October 28, 2003 -- On the hit TV show Law and Order, defendants and their lawyers seek insanity pleas in hopes of lesser sentences for their crimes. In real life, sanity evaluations are high stakes undertakings that are backed by very little research or analysis according to an examination led by Janet Warren, professor of clinical psychiatric medicine and associate director of the Institute of Law, Psychiatry and Public Policy (ILPP) at the University of Virginia Health System. Her findings raise questions concerning how sanity decisions are applied in the state of Virginia and will appear in the October issue of Behavioral Sciences & the Law.

According to some researchers and experts in the field, guidelines for practicing in the area of forensic psychology can be ill defined, an accusation that warrants concern from courts and citizens alike. Warren’s finding with the broadest societal concern was that minorities were less likely to receive an insanity opinion than their white counterparts. Also among the findings was that insanity opinions were regularly given to criminals who had affective diagnoses and a previous psychiatric treatment. However, those with a prior criminal history, a diagnosed personality disorder, or who were intoxicated at the time of the offense, were less likely to be deemed insane.

"While the discrepancy between minorities and whites receiving an insanity opinion was small, it is important in light of the longstanding racial disparity within the American criminal justice system," Warren said. "The clinical conditions that represent the threshold for mental disease or defect look the same way regardless of class, race or ethnicity. Therefore, a concern would be that unconscious racial biases might be at play."

Warren and her research team examined 5,175 sanity evaluations for defendants in Virginia’s justice system over a ten-year period. In that time, they looked for consistency in how decisions of sanity were made, the process and outcome differences in sanity evaluations conducted by psychologists versus psychiatrists, the clinical content in sanity evaluations and the clinical, criminal and demographic characteristics of defendants and how they measure up against the opinions that point to insanity.

Sanity opinions were derived based on considerations about behavior at the time that the crime was committed. These included the ability to understand the nature, character and consequences of the crime committed, the ability to distinguish right from wrong and the ability to resist the impulse to act.

The analysis also suggests that there are no significant changes in the proportion of defendants found to be insane from one year to the next. According to Warren, these numbers are noteworthy given the lengthy time period and the numerous evaluators, which make for a sample size that should be sensitive even to modest year-to-year changes in opinion rates. These results suggest that a community-based forensic mental health system operative in Virginia is able to offer the courts a reliable cohort of forensic evaluators.

"With this analysis reflecting the work of over 200 evaluators, our findings may be more representative of the sanity evaluation process than previous studies," Warren said. "These findings speak to factors that psychologists and psychiatrists consider when offering opinions to the court."

The ILPP trains all forensic evaluators in the Commonwealth and posts the names of qualified people to an expert directory that is connected to the website for the Institute of Law, Psychiatry and Public Policy. Judges and attorneys who want to locate experts in their geographical location use this.

Warren also emphasizes that there is value in the public understanding more about this defense and the infrequency with which it applies to any particular defendant even if they are mentally ill.
"Virginia has about 30 findings of Not Guilty by Reason of Insanity each year. However, estimates suggest that up to 20 percent of the people currently imprisoned in our prisons suffer from a serious mental disorder," Warren said. "Therefore the real issue is not why do criminals get off by using the insanity defense, but why are we moving our mentally ill out of hospitals and into our jails and prisons? This is one instance when TV does not quite have it right."