Recent studies indicate that a small, but critical subgroup of psychiatric patients is involved in a disproportionately large number of violent incidents among the mentally ill. This subgroup is an appropriate focus for intensive community-based treatment programs designed to reduce violence. However, little research has been conducted on methods for identifying patients who repeatedly become involved in violent incidents. This article describes a large follow-up study in which these patients were identified using a simple screening process that is feasible for routine use. This screening process efficiently and effectively identified a small minority of patients who were at risk for repeated involvement in violence. Patients deemed “at risk” by the screening process had an average of 7 violent incidents during a six-month follow-up period. The characteristics of these patients are described, and implications of the screening tool for conducting future research, targeting individuals for more intensive treatment services, and developing violence-focused treatment programs are discussed.