title: Informed decision making in persons acquitted not guilty by reason of insanity.
abstract: 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.
authors.affiliation: Georgia Division of Mental Health, Mental Retardation, and Substance Abuse, Atlanta 30303.
authors.forename: R L
authors.initials: RL
authors.lastname: Elliott
authors.forename: E
authors.initials: E
authors.lastname: Nelson
authors.forename: W L
authors.initials: WL
authors.lastname: Fitch
authors.forename: R
authors.initials: R
authors.lastname: Scott
authors.forename: G
authors.initials: G
authors.lastname: Wolber
authors.forename: R
authors.initials: R
authors.lastname: Singh
mesh_terms: D000328:Adult; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence*; D005104:Expert Testimony / Q000331:legislation & jurisprudence*; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence; D007298:Insanity Defense; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology / Q000534:rehabilitation; D008609:Mental Status Schedule; D008875:Middle Aged; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation