If you are found not guilty by reason of insanity, you may be transferred to a state forensic psychiatric hospital, where discharge can take months or even years.
The intersection of mental health and criminal law is complex, particularly in the field of legal defense. While used interchangeably, the terms “insanity defense” and “mental health defense” differ from each other and hold different legal meanings entirely.
Understanding the difference between the two helps individuals understand how the law considers a mental illness and how mental health plays a pivotal role in determining an individual’s responsibilities and the consequences of their actions.
Before diving into the subject of an insanity and mental health defense, it is important to note that these are primarily used in a criminal case.
Insanity Defense
Insanity defense is a legal strategy used by individuals diagnosed with severe mental and psychiatric conditions by Board-Certified Psychiatrists and Neurologists. It is used to prove to courts that an individual cannot be held responsible for their actions since they were “legally insane” at the time of the offense and, as a result, could not tell right from wrong.
If an insanity defense is successful, it leads to a verdict of “Not Guilty by Reason of Insanity (NGRI).” An NGRI verdict indicates that the law does not hold the individual criminally responsible for their actions, and they are ordered to get treated in a mental health facility, instead of serving their time in prison.
However, it is imperative to note that it is not always easy to achieve an ‘insanity defense’. There are only a few mental health conditions that qualify for an insanity defense:
- Schizophrenia with Psychosis
- Manic Episodes with Psychosis
- Postpartum Psychosis
- Acute Delirium
- Moderate to Severe Dementia
- Proven Seizures
- Moderate to Severe Neurocognitive Disorders
- Medication Induced Psychosis. (Medications such as stimulants, steroids and serotonin-enhancing agents can induce psychosis in individuals.)
- Brain Tumor or Abscess
- History of brain injury
- Moderate to severe developmental delay
In order to maintain a fair and just legal process, there is usually no such thing as “temporary insanity.” There are a few mental health conditions that an individual cannot use to contest their criminal charge:
- Depression
- Panic Attacks
- Intermittent Explosive Disorder
- Post Traumatic Stress disorder
- ’Temporary Insanity’
- Recreational Drug Induced Psychosis
- Borderline Personality Disorder
- Dissociative Identity Disorder
Conditions that may qualify for ‘temporary insanity’ include:
- Delirium
- Side effects of prescription medications
- Acute brain injury
Achieving an insanity defense
Achieving a not guilty by reason of insanity defense is not always the best outcome.
For minor crimes, prison sentences may be short, or you may be offered probation. If you are found not guilty by reason of insanity, you may be transferred to a state forensic psychiatric hospital, where discharge can take months or even years. You may then need a private evaluator to advocate for release as state systems are slow.
The advantage of a not guilty by reason on insanity defense is that you will not have a misdemeanor or felony on your record. This is especially important for younger clients.
Mental Health Defense
A mental health defense is a broader legal criminal defense strategy that argues to consider an individual’s mental illness during the time of the offense, not to negate their criminal responsibility, but to mitigate their sentencing and culpability. The primary goal of a mental health defense is to prove to the court that the individual was mentally impaired and was unable to form intent at the time of the offense.
The “mental health defense” is majorly used to prove diminished capacity, contest the individual’s ability to stand trial, and mitigate their sentencing. This means that even if the individual is found guilty, their mental illness, triggers, provocation, and past trauma should be considered to reduce their criminal charges. This defense holds the individual accountable but asks the court for some degree of leniency to consider the individual’s impaired mental health.
The mental health defense is also a way to prove to the court that the individual is consistently working on improving their mental health by receiving treatment, following up on their appointments, and regularly attending therapy sessions.
Conditions that may qualify for mental health defense for minor violent crimes such as resisting arrest or offenses include:
- Post-traumatic stress disorder (PTSD)
- Panic attacks
Can depression be a mental health defense?
Depression and ADHD can sometimes be a defense for non-violent crimes such as:
- Late filing of taxes
- Childhood neglect
- Possession of illegal recreational drugs
Having depression or ADHD does not mean that you are not guilty, but you may receive a lighter sentence or achieve a plea deal if you:
- Acknowledge responsibility,
- Show you are receiving treatment
- Show that you are taking active steps to fix the problem
The purpose of a mental health defense is to demonstrate that you have good insight, that you are fixing issues that increase the risk of committing crimes, that you are receiving treatment, therefore you are no longer a risk to the community, and present a low risk of re-offending.
Mental Health Evaluation for Insanity Defense
For an insanity defense, the burden of proof lies on the defendant to prove their insanity at the time of the offense. Therefore, they must provide convincing and conclusive evidence of their impaired state of mind. In order to do this, they must provide the following documents to the psychiatrist working on their evaluation:
- Past psychiatric history documents- These documents would have to include previous mental health evaluations conducted, details of inpatient or outpatient programs, letters from previous and current therapists and psychiatrists, and details of hospitalizations (if any).
- Current medications- A list of current medications the defendant is taking, along with a list of past medications, noting their side effects (if any), and whether any of them are.
- Legal documents- Any past police records, including any domestic violence reports, ACS cases, any past criminal charges, or any other forensic charges against the defendant. These documents also include any court orders or official documents issued by the court.
- Character references- Character letters from individuals who know the defendant personally, including letters from family members, friends, current and previous employers, colleagues, or professors.
Mental Health Evaluation for Mental Health Defense
For a mental health defense, the burden of proof lies on the defendant, and they must prove that their mental illness rendered them incapable of realizing the consequences of their actions at the time of the offense. However, to prove their mental incompetence, they must provide some documents to their psychiatrist. These documents would include past mental health evaluations, details of inpatient or outpatient programs, hospitalizations, letters from previous and current therapists and psychiatrists, and all other relevant documents pertaining to their mental health.
Other documents would include a list of current medications and past medications, along with documentation of any side effects experienced, legal documents including police reports and court orders, and character references from individuals who know the defendant personally.
One of the goals of an evaluation for mental health defense is to paint a picture of who the defendant is as a person. It is helpful if a defendant can demonstrate that breaking the law is unusual for them, and that there has not been a lifelong history of antisocial behavior.
Role of Forensic Psychiatry in Legal Defense
A forensic psychiatrist is a medical doctor who works at the intersection of psychology and law. They break down complex mental health terms so that they are comprehensible by the court. A forensic psychiatrist’s expert opinion in a criminal defense case determines the defendant’s fate— whether they would be deemed legally insane and be assigned to a mental asylum, or be criminally charged with a reduced sentence, considering their mental health as a mitigating factor.
To conduct a thorough psychiatric evaluation, a forensic psychiatrist follows the following steps:
- Reviews the medical collateral- One of the most important steps of any forensic evaluation is to review the medical records of the individual. The forensic psychiatrist reviews the defendant’s medical history, past psychiatric history, history of any medical illnesses, records of any inpatient or outpatient program, details of any hospitalizations, letters from previous and current psychiatrists and therapists, and previous mental health evaluations.
- Conducts comprehensive interview sessions- The forensic psychiatrist conducts comprehensive and thorough interviews to assess the defendant’s case, their behavior, mental health status at the time of the offense as well as during the interviews, and their mental capacity to understand the current legal situation.
- Psychological testing- Psychological testing includes tests assessing the defendant’s risk of reoffending, multiple risk assessment scales, and other tests to evaluate their cognitive functioning.
- Reviews criminal history- The forensic psychiatrist reviews the previous criminal records of the defendant including police reports, domestic violence reports, court orders, ACS cases, and any and all legal documents pertaining to their current legal charge.
- Reviews pharmacy records- The forensic psychiatrist reviews the defendant’s pharmacy records to assess their medication history, including prescriptions for psychiatric medications (if any), pain management drugs, or any other controlled substances. This helps the psychiatrist identify any potential substance abuse or misuse of medications.
- Contacts the character references- The last and most important step of the psychiatric evaluation for a forensic psychiatrist is to contact the defendant’s character references and get more details about the defendant. By doing so, the psychiatrist gets an insight into their day-to-day life and an understanding of how their mental illness impacts their daily functioning.
Insanity defense versus malingering
Judges and public prosecutors tend to be suspicious of insanity defense claims. Therefore, when presenting a ‘not guilty by reason of insanity defense,’ it is important to present a thorough psychiatric evaluation from a Board Certified Psychiatrist, to demonstrate that your illness is real and that you are not inventing past or current symptoms in order to avoid a jail sentence.
As legal systems involve, balancing the public safety and rights of a defendant with a mental health condition is critical and has become imperative. Considering the mental condition of an individual during a legal proceeding not only prioritizes their mental health but also helps the justice system deliver fair and just verdicts. The effectiveness of these criminal defenses mainly depends on the comprehensive psychiatric evaluations conducted by expert Board Certified Psychiatrists.
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