The Forensic Monitoring System (FMS) of the Missouri Department of Mental Health considers and approves consumers committed under not guilty by reason of insanity (NGRI) status for release. The system extends to the outpatient sector to ensure that such persons maintain their mental stability and do not pose a danger to the community. The process of conditional release and the organization of the FMS are outlined, reasons for the low recidivism rate are discussed, and paternalism in requiring treatment compliance as a condition of individual liberty is explored. Case examples illustrate the success, in terms of revocation and rearrest rates, of the Missouri system, which typically sees an annual return to inpatient custody of only 7%, and a still lower rate of criminal recidivism. Cost‐effectiveness is discussed in terms of resources spent so that recovered persons with dangerous mental illnesses may live in safety outside of an institution. Copyright © 2016 John Wiley & Sons, Ltd.