How difficult is it to be released from a mental hospital after Not Guilty by Reason of Insanity?

Inspired in part by this:

What are the procedures and policies like (especially in practice) for determining whether or not someone who has been found NGRI by the courts should be released? Are people found NGRI subject to different, or higher, standards for being found competent to live in society than others that have gained the attention of mental health law?


John is an involuntary patient at a mental hospital. He was never found NGRI (or convicted of a crime), but was adjudicated into “the system” through the civil court system after his wife reported that he was unstable and was concerned that if he didn’t get help, he might commit a crime. His diagnosis was <diagnosis>.

Bill is also an involuntary patient at the same institution, but he was put there after being found NGRI for a crime. His mental health diagnosis was the same as John. The primary difference is that Bill didn’t attract the attention of the law and the medical establishment until after he had slipped so far that he actually killed someone (or something similar).

Both John and Bill are up for evaluation for potential release. Will Bill be held to a higher standard (e.g. must be stable longer, or must demonstrate a greater amount of stability and sanity) than John? If so, what exactly would the difference be?

Actual cases, applicable statutes, hospital policies, or other such rules might be interesting.

I believe Ii depends on state law. In NY the psychiatrically incarcerated have some due process rights, are represented for free by Mental Hygiene Legal Services, and can seek a jury trial for their release in some instances.

For the most part “NG by reason on insanity” is an indefinite sentence, to include “forever.”

I’m not sure if that helped answer your question or not.

Sorry, not really. I’m more interested in whether or not there are either substantive differences in how one gets out (NGRI, or just a plain civil commitment), or whether or not an NGRI is a mark against you for release when you actually are being evaluated later.


Dr. Smith: “I think we can release him. I have observed him for the past 6 months and reviewed the previous doctor’s notes, and he has demonstrated a year of stability and is clearly capable of functioning in the real world.”
Dr. Jones: “But he was found NGRI for murder!”
Dr. Smith (shuffling papers): “Oh, I must have missed that in the intake report. In that case, no, he’s not ready. Let’s wait another year.”

Depends on the laws of the jurisdiction, but it’s VERY difficult in Australia. The Australian equivalent waives a considerable aspect of what one would consider due process, and in some cases even right of trial by jury even though the person may be fit for trial.

Depending on the type of mental disorder, they may not be committed to a psychiatric institution at all, but to regular ol’ prison and forced medication.

If you’re asking what happens in cases that hasn’t reached trial yet for whatever reasons, the person would be in pretty much self-arranged care able to admit and discharge themselves at will, whether the care is provided by the state or privately funded. Most people who are seeking such a defence voluntarily submit themselves to such facilities since it is in their best interest (an established mental health care plan is always favoured to forced psychiatric care), plus the kind of “prison hospitals” you think of can’t receive admissions wihout an NGRI.

If a person for whatever reason was apprehended by police and then sent to a psychiatric facility for assessment and admission, they cannot hold the patient past a set number of hours as mandated by the legislature except under very special circumstances.

So in your scenario, John can discharge himself at will any time since he admitted himself at will in the first place and there will be no “review for discharge”. If Bill is in a prison psychiatric facility, upon “evaluation” he would either be released straight into prison (the type of prison depends on the type of crime) or into the care of a private facility (generally this latter case means they’re waiting for him to kick the bucket). Once he serves his prison term, Bill’s out, mental health status notwithstanding.

As for your requests for case laws (this is impossible since your request is about “what happens after it’s gone through the court” - the court only records, as it were, court cases that happen within the confines of the court), statutes (these things span a labyrinthine mess of hospital regulations, mental health regulations, sentencing regulations, crime regulations and so on), trust me it’s not interesting. What’s interesting is the legal fiction of the “criminally insane” is so pervasive people think it’s real.

No, John was INvoluntarily committed. I don’t have the final answer to the OP, but:

Here in NJ, and I’m sure in most if not all other states as well, the patient has certain rights to challenge such commitment, and IIRC the burden is upon the facility to demonstrate that the commitment should continue, that the individual is still a danger to him/herself or others.

I have no idea whether having also been found to have committed a crime for which he/she would otherwise have been sent to prison has any impact on the process or not, but I would think that the sentencing court would have some input into the decision.

This is one of the things that I am wondering about in the OP. That is, all other things being equal, is a person going to face a more difficult challenge in getting out of a mental hospital if they were put there due to NGRI in a criminal court as opposed to being involuntarily committed in civil court (requiring only a showing of mental illness and danger, without a requirement to show the actual completion of an antisocial act that would be a crime if committed with the right intent)

Hello all My name is Gillie and back in 2007 I was found N.G.R.I. on a plea deal and was only two do two years in a mental hospital and get out well I don’t take meds, and I have been in Texas courts alot on trying to start a Risk asistment and Ive been here for 5 years now fighting the courts on getting out…

As a generalisation, it is harder to get out after an NGRI than after mere involuntary hospitalisation. The quantum of difference it makes will vary across jurisdictions as a result of local laws but also because of the vagaries of funding, the local community’s and local psychiatrists’ appetite for risk, and so on.

The reason is obvious enough.

Most unwell offenders who commit minor crimes don’t plead insanity-they frequently want the certainty of an ordinary sentence. Gillie is an example of what can happen, and is an exception to the general point I make. So it’s typically only the high end crimes where it’s worthwhile to run the defence.

Thus, the population of people who are found NGRI is skewed to towards those who have committed very serious offences. It means that their personal disease processes have led them to behave in (typically) very violent ways that are also unpredictable. The disease processes of general involuntary patients have not, or else they’d be in the NGRI pool, too.

The static risk that the history represents means that it takes longer to be confident the NGRI patients are stable. A person who is resistant to their meds who has a history of muttering in the street if they go off them is one sort of risk; a similar person who has killed if they go off them is quite another.

Yes, the main issue is - if a person has already committed something horrible, the doctor signing to release them is essentially putting their reputation on the line. I would imagine they would indeed look harder the more serious the NGRI crime.

There seems to be a difference between the 2 people in the OP’s example. One person has seemingly gone farther then the other, perhaps crossing lines that would tend to make one person needing more ‘help’ then the other in leading a normal life.

But even being convicted of a crime or a guilty plea does not mean that the person has actually done the crime, so that line may have never been crossed, also the person who was involuntarily institutionalized without committing the crime may have actually passed that line in their mind, made a decision to do it just stopped before getting the opportunity.

So there are cases on either side where a person may be seen as going further and therefor needing more or different help.

And also the real world issue is having a dr willing to sign off that this person who was found NG-BROI is fit to leave, which takes some more, errr balls, then a person not in that situation.

Well, if you saw the postcard Charles Manson sent to Marilyn Manson, it’s quite clear that man should never be released.

OP returning here.

Let’s assume that Bill and John are equally mentally ill with the same fundamental diagnoses, and if all other things were equal, they both would have insanely killed. The difference is that John had a concerned family member who “reported” him to mental health authorities and they were able to institutionalize him before he actually pulled the trigger. Later psychiatric analysis results in the conclusion that John was, actually, homicidally insane but just hadn’t gotten around to pulling the trigger yet and the intervention prevented it. The only reasonable conclusion of the treating doctors was that he would have pulled the trigger had it not been for the intervention. Bill didn’t have such a strong support network and there was nobody who thought to help, with the result being that he actually pulled the trigger. Now, both are institutionalized. All other things being equal, will John have an easier time getting out, for example might the hospital release John after only 6 months of acceptable behavior while require that Bill show two years of acceptable behavior, all because of the fact that he completed his homicide? Let’s assume that we can equalize their support networks (say, John’s wife has now left him for his less crazy high school rival so John and Bill’s outside support networks are equal)

Well, at the facility where I work, the scenario would typically be something like this:

John has violent delusions and paranoia. He is ordered by a court to be held for 72 hours for evaluation and treatment at a state run psychiatric hospital. The doctor petitions the court, and is granted, a further 120 day commitment on the ground of John being dangerous to the public. With treatment, John is able to resolve the symptoms of delusions and paranoia. His doctor is satisfied that he has no homicidal or suicidal ideation. A social worker works with him to arrange follow-up care and housing. John is discharged with a prognosis for recovery that takes into account his behavior, social support, willingness to change, etc. So long as John does not commit a criminal offense or behave in any way that would get him committed, the hospital and the court have no further say on what he may do. He may continue to seek treatment and take his meds, or he may throw away his pills and live as a transient.

Bill murders his wife in a delusional paranoid state. He is found not culpable for his actions by a court-appointed psychologist and NGRI by the court. He is committed to a stay in a psychiatric facility and is treated and stabilized. Whether it is 6months or two years into his incarceration, the doctor must make his recommendation to the court for his release, the court must agree, arrangements must be made by the social worker and public defender, and conditions must be set. When Bill is released, he is on a sort of probation; he must continue to take medication as directed, he must check in periodically with an officer of the court, he must continue to attend therapy or treatment. He may not leave the state, etc. If he violates any of these conditions, he will be committed again until such a time as his doctor is satisfied he should be released and the court agrees.
We actually have a guy who has been here over 30 years, with some brief discharges here and there, because even though his delusions have resolved, he is unable to function safely in society. Partly because his is so institutionalized because his long stay; whenever he has been released he has associated with criminals and committed minor offenses (drug possession, trespassing). With no social support, it is likely he will never be permanently released.

Sorry for the lengthy post, but I wanted to answer OP’s question as thoroughly as possible.

Charles Manson may be a nut, but he was convicted as an ordinary criminal. He is in prison, not a mental hospital.

You don’t get to plead NGRI just for being insane. You have to be the kind of insane where your psychosis is so severe that you are unable to understand that your actions were wrong.

Most mentally ill criminals (even psychotic ones) don’t fall into that category.

Silly, isn’t it.

Of course the courts must fear if they started not punishing anyone mentally ill, then very shortly it would be discovered that most of the theories behind the modern justice system such as deterrence are simply untenable…

Very true.

Long ago in grad school I was forced to read the relevant statutes from every state. friedo has nailed it.

If anyone’s really interested it goes back to the Mc’Naughten rule: M'Naghten rules - Wikipedia