SEPTEMBER 2006
NOT GUILTY BY REASON OF INSANITY IN NEVADA
By Melissa Piasecki, M.D. Associate Professor, and Steve Zuchowski, M.D. Assistant Professor, University of Nevada School of Medicine, Department of Psychiatry
The question of criminal responsibility in mentally ill defendants is one of the highest-profile topics in forensic psychiatry. Perhaps no recent case has generated more controversy than that of Andrea Yates, the Texas woman who drowned her five children in 2001. Initially found criminally responsible, upon retrial the jury found her not guilty by reason of insanity because, according to some experts, she believed she was acting in her children’s best interests in killing them. In this brief article we will describe the current standard for Not Guilty by Reason of Insanity (NGRI) in Nevada and explain how criminal responsibility is evaluated by a forensic psychiatrist.
There is a wide variation among the states in relation to how mental illness influences criminal responsibility. Some states (Idaho, Utah, Montana and Kansas) do not allow for the defense of NGRI. Other states have relatively liberal definitions that encompass volitional (irresistible impulse) as well as cognitive elements. Nevada abolished the plea in 1995. In 2001, the Nevada Supreme Court reinstated the plea in the case of Frederick Finger.
In 1996, Finger, who had a history of schizophrenia - a chronic mental illness often characterized by delusions (fixed, false beliefs) and hallucinations (false sensory perceptions) - killed his mother with a knife. In spite of limited statutory options, Mr. Finger initially pled NGRI and then refused to enter another plea when his NGRI plea was rejected. Ultimately, he pled guilty but mentally ill, planning to raise the constitutional issues on appeal. He was sentenced to a prison term. His appeal to the Nevada Supreme Court resulted in a ruling that stated, “To be legally insane, a defendant must be in a delusional state such that he cannot know or understand the nature and capacity of his act, or he cannot appreciate the wrongfulness of his act, that is, that the act is not authorized by law.” (Finger v. State 2001).
The Court elaborated that the NGRI defense would apply only in very specific circumstances. One application would be if a delusional person was so cognitively disturbed that he did not know or understand the nature of what he was doing. For example, if a man, due to a delusional belief that he was shooting someone with a water pistol rather than a real gun, committed a killing, he would be eligible for an NGRI defense. Also, if a defendant’s actions are based on delusions, which if true would be justifiable (i.e. he could not appreciate the wrongfulness), he would be eligible for the NGRI defense. For example, if a defendant held the delusional belief that his neighbor was shooting at him with a gun, the defendant, finding no alternative except for shooting back in misperceived self-defense, would qualify for the NGRI defense.
Many people confuse the concepts of competence to stand trial and criminal responsibility. Competence to stand trial is a present-state evaluation based on the Dusky standard (Dusky v. U.S. 1960). That is, can the defendant consult with a lawyer with rational understanding and does he have a rational and factual understanding of the proceedings? A criminal responsibility evaluation is a retrospective assessment of a defendant’s mental state at the time of the alleged crime.
Key elements to the psychiatric evaluation of criminal responsibility are the presence of a mental illness at the time of the event and the role of the mental illness in determining the person’s actions. In order to determine presence of mental illness, the forensic psychiatrist looks for past evidence of mental illness (as found in treatment records) and for evidence of disturbed thinking and behavior in the records from the time of the event, such as police reports and contemporaneous statements given by the defendant, the victim, and witnesses. Because an examination for criminal responsibility often occurs months or even years following the event, the mental state of the defendant at the time of the evaluation may not be critical in the evaluation of criminal responsibility. A defendant may develop symptoms of mental illness after the criminal act (e.g. triggered by the stress of incarceration) which likely has no bearing on his criminal responsibility.
In order to retrospectively determine the role of mental illness in the person’s actions, the forensic psychiatrist again turns to past records. This is, in part, because many defendants no longer have clear recall of their thoughts and motivations at the time of the event. Defendants may also deliberately seek to deceive the examiner by retrospectively claiming false symptoms. A record review is central to sorting these issues out. Evidence of avoiding detection, evasion, and covering-up actions suggest that the person knew the wrongfulness of his actions.
A third important element in the forensic evaluation of criminal responsibility is determining whether or not the defendant was intoxicated by drugs or alcohol at the time of the event. This is of critical importance because Nevada statutes exclude voluntary intoxication as grounds for acquittal (NRS 193.220). Substance use is most often established by reviewing medical and other records as well as by interviewing the defendant. Not uncommonly, mental illness and intoxication are both factors in determining the defendant’s behavior at the time of the act. These complicated situations are likely to be sorted out on a case-by-case basis.
If a defendant is acquitted NGRI in Nevada, he is committed to a forensic hospital (Lakes Crossing Center in Sparks) for an evaluation to determine whether or not he continues to be a “mentally ill person” as defined in NRS 433A.115. A hearing immediately follows and if the person meets the statutory definition of being a mentally ill person, the Court may recommit him with periodic reviews. If mental illness symptoms remit or resolve to such an extent that he is no longer dangerous to self or others, the Court may order his release. Unlike many states with NGRI provisions in the law, Nevada does not yet have a formal conditional release program for NGRI acquittees.
Melissa Piasecki, M.D., is an Associate Professor of Psychiatry and departmental Vice Chair for Education at the University of Nevada School of Medicine. She is also on faculty with the National Judicial College and the National Council of Juvenile and Family Court Judges. Dr. Piasecki received her Doctorate in Medicine in 1991 and recently completed her fellowship in Forensic Psychiatry at the University of Hawaii, where she also served as a Hawaii Court appointed forensic evaluator. She has an extensive list of publications, articles and books in clinical and forensic psychiatry.