PETITION FOR REFORM OF INSANITY LAWS AND PROTECTION OF VICTIMS

A Request for Legislative Review and Reform of Laws Governing Not Guilty by Reason of Insanity

To the Members of the Legislature:

We are asking you to take a serious look at the laws governing the insanity defense and, specifically, the use of a verdict of Not Guilty by Reason of Insanity (NGRI).

This request is not based on the belief that mental illness is fake.

It is not based on the belief that people with mental illness are dangerous.

It is not based on a desire to deny anyone medical treatment.

And it is not a request to remove constitutional protections from people who are accused of crimes.

It is based on a much simpler question:

Is it appropriate for a medical diagnosis, combined with retrospective opinions about a person's mental state, to completely eliminate criminal accountability for an otherwise proven criminal act?

We believe our legislatures have an obligation to seriously examine that question.

Not because mental illness does not matter.

But because it matters enormously, and so does justice for the person who was harmed.

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1. MENTAL ILLNESS AND CRIMINAL RESPONSIBILITY ARE NOT THE SAME THING

A psychiatric diagnosis answers a medical question.

Criminal responsibility answers a legal question.

Those questions overlap, but they are not identical.

A person can have schizophrenia.

A person can have bipolar disorder.

A person can experience severe depression.

A person can experience psychosis.

A mother can experience postpartum depression or postpartum psychosis.

All of those conditions are real, serious medical conditions that deserve appropriate treatment.

But having a diagnosis does not tell us everything about a particular person's behavior at a particular moment.

Two people can have the exact same diagnosis and receive the exact same medication and therapy and respond completely differently.

One person may improve dramatically.

Another may improve only partially.

Another may experience significant side effects.

Another may stop taking the medication.

Another may respond well initially and later relapse.

That is not an indictment of psychiatric medicine.

It is simply reality.

Psychiatric treatment is not a mathematical equation where:

Diagnosis + Medication = Guaranteed Outcome.

There is no such guarantee.

Research examining antipsychotic treatment in schizophrenia has demonstrated substantial variability in treatment response among individuals. A meta-analysis involving 52 randomized clinical trials and more than 15,000 participants specifically examined variability in response to antipsychotic treatment and concluded that individual differences in response remain an important issue.

That matters when the criminal justice system is making decisions that can affect a person's liberty for decades.

The law should not assume that because a treatment worked for one person with a particular diagnosis, it will necessarily work the same way for another.

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2. TREATMENT AFTER RELEASE CANNOT BE GUARANTEED

There is another reality that we cannot ignore.

A person can be completely compliant with treatment while inside a secure psychiatric facility and behave very differently once they return to the community.

Outside of an institution, a person may have to make their own appointments.

They may have to obtain their own medication.

They may have transportation problems.

They may lose insurance.

They may experience medication side effects.

They may decide they no longer need medication.

They may stop therapy.

They may lose insight into their illness.

They may simply choose not to follow the treatment plan.

That does not mean people with mental illness are irresponsible.

It means they are human.

Research on medication adherence in schizophrenia demonstrates that adherence is far from universal. One systematic review found substantial variation in adherence rates across studies, while another review using electronic monitoring found adherence to oral antipsychotic medication to be approximately 70%, depending on how adherence was measured.

There is also evidence that discontinuing antipsychotic medication substantially increases the risk of relapse.

Again, this does not mean every person who stops medication will become dangerous.

It means something much more important:

The State cannot guarantee that a person who is stable under controlled treatment conditions will remain stable indefinitely after release.

So why would we build a justice system that depends upon that assumption?

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3. MEDICAL PROFESSIONALS DO NOT ALWAYS AGREE

This is another issue that deserves much more attention.

In insanity cases, the jury is often asked to listen to highly qualified psychiatrists and psychologists who may disagree about what happened inside a defendant's mind.

That disagreement is not necessarily because someone is lying.

It can occur because forensic psychiatric evaluations involve professional judgment.

One study examined 483 forensic evaluation reports involving 165 criminal defendants and found unanimous agreement about legal sanity among evaluators in only 55.1% of cases.

That means that in a substantial percentage of cases, qualified professionals did not all reach the same conclusion.

Other research has also identified variability in forensic psychiatric assessments, including differences in methodology, training, interpretation, and evaluation practices.

That should make legislators pause.

Because the final decision is not being made in a laboratory.

It is being made in a courtroom.

And the question can ultimately become:

Which expert does the jury believe?

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4. EVEN DIAGNOSIS ITSELF IS NOT PERFECTLY CONSISTENT

This is not an argument that psychiatric diagnoses are useless.

They are not.

But psychiatric diagnosis involves clinical judgment.

Research has demonstrated variability between clinicians when making psychiatric diagnoses, even when standardized diagnostic systems are used.

That means we have to be careful about turning a diagnosis into a legal conclusion that determines whether someone is criminally responsible.

If two qualified professionals can examine the same person and disagree about diagnosis, and two forensic professionals can examine the same defendant and disagree about legal sanity, then the Legislature should ask whether it makes sense to allow that chain of professional judgment to become the mechanism through which criminal accountability disappears completely.

The question is not whether doctors should be trusted.

The question is whether any medical professional can reasonably be expected to provide the level of certainty that the legal system sometimes asks of them in an insanity case.

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5. THE JURY IS THEN ASKED TO RESOLVE THAT UNCERTAINTY

This is where the problem becomes even more complicated.

The jury is not made up of psychiatrists.

It is made up of ordinary citizens who are asked to take competing medical opinions and apply a complicated legal standard to them.

Research has found significant problems with juror understanding of mental-illness verdicts.

One study involving 96 prospective jurors found that only 4.2% correctly identified both the meaning and disposition associated with NGRI and guilty-but-mentally-ill verdicts.

That finding does not mean jurors are incapable of doing their jobs.

It means the system is asking ordinary citizens to understand legal and psychiatric concepts that even professionals can disagree about.

That deserves legislative scrutiny.

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6. REASONABLE DOUBT SHOULD NOT BE CONFUSED WITH MEDICAL CERTAINTY

We absolutely believe in reasonable doubt.

The prosecution should have to prove every element of a crime beyond a reasonable doubt.

That principle should never be weakened.

But there is a difference between requiring the prosecution to prove a criminal act and asking a jury to reconstruct exactly what was happening inside a person's mind at a specific moment in the past.

Mental state is often reconstructed after the fact.

Experts review medical records.

They review interviews.

They review behavior.

They review statements.

They review medications.

They review family history.

They review videos, texts, phone calls, photographs, and other evidence.

Then they attempt to reconstruct a person's mental state at the time of the offense.

Sometimes they agree.

Sometimes they don't.

The jury is then asked to make a legal determination based on those competing interpretations.

That is an extraordinary amount of uncertainty to place at the center of a criminal verdict.

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7. POSTPARTUM PSYCHOSIS DESERVES MEDICAL TREATMENT — NOT A CATEGORICAL LEGAL EXEMPTION

This issue needs to be addressed directly because it is often used as the strongest argument against reform.

Postpartum depression is real.

Postpartum psychosis is real.

They deserve medical recognition, research, treatment, and emergency intervention when necessary.

Nothing in this petition says otherwise.

But recognizing postpartum psychiatric illness does not require the law to automatically conclude that a person experiencing it cannot be held criminally responsible.

Research examining postpartum psychosis and infanticide cases has demonstrated that courts have reached different legal outcomes in different circumstances.

That inconsistency should tell us something.

It tells us that the existence of postpartum psychiatric illness does not itself answer the legal question.

The important question should remain individualized:

What happened, what can be proven, and what does the law require?

We should not create a rule that tells mothers that postpartum psychiatric illness makes them less responsible citizens.

But we should also not create a rule that tells the families of children killed during a postpartum psychiatric episode that the diagnosis automatically erases criminal accountability.

We can acknowledge the illness without erasing the victim.

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8. THIS REFORM IS NOT AN ATTACK ON PEOPLE WITH MENTAL ILLNESS

In fact, one of the reasons we believe reform is necessary is because we do not want mental illness turned into a legal identity.

If the law repeatedly tells society that schizophrenia, bipolar disorder, psychosis, postpartum psychosis, or another psychiatric diagnosis can make a person legally incapable of responsibility, we risk reinforcing a dangerous idea:

that people with mental illness are fundamentally different from other citizens when it comes to responsibility.

We should be very careful about that.

A person with schizophrenia is not less of a citizen.

A person with bipolar disorder is not less of a citizen.

A person who has experienced psychosis is not automatically dangerous.

A mother who has experienced postpartum psychosis is not automatically dangerous.

Mental illness should not become a shortcut to determining whether someone is competent, dangerous, trustworthy, employable, capable of parenting, or entitled to other rights.

Those determinations should be individualized and based upon legally relevant evidence.

Diagnosis should never become a substitute for evidence.

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9. THERE IS A REAL CIVIL-RIGHTS ISSUE HERE

This is one of the most important reasons for reform.

If we establish the principle that a psychiatric diagnosis can change a person's fundamental legal status, we have to be extremely careful about where that principle leads.

If mental illness becomes accepted as evidence of diminished responsibility, it becomes easier for future policymakers to argue that certain diagnoses should justify additional restrictions somewhere else.

That could eventually lead to arguments concerning:

- parental rights;

- child custody;

- employment;

- professional licensing;

- firearms;

- housing;

- guardianship;

- independent living;

- civil commitment;

- or other civil liberties.

We are not claiming that NGRI automatically causes those laws.

We are saying something much more reasonable:

The law should be extremely cautious about establishing diagnosis as a proxy for a person's capabilities or rights.

The safest principle is individualized evidence.

Not labels.

Not stereotypes.

Not assumptions.

Evidence.

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10. ACCOUNTABILITY DOES NOT MEAN ABANDONING TREATMENT

There is a false choice that appears repeatedly in this debate:

Either we hold someone accountable,

or

we treat their mental illness.

That is not true.

We can do both.

A person can be convicted and receive psychiatric treatment.

A person can be sentenced and receive psychiatric medication.

A person can serve a sentence in a secure treatment environment.

A person can receive therapy.

A person can receive substance-abuse treatment.

A person can receive suicide-prevention services.

A person can receive whatever medical care is necessary.

Treatment does not have to disappear simply because criminal accountability exists.

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11. TREATMENT IS NOT THE SAME THING AS SERVING A SENTENCE

This distinction is especially important.

A person can become clinically stable.

They can become medication compliant.

They can become remorseful.

They can develop insight.

They can participate successfully in therapy.

They can become a productive member of a treatment community.

All of those things are good.

But none of them changes what happened to the victim.

Clinical improvement is not the same thing as serving a criminal sentence.

This petition therefore asks that psychiatric improvement alone not automatically result in the elimination or shortening of criminal accountability.

Nothing here should prevent lawful parole, clemency, compassionate release, earned-release programs, or any other mechanism required by state law or the Constitution.

The point is simply this:

Treatment should not automatically equal punishment completed.

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12. PUBLIC SAFETY REQUIRES HUMILITY, NOT FEAR

We should also be honest about what the research does and does not show.

We should not claim that every person found NGRI will reoffend.

That would be irresponsible and unsupported.

But we also should not claim the opposite—that psychiatric treatment guarantees that a person will never again pose a criminal risk.

Research examining insanity acquittees released from North Carolina's forensic treatment system between 1996 and 2020 found measurable rates of subsequent criminal recidivism and rehospitalization.

The existence of recidivism does not prove that mental illness causes crime.

It does demonstrate why long-term public-safety decisions should be based on individualized evidence rather than assumptions that treatment creates permanent stability.

We should not fear mentally ill people.

We should also not pretend that medicine can guarantee the future.

Both statements can be true.

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13. THE VICTIM DOES NOT BECOME LESS OF A VICTIM BECAUSE THE DEFENDANT IS SICK

This should be obvious, but it needs to be said.

A murdered child is still dead.

A sexually abused child was still abused.

A family still lost someone.

A parent still has to bury a child.

A sibling still has to grow up without their brother or sister.

The defendant's diagnosis does not change any of that.

The victim should not become a footnote because the defendant has a psychiatric condition.

The justice system must be capable of recognizing the defendant's illness without making the victim disappear from the conversation.

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14. CHILDREN DESERVE PARTICULAR PROTECTION

Children are uniquely dependent upon adults.

They cannot simply leave.

They rely upon parents, guardians, and caregivers for food, shelter, safety, and protection.

When a person entrusted with that responsibility intentionally kills a child, the law should recognize the extraordinary breach of trust involved.

Where multiple children are killed, each child should be recognized as an individual victim.

One family can lose several children in one event.

That does not make them one victim.

Every child deserves to be individually recognized by the law.

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15. THIS IS NOT ABOUT PUNISHING PEOPLE FOR BEING SICK

That distinction should be written directly into any legislation.

No person should be punished merely for having a psychiatric diagnosis.

A diagnosis alone should not establish:

- criminality;

- dangerousness;

- incompetence;

- unfitness;

- or diminished citizenship.

Criminal punishment should remain tied to criminal conduct proven under the law.

Mental illness should remain relevant to medical treatment and any other area where the Constitution or statute requires individualized consideration.

That is the balance we are asking for.

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16. THE SUPREME COURT HAS ALREADY GIVEN STATES ROOM TO EXAMINE THEIR APPROACH

In Kahler v. Kansas, the United States Supreme Court considered Kansas's approach to insanity and held that the Constitution does not require every state to use a particular traditional insanity defense.

That is important.

This petition does not claim that the Constitution requires the abolition of NGRI.

It asks state legislatures to determine whether their existing insanity laws are the best way to balance:

- constitutional rights;

- victims' rights;

- medical treatment;

- public safety;

- criminal accountability; and

- the integrity of the courts.

That is a legitimate legislative question.

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17. THE SYSTEM SHOULD NOT DEPEND ON CERTAINTY THAT MEDICINE CANNOT PROVIDE

This may be the central issue.

We cannot guarantee that a diagnosis is perfectly accurate.

We cannot guarantee that every treatment will work.

We cannot guarantee that every person will remain compliant.

We cannot guarantee that medication will never be stopped.

We cannot guarantee that symptoms will never return.

We cannot guarantee that every expert will agree.

We cannot guarantee that a person who is stable today will be stable ten years from now.

And we cannot guarantee that a person released from psychiatric treatment will never commit another crime.

None of those facts mean that psychiatric medicine has failed.

They mean that human beings are complicated.

Our laws should recognize that.

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18. THE CHAIN OF UNCERTAINTY

Consider what may happen in a typical insanity case:

A diagnosis is made.

That diagnosis is interpreted through the person's symptoms.

Those symptoms are used to reconstruct the person's mental state at the time of the offense.

Experts form opinions.

The experts may disagree.

The attorneys present competing interpretations.

The jury must understand those opinions.

The jury must understand the legal standard.

The jury must decide whether the standard has been met.

If NGRI is returned, the person enters a psychiatric system.

Treatment begins.

Treatment may or may not produce the expected response.

The person may or may not remain compliant.

The person's condition may change.

Eventually, another decision must be made concerning release.

That is an extraordinary chain of decisions.

Every individual step deserves careful consideration.

But when the consequence of that entire chain is the complete elimination of criminal accountability, the Legislature should ask whether there is a better way.

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19. THE BETTER APPROACH: ACCOUNTABILITY WITHOUT ABANDONMENT

We are not asking the State to abandon people who are mentally ill.

We are asking the State not to abandon victims either.

We are asking for a system where:

Mental illness receives treatment.

Defendants receive due process.

Competency protections remain intact.

Victims receive recognition.

Criminal conduct receives lawful consequences.

Psychiatric diagnosis does not become a separate category of citizenship.

Clinical improvement does not automatically equal completion of a sentence.

Release decisions are based upon individualized evidence and lawful procedures.

That is not cruelty.

That is accountability without abandonment.

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20. PRESERVING THE DIGNITY OF THE JUDICIAL SYSTEM

A justice system earns public trust by making clear distinctions.

It must distinguish:

illness from criminal conduct;

diagnosis from dangerousness;

competency from criminal responsibility;

treatment from punishment;

rehabilitation from completion of a sentence;

mitigation from exoneration;

and

compassion from acquittal.

When those concepts become blurred, the public loses confidence in the ability of the courts to deliver consistent justice.

We should be able to say two things at the same time:

This person was seriously mentally ill.

And:

This victim deserved justice.

Those statements do not contradict each other.

21. THE QUESTION WE SHOULD BE ASKING

The question should not be:

“Do you believe mental illness is real?”

Of course it is.

The question should not be:

“Do you believe mentally ill people deserve treatment?”

Of course they do.

The question should be:

Does the existence of mental illness require the State to erase criminal accountability for an otherwise proven offense?

We believe the answer should be no.

A person can be sick and still be accountable.

A person can be treated and still be sentenced.

A person can recover and still have a criminal sentence.

A person can receive compassion without the victim receiving less justice.

22. OUR REQUEST

We respectfully ask the Legislature to:

Review the state's existing insanity laws.

Hold public hearings on their effectiveness and consequences.

Hear from victims and surviving family members.

Hear from psychiatrists and psychologists.

Hear from forensic mental-health professionals.

Hear from prosecutors and defense attorneys.

Review the research concerning juror comprehension.

Review research concerning forensic-evaluator disagreement.

Review research concerning treatment response and medication adherence.

Review research concerning recidivism and release of insanity acquittees.

Review the legal treatment of postpartum psychiatric illness.

Examine the constitutional principles recognized in Kahler v. Kansas.

Consider replacing categorical mental-illness-based criminal exoneration with a system that separates treatment from criminal accountability.

Preserve all constitutionally required competency and due-process protections.

Guarantee medically necessary treatment.

Prohibit psychiatric diagnosis alone from establishing dangerousness, incompetence, or unfitness for citizenship.

Prevent clinical improvement alone from automatically eliminating criminal accountability.

Strengthen recognition and protection of victims, particularly children.

Recognize each victim individually where multiple victims are involved.

Enact legislation that protects both the dignity of people with mental illness and the dignity of victims.

CONCLUSION

This petition is not asking lawmakers to choose between compassion and justice.

It is asking lawmakers to stop pretending that they are opposites.

We can recognize that someone was profoundly mentally ill.

We can provide that person treatment.

We can protect their constitutional rights.

And we can still recognize that another human being was harmed or killed.

Mental illness is not a crime.

But neither is mental illness a magic eraser for one.

Treatment can help a person.

It cannot bring a victim back.

Medication can stabilize symptoms.

It cannot undo what happened.

Therapy can produce meaningful rehabilitation.

It cannot give a murdered child another birthday.

A person can recover.

The victim cannot recover from death.

And that difference matters.

We should not build laws around the assumption that psychiatric diagnosis provides certainty when psychiatric science itself recognizes uncertainty.

We should not assume that two people with the same diagnosis will respond identically to treatment.

We should not assume that someone who complies with treatment in a controlled environment will necessarily continue that treatment forever in the community.

We should not assume that every qualified expert will reach the same conclusion about a defendant's mental state.

And we should not ask jurors to resolve those uncertainties without acknowledging how complicated these decisions actually are.

At the same time, we must be careful not to create a new injustice.

People with mental illness are not lesser citizens.

They should not be presumed dangerous.

They should not lose rights simply because they carry a diagnosis.

They should not be defined by the worst moment of their illness.

That is why the solution should be individualized evidence—not diagnosis.

The law should judge conduct.

The medical system should treat illness.

The courts should protect constitutional rights.

And victims should remain visible.

Mental illness may explain conduct.

It does not erase the victim.

Treatment may change a person.

It does not undo the crime.

Rehabilitation is valuable.

It is not the same thing as accountability.

And perhaps most importantly:

Mental illness should never make someone a lesser citizen.

But it should not make a victim a lesser victim either.

We respectfully ask the Legislature to examine the evidence, hear from the people affected, and reform the law accordingly.

Accountability without abandonment.

Treatment without diminished citizenship.

Justice without forgetting the victim.

And a judicial system worthy of the public's trust.

SELECTED RESEARCH AND LEGAL AUTHORITIES

Kahler v. Kansas, 589 U.S. 271 (2020).

United States Supreme Court decision holding that the Constitution does not require states to adopt a particular traditional insanity defense.

Sloat & Frierson (2005), “Juror Knowledge and Attitudes Regarding Mental Illness Verdicts.”

Study of 96 prospective jurors finding substantial misunderstanding of NGRI and guilty-but-mentally-ill verdicts.

Forensic evaluator agreement research.

Study examining 483 forensic evaluation reports involving 165 defendants found unanimous agreement concerning legal sanity in only 55.1% of cases.

Research concerning antipsychotic treatment response.

Meta-analysis involving 52 randomized clinical trials and 15,360 participants examined variability in response to antipsychotic treatment.

Research concerning antipsychotic adherence.

Systematic reviews demonstrate substantial variability in medication adherence among people with schizophrenia and related disorders.

Research concerning antipsychotic discontinuation and relapse.

Meta-analytic research has found increased risk of psychotic relapse following antipsychotic discontinuation compared with maintenance treatment.

Research concerning insanity acquittee outcomes.

North Carolina research examining insanity acquittees discharged from forensic treatment between 1996 and 2020 found measurable rates of subsequent criminal recidivism and rehospitalization.

Research concerning postpartum psychosis and infanticide.

Published forensic-psychiatric literature demonstrates substantial variation in the legal outcomes of cases involving postpartum psychosis, underscoring the distinction between the existence of a medical condition and the legal determination of criminal responsibility.

FINAL STATEMENT

We are not asking the Legislature to decide that mentally ill people are dangerous.

We are asking the Legislature to decide that mental illness should never become a substitute for individualized justice.

We are not asking the Legislature to abandon treatment.

We are asking it to separate treatment from accountability.

We are not asking the Legislature to forget compassion.

We are asking it to extend compassion to victims as well.

And we are not asking the Legislature to choose between the dignity of a defendant and the dignity of a victim.

We are asking for a justice system capable of protecting both.