This study examined the discrimination and calibration properties of Violence Risk Appraisal Guide–Revised (VRAG-R) scores and risk bins in a sample of 124 forensic psychiatric inpatients found Not Criminally Responsible on Account of Mental Disorder (NCRMD) or Unfit to Stand Trial (UST), admitted under Saskatchewan Review Board jurisdiction during a 38-year catchment period. The VRAG-R was scored on all NCR and UST individuals from file, and recidivism data were obtained via official criminal records. The VRAG-R demonstrated strong discrimination properties for general and violent recidivism over 3-year, 5-year, and overall follow-ups. Calibration analyses revealed that VRAG-R recidivism norms tended to estimate higher rates of recidivism than actually observed. Overall, the results supported the use of the VRAG-R for psychological risk assessments with a population of persons found NCRMD; however, it should be a multi-measure process that involves other empirically validated tools.