Forensic decision-making is subject to irrelevant influences and disregards pertinent risk factors. Although this seems to be improving, research has failed to examine if any progress has been made in almost a decade. Files were coded for 89 male Not Criminally Responsible on Account of Mental Disorder patients that had a Review Board (RB) hearing between 2007-2014 to investigate whether items from four empirically supported risk measures were considered. Only 57% of experts and one quarter of RB reports noted use of a structured risk assessment which increased over time. Despite inconsistency of use, empirically supported factors were frequently discussed and centered on mental health, treatment, criminal history, and reintegration. Overall, disposition decisions were predicted by discussion of both valid risk and protective factors, however, were also biased by physical attractiveness. The results highlight the need for policies to ensure greater structure in how risk assessments are implemented into practice.