What happens after a defendant is found not guilty by reason of insanity?
nytimes.com
nytimes.com
Here, "psychiatric hospital" literally means "prison with carpets". There are locked doors instead of bars, and caretakers instead of guards, but it's a prison all the same.
My brother had a mental breakdown (not violent or criminal, but threatening enough to himself for police to be involved), and ended up in the state "hospital" for quite a while. I almost wish it was a prison instead, because at least prison is honest about what it is.
These "hospitals" may be necessary for some, but as soon as you walk inside, you take a deep dive into the uncanny valley, and you yourself begin to question your own sanity. I won't even try to imagine what it would be like to be thrown inside with no trial, and told that you can't leave unless you prove to your accusers that you are adequately "normal"
The worst thing about the situation is that my brother didn't believe or understand he was ill, and the state gave him every reason to be angry, and reject the situation, rather than come to terms with it.
Thankfully now, he is in an assisted living facility, is allowed to leave, and can feel more like a human being, but while he is very normal, functional, etc. he can't just go find work and go live his life. There doesn't seem to be an end game, and that alone is its own prison.
Additionally, some classes of people are mandated reporters. If they fail to report the threat, or attempt, they will lose their license and, I think, can face both civil and criminal charges. Again, some variation depending on jurisdiction.
Teachers, health care professionals, day care workers, police, etc. are all mandated reporters. They must, by law, report an attempt or threat. An attempt, by law, means a minimum of 72 hours of involuntary commitment. After which, a judge can be called in to extend the stay.
I had a sister who was mentally ill. For my last two years in the Marines, I was a transportation officer at a detention facility (brig), where I was a mandated reporter and sometimes had to work with people who had developed their mental illness during their enlistment or had somehow managed to pass the psych eval and managed to enlist. There were a suprisingly large number of them.
So, I've had some exposure to the system and the missus used to work in the field. For a while, I volunteered to help some of them out. I used to take some fishing, hiking, and to do things like archery practice. I was a mandated reporter during that, and had to take a number of classes on mental health.
If you're curious, I stopped because I don't have the heart for it. It isn't that I don't have a heart for the mentally ill, it's that I don't have the heart for the system in which they are stuck. I don't like being powerless and I was unable to effect change.
Unfortunately, the system is designed to deal with a broad spectrum of people with myriad complexities. They do tend to take a very hard line approach and to assume the worst. They also have reason to not always trust the patient.
It's tricky with mental health. In many ways, it's a damned if you do and damned if you don't situation. This is more true during the initial observation period and one of the reasons many facilities do isolation for the first 24 hours, even for voluntary commitments.
It should be noted that voluntary commitments can rapidly and more easily become involuntary commitments. After all, the patient has already admitted that they are unwell.
Nope, I have no idea how to fix this mess.
Yes. Once admitted you have something no matter how convincing you are. Never talked to someone who walked out having not be diagnosed with something.
Warning: This may be a bit long and hastily written.
For reasons, I once doubted my sanity. To make a long story short, I used to use an obscene amount of drugs. I'm an addict in recovery, sort of - I take prescribed Suboxone.
I didn't use because I didn't feel well, I used because I wanted to feel even better. I was never a stereotypical addict, I was a functioning addict. I had no major trauma, no abuse history, or any history of mental illness.
I used because I liked being high. I wasn't escaping anything. My life was fine. I just liked getting high. My drug of choice was opiates, they helped me sleep and not think all the time. In fact, I have a Ph.D. in Applied Mathematics - from MIT. I have plenty of money, healthy relationships, and no real criminal record, or at least convictions.
So, after rehab, I doubted my sanity. I doubted whether or not I was sane. I mean, what sort of sane person wants to shut their brain down and get high? What sane person knows the risks of addiction but still chooses to inject themselves with untested drugs purchased from shady people?
So, I went to the shrink and we had a few sessions. I did my best to be absolutely honest with them. Even during the peak of my drug use, I was completely honest with my physicians. They are tasked with saving my life, I shouldn't lie to them. I did the same thing with the head doctor.
Finally, he sets me up for advanced and expensive training. It was three eight hour days, one of which was spent taking this giant test called something like the MMPI. It is one of those tests where you fill in the ovals and it's thousands of questions long.
Two of the days were spent talking to people and doing some writing. They didn't feel obligated to hook me up to any of the machines.
It took a bit for the results to come back and it turns out, I'm not even remotely insane. I kind of hoped I was, because then I'd have a reason for some of my choices. Nope... I'm probably more close to clinically sane than the people who administered the tests.
Except, and this is the important part, they won't tell you that you're sane. This isn't verbatime, but it went something like this, "You show no signs of your life being negatively impacted by any diagnosable mental illness. You exhibit no significant traits of any clinically diagnosable disability as defined in the DSM-V." It was something like that.
So, even after all those tests, and apparently being pretty damned sane, they still wouldn't call me sane - only that I wasn't able to be diagnosed with anything on the list and that my life wasn't being harmed by any uncontrolable brain functions.
That's as close to sane as they appear to admit. The initial head doc hadn't done the tests, but had sent me out for them. We both got a good chuckle at the responses.
He then recommended I visit a therapist once a week and offered me some sleeping pills.
At the very least, they do seem inclined to keep you in their care. They won't say you're sane, either. Even when they couldn't pinpoint an issue, they still wouldn't say I was sane. The closest they came was saying that I'd no signs of my life being harmed because of a mental process I couldn't control.
Go figure?
Also, you have an interesting life story :)
whose mental health care provider? Yours, or the one who is legally bound to be an agent of the state? you wouldn't talk to a lawyer who was obligated to report your confidences to the police, so why a doctor?
I think for the majority of cases committing themselves usually makes the situation worse.
The smart people “play” healthy, not admitting ongoing doubts and concerns. Why? Because you go to the hospital to make rapid medication changes. The therapy offered is often insufficient, both in terms of one-one-one therapy and simply what you can cover during your stay. Overstaying is enough to make anyone clinically depressed. It can also cost a lot; while it is illegal to fire for mental health leaves, it is not uncommon to get let go for “unrelated reasons”, to prevent paying for future stays, or simply because they’re uncomfortable supporting their employees to this extent.
Mental health hospitals are aimed at maximizing the number of beds in use, ensuring everyone is at least as medicated as the doctor thinks they can handle, and pumping insurance companies for money. If you are considering one, use it to prevent crises, not to expect any kind of therapy suited for long-term help. The simply do not have the available attention, funding, or even reliable pharmaceutical research to make a dent in the latter.
To be honest, I have high hopes for psychedelics to make fruitful, therapeutic use in a short stay. As it is I’ve lost faith in the pharmaceutical industry to demonstrate the pills they make are effective, let alone not harmful to the general population. 3/5ths of the mental health prescriptions I’ve been given have been pulled from the market, linked to high suicide rates, or linked to other serious medical issues (no shit, Risperdal made me lactate as a male.)
...and of course, the absolute worst part is seeing people you know will never function in society, many rimes without family. I suppose better the asylum than the street, but we will likely always need long-term mental health care in publicly funded facilities.
Thoses drugs are dangerous and do not cure a patient usually leaving them in a worse state mentally. When you are the one forced to make these decisions its tough because there are no easy answers.
I find the traveling through time reference interesting. I remember the line from slaughter house 5. What cosmic truth was he approaching?
> People see distorted faces, visions, hear things and the worst part are not these hallucinations, but delusions, strong beliefs
> but to them it was like they really uncovered some deeper meaning.
> ome internal conflicts ... and then started decompensating
If anyone is interested in a taste of what that might be like, the recent game "Hellblade: Senua's Sacrifice" is very impressive. It's basically a psychosis simulator, developed under heavy consultation from a group of patients that suffer from psychosis/delusions.
Similar to how you mentioned it's not just the hallucinations, the game does things like using "find the perspective that makes those logs look like a rune/glyph" to prime/encourage the plater to see potential "deeper meanings". Headphones are required, because binaural recording techniques are used very heavily to e.g. place voices in specific locations "in" and around your head.
Warning: this recommendation includes a very strong trigger warning re: grief, mental and physical abuse, and (obviously) the very graphic realities of severe psychosis and other mental health issues.
Commentary by the devs and some of the consulted patients about making the psychosis simulator: (some mostly-minor spoilers) https://www.youtube.com/watch?v=0jF3rr6t2Hg
Development diaries: https://www.youtube.com/playlist?list=PLbpkF8TRYizaT6GfMcKBG...
If you prefer watching as LP, I recommend (Yogscast) Hannah's: https://www.youtube.com/playlist?list=PLK9CD9s2JfIeoub7dINHI...
It helped my Mom and me immensely when our family member had a psychotic break. I highly recommend them if you can make the time.
- C.S. Lewis - That Hideous Strength
When Tom was just 18, he had finished school and was headed off to a large university on a sports scholarship. Not having any money, and coming from a poor family, he looked forward to this. It was going to be his big break.
But, Tom needed a wardrobe fit for a nice university. So, Tom went to the mall and proceeded to steal some clothing. Security tried to stop Tom so he pushed the security guard and ran away.
Tom, of course, went to jail. The DA offered Tom a 30 day sentence in a plea agreement and Tom, deciding his life was over, took a razor blade and cut his own throat.
Tom's 30 day sentence resulted in 10 years in a State mental hospital. Curiously, when he was released from the mental hospital, they still made him serve his 30 days.
Tom, now having nothing and a giant scar where normal skin once was, tried to meander through life as best as he could. This is where I met Tom. Tom loved drinking and doing drugs. His childhood years of experimentation had been lost to the system and Tom was making up for that. Tom and I had good times. I eventually moved on and no longer spent time with Tom. I'm not sure who was a worse influence on who, but that's immaterial and a story for another time.
One day, Tom had had enough. He just wasn't going to function and decided to end it all. He went down to the facility where he normally met his providers and took someone hostage. This, of course, resulted in the police being called.
Tom, for all his brilliance, was having none of it. The police came through the door and Tom attacked the first one through the door with his knife.
I'd like to say he put up a good fight, that he gave a good showing, and that he fought long and hard. No, he did no such thing. Cops being cops, Tom hadn't made it more than a couple of steps before they shot him.
Tom survived and is now back in that same State hospital. His letters tell me that he is even back in the same room. He expects to remain there for the rest of his life and likes to think he was sane, but just desperate, when the shoplifting occurred. He strongly suspects the system has made him even less sane and even more unstable. He seems to be okay with spending his life there.
All for some clothing to fit in at university...
This is the core of Robert Whitaker's thesis: psychiatric medications take a episodic condition and make it chronic. Ref: anatomy of an epidemic (2010)
In Psychiatrists Must Face Possibility That Medications Hurt More Than They Help, blogger John Horgan says the most recent studies seem to confirm Whitaker's hypothesis: https://blogs.scientificamerican.com/cross-check/psychiatris...
A decade later, he's been released- under a lot of conditions and on a lot of medication, but people are very upset that he'd ever be free at all. In interviews, he's a very interesting person. "Regret" and "shame" aren't strong enough words.
It's a hard debate- if he was not guilty due to a medical condition, then he was not found guilty and shouldn't be in prison, certainly. But he did cut a guy's head off. Would you want to live next to the guy who did that while not in control of himself?
It's the extreme end of the situation, to be certain, but extremes are a great place to examine any system.
No, he's been given an 'absolute discharge'. There are no legal obligations for him.
This is one of the biggest issues we have in this country, our prison system is used to make up for a lack of mental health care.
I'd not want more money than it costs for upkeep and I'll not be a physical caretaker - I don't wash asses. Still, I've got plenty to keep someone occupied and they'd have to be alone when I travel. I guess I'd want to be pretty selective, the person(s) would have to be interesting and intelligent.
I'm not sure if the missus would be happy about it, but she might be. She used to work with the mentally ill.
Someone locked up for insanity wouldn't be released while they are still a danger to the public. But anyone imprisoned for a violent crime might be released while still a very clear danger to society, even murderers and similar. Time limited sentences work that way.
Although I guess it would make more sense to be looking at a chart of 2nd offences.
My understanding is that prisons are said to have four purposes: deterrence, incapacitation, retribution, and rehabilitation.
However, in the absence of having prisons a society would likely create prisons to protect the people of society. My conclusion is that prisons are meant to protect the populace with those other reasons being secondary based upon cultural mores.
How would prisons protect people? By deterring the people who might endanger them, by removing the capacity of people who do cause harm to cause more harm, by punishing those people, and by rehabilitating them into society.
The reasons aren't secondary or primary. They're different sides of the same coin, just stated from different perspectives: how to deal with the problem of crime vs. how to protect society from criminals.
I know of people on various medications for psychiatric reasons that have (against their doctor's recommendation) gone off their meds because they didn't like the side-effects. That might be fine (if unfortunate/difficult) for a mental illness that doesn't drive the sufferer to violence, but in the case where it does, how can you responsibly release someone if you don't have a mechanism to ensure they stay on their medication?
I think the actual 'enforcement' in the way you are thinking would be backed up with some kind of court ruling that they were required to take the medication, I'm not so sure how that angle would work.
They don't seem to work in that sense. There doesn't seem to have been a reduction in hospital use in that group.
English MH treatment is very different to the US though.
Well, if he is considered sane by trustworthy professionals, then why not?
I can't see how it's different to live next to someone who is cured after 10 years of treatment, as opposed to say someone who was in prison for 10 years for the same crime (Where I live this would likely be considered more severe than the normal 12 years out after 9 though). Probably 18 or life, where "life" is often at least 18.
I'd prefer not to live next to that person, but there isn't really much I can do about living next to an ex convict, or in this case an ex- mental patient?
Psychology as a science is remarkable in its inability to make accurate predictions. I'd ask those professionals be criminally liable if their assessment proves inaccurate.
I'd ask those professionals be criminally liable if their assessment proves inaccurate.
Similarly a DA only attempts to prove to a jury that a defendant is guilty and it us their job to argue as much.
If an expert witness claims something that is untrue he would be subject to perjury.
If we want to have concept like people being cured of medical conditions, then we must also accept that doctors will make imperfect distinction between healthy and sick.
The question society must make is how far we can accept that mistakes happen, and what safe guards we impose to handle the situations when someone fails.
Obviously if someone is found lying they should be held responsible - but the released person reoffending does not make the evaluation willfully dishonest.
Now, this is a nearly non existent problem isn't it? For major crimes, being locked up in psychiatric care is a longer, or indefinite sentence, than would be served in prison (this varies between countries of course).
This guy was getting locked up no matter what. The only question was, was he getting locked up in a prison or in a psych ward? So do we trust psychiatry enough to say "lock him up here rather than there"? Sure.
Do we trust them enough to say "It's safe to release him now"? That's a harder question.
In the involuntary commitment case, is it reasonable to hold a person longer than what the equivalent prison sentence would be, even if the person is still considered mentally ill after the equivalent time?
In England a prisoner who becomes mentally ill and is sent to hospital will be kept in hospital until they are well. The legal powers to send them to hospital and keep them there are listed in the Mental Health Act. People are detained under section of the MHA - commonly known as sectioned.
When a prisoner detained under section is in hospital and their prison sentence ends their section is converted to a different one, which allows treatment to continue.
That's not true. Doctors didn't make a decision to lock up the individual.
It's much easier to say that someone who executed other people is crazy than it is to say that person's craziness and tendencies toward evil have been cured.
Yes it's hard to say someone is sane, and also rare. Which is why this is such a small problem - people aren't often declared sane and released if they committed serious crimes.
> It's much easier to say that someone who executed other people is crazy than it is to say that person's craziness and tendencies toward evil have been cured.
No. It's literally the exact same evaluation. The reason it feels easier is because the stakes seem lower. Lock someone in prison or hospital? Big deal? When releasing, it's a risk assessment too. But the evaluation is exactly the same.
> No. It's literally the exact same evaluation. The reason it feels easier is because the stakes seem lower. Lock someone in prison or hospital? Big deal? When releasing, it's a risk assessment too. But the evaluation is exactly the same.
You said I was wrong, and then wrote text that supported my comment.
It doesn't matter if the evaluation is the same. The state of sanity differs from the state of insanity, yet not showing insanity is different from showing sanity. There are true-positives, true-negatives, false-positives, and false-negatives.
> showing insanity is different from showing sanity. There are true-positives, true-negatives, false-positives, and false-negatives.
Right. And a false positive might send someone to this facility instead of prison while a true negative might let someone out while dangerous.
For example, soldiers kill people, because it's "war" or they have "orders" or it's "the just way to deal with things".
If they'd kill the same person on the streets as a civilian, everyone would be disgusted and angry. Yet for it's former reason people feel the need to give medals and applaud.
You should think about this really hard for a second.
Our minds are not entirely our own, and simple cognitive pushes here and there can change our entire perspective just like that, while OBJECTIVELY it's still a dead human in this particular example.
With that said, one should not seek black and white answers in this concept. Mentall illnesses and for that matter the law system are dynamic and constantly in motion.
If that became the case, no one would be released, ever.
There is science, and there is Science.
Now, this is obviously a hard and delicate problem when it comes to the releasing part of the equation.
But the argument that they are either incapable or untrustworthy to make the judgment doesn't fly - why were they capable and trustworthy when locking someone up then?
1) The person would have been locked up whether found sane or insane. The only different was location.
2) You are admitting facts not in evidence, when you assume that the doctors were capable and trustworthy when determining the insanity. There is science and there is Science.
Right. Which is why that decision is done with lower stakes. But
> You are admitting facts not in evidence, when you assume that the doctors were capable and trustworthy when determining the insanity.
All I'm saying is that regardless of how accurate and trustworthy they are, if we trust them do do A we better trust them when doing B, even if the stakes and risk of mistakes are higher.
I can't see any other solution, do you? The only theoretically possible solution would be to lock people up for life if found insane - but I don't think that's a viable approach.
It's much harder to tell whether a person will offend again, and there are severe consequences if that person does offend again, so professionals are risk averse.
Right. But this often takes place several months or years after the crime was committed. So might still be difficult.
> It's much harder to tell whether a person will offend again, and there are severe consequences if that person does offend again
Yes, someone might get hurt. So yes, risk aversion involved. But also: there are severe consequences for the opposite too. Remember this is a person that is not guilty (responsible) for a crime, that is kept locked up.
Manitoba, not Ontario. I remember my shock of this happening in Western Canada where I was at the time.
Although there's some dissent, in law the typical expression you hear is the opposite: https://en.wikipedia.org/wiki/Hard_cases_make_bad_law
I would prefer to not live next to anyone who if they got the wrong medical condition, the wrong combination of drugs or medical procedure, or wrong parasite, could go on a rampage and kill someone. The question is if that is possible, or if its just part of human biology that medical with the wrong set of circumstances there will be a fringe possibility that people do things which they otherwise would not.
“Free will” isn't something “science isn't sure even exists”, it is instead fundamentally incompatible with the model of reality which is required by science.
Like, do people have free will while they are sleepwalking? Science doesn't have a good answer, but people have successfully been acquitted of crimes they claimed they committed while asleep. It's far easier to answer questions about free will when you think of it in legal terms, and it matches up pretty well with your intuitions about things.
Perhaps there is a combined higher probability that one of your other neighbors will one day snap and go crazy than the medicated/or rehabilitated one doing so again. Unless you're not worried about that, but rather your "sensibilities are offended" by his action. Well, in that case, "the devil you know..."
"... we have to be respectful of people who disagree with the decision on that basis, but recognize that we've made a decision as a civilized country that we don't punish people who really didn't know what they were doing at the time of the offence, and really didn't know that they were doing something wrong, and that's a very, very small subset of people..."
In the US, our insanity defense laws are setup to maintain the appearance that we are a civilized country during the court phase - and then after the case vanishes from the headlines, we become savages that lock these people in padded rooms, often until they die. Canada actually is a civilized country that is willing to abide by the spirit of such laws, even when the outcome is controversial.
I'm an American, but I find myself cringing more and more when I say that these days.
[1] http://www.cbc.ca/news/canada/manitoba/vince-li-discharge-1....
He was too dangerous and unpredictable to live with us anymore. The rest of the family kept weapons under our beds of various kinds, hoping to God we would never need to use them. A group home was a joke, he would have assaulted someone within a week. He would escape and start driving on the wrong side of the road on purpose for "reasons". We hid the keys, but he was above normal intelligence despite his insanity and would always find them. He would attack his family and the neighbors when he thought we were after him.
His prospects were jail and homelessness, we were so happy when he ended up in a high security mental facility, ecstatic.
Now he's in a place that's better than jail or being homeless where people care about him at least a slight amount and there's relative safety. He's not surrounded by criminals, behind bars, or dying on the street.
Yeah, it's not a great place to be, but the best outcome an extremely schizophrenic large male can hope for. He doesn't deserve jail because he has no bearing on what is allowed in society and attacks people out of fear. When he's calm it can seem like you're talking to a normal person for a few minutes. Then he goes off the rails... But still there's a really intelligent shard of sanity in there somewhere.
Still, our history with mental health facilities shows that we have a less than stellar reputation of actually treating individuals - wouldn't surprise me if to this day there are still people locked up in these places that SHOULD be capable of release.
I think a problem in the US (at least by appearance) is that the regular prison system for those found same offers too little rehabilitation and care fit minor psychological disorders such as hyperactivity disorders etc. Locking half as many people up for half as long as they are currently would quadruple resources available to rehabilitate those who need it.
> After the incident, People for the Ethical Treatment of Animals attempted to run an ad in the Portage Daily Graphic comparing the killing of McLean to the consumption of animals
WTF peta?
http://slatestarcodex.com/2014/12/17/the-toxoplasma-of-rage/
Couldn't the supreme court rule this type of punishment as "cruel and unusual punishment"? Technically there is a policy of reviewing "every 2 years" in perpetuity, so it's not like they don't have a formal punishment.
They mention a Supreme Court ruling regarding "due process" but not the 8th amendment. So it's basically as if this is sidestepping the constitution by pretending they aren't being punished?
https://www.wikiwand.com/en/Eighth_Amendment_to_the_United_S...
The Supreme Court has ruled that lifetime sex offender registration, despite few demonstrable positive effects on sex offender rehabilitation or sex offense prevention and despite their only apparent goal being the unpersoning of people who commit certain offenses, does not transgress the Eight Amendment because the sex offender registries are a "public safety" measure, not an actual punishment. Doubtless they will do the same for something like this.
What is the purpose of such database? It falls or stands on recidivism. If there is a way (e.g. medical cocktail) where the chance of recidivism is close enough to 0 just like the average civilian there's no practical need for any "special" register. This stands on the premise that the sex offender actively uses their medical cocktail as prescribed.
This is what you will continually see, and only a separate state, such as the Federal Government existing in parallel jurisdiction, is able to step in, which it doesn't do mostly for historical reasons.
Cruel and unusual punishment applies regardless of actual or claimed innocence, they could have totally done the crime and the punishment could still be unconstitutional.
This is not a catch-22 side effect of inflexible poorly written law, but an intentional side-stepping of built-in protections against abuse of power.
1) Keep professing innocence and stay in prison.
2) Lie and express remorse, and maybe get out.
3) Lie and express remorse, and maybe get out... and then work to retroactively exonerate yourself, when you're on the outside and actually have some chance of doing so without a lucky guardian angel taking interest in your case while you're in prison.
There are no legal ramifications to "admitting" guilt and expressing remorse. You already have the conviction on your record, so in the eyes of the law, you committed the crime, end of story.
I'm sympathetic to the parole board here, to be honest (which feels really weird to say). While they of course know abstractly that some innocent people are in jail and shouldn't be, they don't have much to go on when it comes to the prisoner in front of them. They have the prisoner's conviction record, without enough context to make a guilty/not-guilty call of their own (and do we even want them making a call along those lines?), and their purpose is to determine if the potential parolee is likely to re-offend. They have to assume the conviction record is correct, or it's basically impossible for them to do their job. And if it is correct, and the prisoner professes innocence, they can't responsibly say that releasing them is a good idea.
Beyond that, if the prisoner is indeed innocent, there is a process for dealing with that outside the parole process. It's not perfect, and it's difficult for a prisoner to gain access, and I'm sure could stand to see some large improvements, but the parole process just isn't the place to get your sentence reduced because you actually are innocent.
Being a convicted felon has long repercussions outside of your original jail time where this calculated - seemingly rational - strategy you discuss is only a short term one...
There is an important point brought up in the OP's linked wikipedia page:
>> Medwed's Second Look clinic, a group dedicated to the release of innocent prisoners, assisted lawyers in his eighth parole board hearing which was successful, releasing him onto indefinite parole. Overturning the original conviction would be hampered by his admissions of guilt at his parole hearings.
The admission of guilt extends well beyond the release from prison. Including jobs, reputation, future convictions... not to mention the possible compensation he could receive for if the original wrongful conviction is overturned.
But I wouldn't want to bet on the supreme court deciding anything about this is unconstitutional, they haven't been inclined to in similar situations when it has come before them.
This is merely legal theatrics and these people are being punished. If these facilities were at least decent places to stay I wouldn't care as much. But they are held essentially in a prison with nurses, indefinitely, regardless of their original offence. Probably with more restrictions than prison. The guy couldn't even get an extra sugar in his tea without a big ordeal...
This is something that needs to be handled through a formal process. Why not give them a real sentence in a medical facility, then when it's done if they are still not 'ready to go back into the public' due to public safety, via a panel of doctors, then have another process with it's own means and standards which have to be passed (within the scope of criminal law) with a bar high enough appropriate to the punishment.
This is not without significant costs to the public either... those doctors, lawyers, courts, and law enforcement involved are extremely expensive and there are more than enough better uses for these resources than getting some emotional gratification of locking people away for little societal ROI.
I was thinking about this, but the numbers don't support this interpretation. It seems like involuntary commitment post-NGRI would be a place rife for abuse, and yet such a tiny tiny tiny fraction of criminal cases go that way. You'd think the number would be much higher if prosecutors wanted to use NGRI for nefarious purposes.
Whether it's a hundred or a thousand I don't see the rationale being any different here. This system seems entirely intentional to me (for very understandable human reasons but ultimately wrong reasons), it's not just an unfortunate side-effect.
I know public services and human effort is a matter of finite resources and prioritization, but there are plenty of human hours involved in each of these cases, from judges to doctors to the victims of the crime, it is not a lot to ask for them to stop bypassing the system and put them through a formal process within the context of their crime.