Informed decision making in persons acquitted not guilty by reason of insanity.
R. L. Elliott, E. Nelson, W. L. Fitch, R. Scott, G. Wolber and R. Singh,
Bull. Amer. Acad. Psychiatry & the Law
21(3): 309-20, 1993.
Deciding to raise an insanity defense carries serious consequences. This is especially true for persons
charged with minor offenses, for whom an acquittal not guilty by reason of insanity (NGRI) might
lead to a longer period of incarceration than would conviction. Before raising an insanity defense,
a defendant should be provided with information necessary to make an informed decision and should
be competent to understand the consequences of the verdict. This study attempted, through
retrospective review and concurrent evaluation, to determine the degree to which trial courts in
Virginia attended to these important aspects of informed decision making before finding defendants
charged with misdemeanors NGRI. The study also attempted to assess the degree to which
defendants were competent and informed at the time of adjudication. In most instances, trial courts
did not consider defendants' competence to make decisions regarding the insanity defense and did
not consider whether defendants were informed about the consequences of a successful insanity
defense at the time of adjudication. The average length of stay for these patients was (at least) 21
months; most would have been released earlier had they been committed civilly rather than
committed as a result of insanity pleas. We stress the need to educate judges, attorneys and forensic
evaluators to the importance of considering defendants competence to plead insanity and of
providing information about the consequences of a successful plea. We also propose that laws be
changed to recognize the importance of these elements in the decision making process regarding
pleas of insanity.