Site visits to 20 facilities were made for the study, but the report highlights the operations in 1 Federal and 2 State facilities: the Pretrial Branch of St. Elizabeth's Hospital, Washington, D.C.; the Biggs Unit of the Fulton State Hospital in Missouri; and the Center for Forensic Psychiatry in Michigan. Descriptions of each program contain a brief history of the forensic service and a summary of the program's goals and objectives. The report illustrates the flow of client-offenders through the program and discusses how mental health information is delineated by the referral sources, acquired by the program staff, and provided to the user. The descriptions also review the procedures in place for feedback, quality control, and program evaluation. The Biggs Unit began operation in 1938 as the sole maximum-security mental health facility for Missouri's male forensic client-offenders. The unit provides both evaluative and treatment services. The Pretrial Branch of St. Elizabeth's Hospital consists of 4 wards containing 100 beds. It serves the criminal divisions of the D.C. Superior Court and the U.S. District Court for the District. The flow of criminal defendants into and through the branch is depicted, beginning with questions relating to the defendant's competency to stand trial. The Center for Forensic Psychiatry diagnoses, evaluates, and treats patients committed by the criminal courts. Diagrams illustrate the process by which the questions of competency to stand trial, criminal responsibility, and diminished capacity are raised, referred to the center, and resolved. The case processing procedures for persons adjudicated not guilty by reason of insanity are also discussed. Forms used by the three mental health facilities are appended. Flow charts are included.