case, of course, there was no criminal trial, because the Government accepted petitioner’s “not guilty by reason of insanity” plea, but in any event the issues of present mental illness and dangerousness are sufficiently different from the issues raised by an insanity defense so that even if the latter were taken as settled there would still be a need for findings of fact on new issues. See supra, at 377-380.

 The jury in Addington had been instructed that they must find Addington mentally ill and in need of hospitalization for his own welfare and protection or for the protection of others based upon “clear, unequivocal and convincing evidence.” 441 U. S., at 421. As explained above, see n. 2, swpra, we held that proof by a preponderance of the evidence would not have been sufficient, and we remanded for a determination by the state courts whether the jury instruction given corresponded to the constitutionally required “clear and convincing evidence” standard. 441 U. S., at 433.

 The record in this case provides a chilling example: Several months after petitioner’s arrest, a psychologist at St. Elizabeths submitted a report on his mental condition to the court. The report disclosed that petitioner was being given 400 milligrams of Thorazine (a psychotropic drug) daily, and that, in the opinion of the staff, petitioner was competent to stand trial. See Record 48-51. Approximately three months later, at petitioner’s May 1976 hearing, Dr. Gertrude Cooper, another staff psychologist at St. Elizabeths, testified that petitioner was being given 900 milligrams of Thorazine a day at that time. Tr. 8. (Shortly before the hearing, however, she had submitted a report which indicated that petitioner was receiving 1,000 milligrams of Thorazine daily, plus a tranquilizer. Record 54.) In her own words, “this is sort of a heavy dose of medication.” Tr. 9. None of Dr. Cooper’s testimony indicates why petitioner’s daily medication was more than doubled after he no longer needed to be competent to stand trial; any specific worsening of his condition would certainly have been relevant at the May hearing.