The discussion first examines the movement of persons from the civil commitment system to the system designed for persons incompetent to stand trial, as well as the movement of persons incompetent to stand trial into the civil commitment system. The intersection of the civil commitment system with the system for dealing with persons incompetent to stand trial is examined using Wisconsin as a case in point. In the mid-1970's, Wisconsin adopted a new civil commitment code designed to exclude nondangerous mentally ill persons from civil commitment. Dickey's empirical study (1980) of the impact of this legislation on the handling of persons incompetent to stand trial is summarized. Next, the U.S. Supreme Court's decision in Jackson v. Indiana (1972) is examined as the focal point for the movement of persons from the system of criminal incompetence to civil commitment. It is noted that since the Jackson case, if an incompetent defendant is found unlikely to gain competence in the foreseeable future, the defendant must either be released or be civilly committed. The discussion considers how California has attempted to conform to the Jackson decision while retaining the basic structure of its civil commitment code. Consideration of civil commitment and insanity issues focuses on the U.S. Supreme Court's decision in Jones v. United States (1983). In this case, the Court held that when a criminal defendant is found not guilty by reason of insanity, the state can confine him/her to a mental institution until he/she is no longer a danger to himself/herself or society. The discussion then turns to areas of future litigation likely to address the propriety of other practices in the handling of insanity acquittees compared with that of civilly committed patients. The chapter concludes with policy considerations. A list of relevant cases and five references are provided.