New Hampshire currently houses mentally ill patients considered dangerous to themselves or others in the Secure Psychiatric Unit (SPU) of the New Hampshire State Prison for Men in Concord. Patients are transferred to the SPU from New Hampshire Hospital when the security level of the Hospital is deemed insufficient to meet the needs of a patient. This housing arrangement has recently come under examination because of the unique patient population, location of the unit, and questions about where patients would be best served. There have been several attempts to pass legislation that would place non-adjudicated mentally ill patients into another facility. This report was originally commissioned to inform discussion of HB 1541, but it will now seek to inform the Commission established by HB 208 to study involuntary commitment in New Hampshire. This report examines the costs and benefits of maintaining the status quo policy at the SPU, as well as the costs, benefits, and transition processes associated with the available alternatives, which include a) improving existing facilities, b) constructing new facilities, c) implementing assisted outpatient therapy, and d) transferring patients out of state.