I'd think you'd have to be truly insane to be declared so by a court. I've read that very few criminals get away with an insanity defense.
In your experience have any "insane" sex offenders been killed while institutionalized, where you work?
None killed but the smaller guys were abused by other larger inmates. Mostly at night when we only had one nurse on duty and several guards. I never worked the night shift , always the day shift. I no longer work though, thankfully I’m retired.