Patients who are committed to a psychiatric inpatient hospital are at increased risk for neuropsychological compromise. This study investigated a large (n = 260) and diverse sample of patients at a forensic state psychiatric hospital. A substantial proportion (35.8%) of the sample performed two standard deviations below the normative mean on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). In addition, 65% of the participants reported a history of developmental delays, less than 12 years of education, or past learning difficulties. Participants who reported these developmental and academic problems performed worse on the RBANS compared with those without such a history. Additionally, the more developmental/educational risk factors a participant reported, the more likely they were to be impaired on the RBANS. Half of the sample reported a history of at least one neurological risk factor (e.g., history of head injury with loss of consciousness). However, in this sample, a history of neurological risk factors did not influence overall performance on the RBANS and did not increase the likelihood of impairment. These results speak to the relevance of neuropsychological services at state psychiatric hospitals and provide some evidence that a history of developmental or academic problems may help identify psychiatric patients with neuropsychological compromise.