Why Is Insanity Defense Rare?

The Insanity Defense Hearing: You’ve probably seen it in a movie where someone claims he/she is innocent due to insanity, and the entire courtroom is astonished! This type of case often receives so much attention and coverage because the insanity defense is used in less than 1% of criminal cases. Yes! It’s that rare! 

The reason for its rarity becomes clear when you understand its definitions and the standards used to evaluate it. Another crucial point is that forensic mental health professionals, such as psychiatrists and psychologists who provide evaluations and expert consulting, play a vital role in these cases, conducting assessments. Let’s understand in detail about the insanity defense rarity, and how forensic psychiatry is involved in this process.

What is the Insanity Defense?

Insanity, in the Criminal Justice System (CJS), is a broad category of behaviors, mood states, cognitive alterations, and other emotional liabilities that impair a person’s ability to “value the wrongfulness of their actions” and/or “conform their behavior to the requirements of the law” at the time of a criminal offense.

The “insanity defense” is also referred to as “not guilty by reason of insanity” or “NGRI”. “NGRI” in law means that if a person found NGRI was not criminally responsible for the crime committed. NGRI is the defendant’s formal plea. 

Furthermore, insanity is not just “feeling kind of crazy today”, hearing voices in your head, or having “disorganized thoughts.” Insanity is a strictly defined condition that only applies to states of psychosis: either schizophrenia, mania, postpartum psychosis, delirium, or neurocognitive disorder (dementia). It usually requires a primary care physician (i.e., PCP/MD/DO) to testify to one of the conditions above.

Insanity does not apply to temporary intoxication secondary to illicit substances, depressive episodes, borderline personality disorder, PTSD, panic disorder, dissociative identity disorder, or intermittent explosive disorder.

Insanity may also apply to circumstances that are less common, but involve obvious impairment of a defendant’s ability to comprehend the wrongfulness of their behavior (brain tumor, abscess, TIA, infection, or epileptic seizure, again usually requires PCP/MD/DO to testify.

So, insanity does not equal “crazy.” So, if a patient has a severe form of ADHD or brain seizures that cause them to dissociate, potentially they could be placed in a hospital rather than a prison, for fair treatment.

An example of someone who could successfully be found NGRI-postpartum psychosis:

“27-year-old mother of 3 recently delivered twins (1 week old) and has been home alone with them for the past 5 days. In the early morning of a weekend, the mother indulges in delusional thoughts, lights her house on fire, and attempts to strangle her young children with blankets. In the fire, the mother and children are carried to safety by a passing neighbor, the mother admits to trying to kill her children to a police officer, and following a year-long trial, she is found not guilty by reason of insanity after being thoroughly investigated by a forensic medical professional. The mother is sent to a state hospital rather than prison.”

Why is the insanity defense necessary?

The insanity defense is a necessary option for the following reasons:

• It provides justice by not punishing someone who did not know their actions were wrong.
• It helps confine dangerous, genuinely mentally ill individuals to forensic mental health inpatient units where they can receive treatment, and the public can remain safe.
• It prevents criminals from “faking” insanity or malingering because numerous mental health professionals are involved in each case, and it is rarely granted.
• It upholds human rights and the rights of the mentally ill. Eliminating it would erode trust and confidence in the legal system, mental health care, and the pursuit of true justice.
• It also enables non-discrimination by acknowledging that a horrific crime may have been caused by illness rather than malignancy.

Why the insanity defense should be allowed?

The defense allows for mentally ill individuals to receive a fair trial. The insanity defense provides for a humane way of treating mentally ill defendants. The insanity defense, with the help of board-certified forensic psychiatrists to examine the defendant’s mental illnesses, makes the trial more objective. 

Why is the insanity defense rarely used?

The insanity defense is rare (NGRI pleas are entered in less than 1% of serious criminal cases). It requires proving that the defendant was unable to distinguish right from wrong at the time of the crime, which necessitates the testimony of a forensic psychiatrist. The forensic psychiatrist examines the defendant’s mental health status using standard diagnostic protocols. 

The heavy burden of proof required for acquittal, the rigorous tests involved, and the high rate of appeals against convictions prevent the insanity defense from becoming a “get out of jail free card.” 

For example, many states put the burden of proof on the accused after the Reagan shooter was acquitted. America substituted the “Alito test” for the “M’Naghten Standard,” making the defense an even higher standard.

Additionally, the insanity defense is often unsuccessful (less than 25% of NGRI pleas result in an acquittal). A successful plea almost always results in indefinite confinement in a mental health facility, which often lasts longer than the sentence that would have been imposed for the crime. 

The Takeaway

The insanity defense provides mentally ill individuals with the opportunity for a fair trial. A successful insanity defense typically requires rigorous mental health evaluation by expert witnesses with a strong understanding of both jurisprudence and mental health, before a verdict is rendered in the defendant’s favor. 

Pleading not guilty by reason of insanity has serious consequences for the accused. Often, these consequences are more detrimental or severe than those associated with a guilty plea. Due to the high financial and emotional costs of mounting a defense based on an insanity plea, and its potentially severe repercussions, defense teams often hesitate to utilize mental illness in this manner.

Therefore, the insanity defense is rarely used, but it is necessary to protect mentally ill people in society.