Monday, March 30, 2020

Supreme Court Upholds States’ Rights to Nullify Insanity Defense

The U.S. Supreme Court ruled last week that states can prevent criminal defendants from pleading insanity without violating their constitutional rights.

In the case Kahler v. Kansas, the justices ruled 6-3 in favor of the state. The defendant, James Kraig Kahler, had been sentenced to death for the murder of his family. His lawyers wanted to mount an insanity defense, but Kansas is one of four states that eliminated a defendant’s ability to plead not guilty by reason of insanity. (Idaho, Montana, and Utah are the others; Alaska substantially limits the insanity defense.)

Justice Elena Kagan wrote the majority opinion for the court, saying that Kansas takes into account a defendant’s mental health at both trial and sentencing, but the option of an insanity defense and the scope of its application are “for Kansas to make—and, if it wishes, to remake and remake again as the future unfolds.”

Experts in psychiatry and the law said that the decision could have significant consequences. “The most immediate impact of the case is on Kansas and the four other states that have elected to effectively get rid of their insanity defenses. Their laws will remain valid,” said Paul Appelbaum, M.D., a member of APA’s Committee on Judicial Action.

He said the longer-term impact of the case is more difficult to predict because states can make their own choices; 45 states and the federal government retain meaningful insanity defense laws. “Given the long-standing acceptance of insanity as a defense to criminal charges—dating back in the Anglo-American tradition to medieval times—most states will probably choose to retain that option [for defendants who want to plead insanity],” Appelbaum said. “Defendants in the states without an effective insanity defense will be most adversely impacted by the decision. More people with severe mental illness will spend decades in prison.”

Debra Pinals, M.D., chair of the APA Council on Psychiatry and Law, agreed. “Persons with serious mental illness who engage in criminal behavior living in states with narrower criteria for insanity, or in states with no insanity defense, will likely be found guilty and sentenced.”

For related information, see the Psychiatric News article “States Move to Exempt People With SMI From Death Penalty.”

(Image: iStock/Amy Sparwasser)

Join APA-NABH Webinar on Caring for Patients Through COVID-19 Crisis: April 1

APA and the National Association for Behavioral Healthcare (NABH) will host a joint webinar on Wednesday, April 1, from 2 p.m. to 3 p.m. EDT with experts working in inpatient, residential, and other nonambulatory care settings about how they are assessing the current environment and developing new protocols to care for their patients during the COVID-19 crisis. Hear from experts about the management of different types of services, key messages to give your team leaders, unique challenges for people with serious mental illness (SMI), how to handle group therapy, and more. Questions can also be submitted via chat during the live session. A recording will be posted after the event. More information about the webinar, including how to register, is posted here.


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