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John Hinckley might soon be released from the psychiatric hospital and rejoin the community.
Hinckley, who was found Not Guilty by Reason of Insanity (NGRI) after attempting to assassinate President Ronald Reagan in 1981, has spent the last few decades living at St. Elizabeth’s Hospital, just outside of Washington, D.C.
The possible release of Hinckley into the community, where he has already been spending much time due to gradual privileges outside of the hospital, seems to polarize many people.
On the one side are those who believe that opening fire on a President should come with a life sentence of confinement. On the other side are those who support the freedom of rehabilitated individuals. And then there is everyone in-between.
Sanity is a legal term, not a clinical one. Approximately 1 in every 100 defendants charged with a felony raise the insanity defense. And even then, it is rarely successful.
The insanity defense dates back Centuries. Many early codes of law provided exceptions to criminal responsibility for the mentally ill. The 18th Century “Wild Beast” standard, for example, stated that the defendant had to be “totally deprived of his understanding and memory, so as to not know what he is doing, no more than an infant, a brute, or a wild beast.” In the 19th Century, the M’Naughten Rule required that the defendant not know the nature/quality of the offense or its wrongfulness.
After Hinckley was adjudicated NGRI for the attempted assassination of President Reagan, there was public outcry and yet a new stricter standard evolved in federal jurisdictions, known as the Federal Insanity Defense Reform Act of 1984.
But what happens after a defendant is found NGRI?
NGRI acquittees are sent to a psychiatric hospital where they are rehabilitated. Treatment involving medication and therapy, delivered by qualified doctors and healthcare professionals, are accompanied by regular assessments of safety.
Once that individual patient is determined to be safe, they can be considered for more freedom. That usually starts with secure privileges like permission to attend recreation groups in the hospital, partake in trips to the commissary, or achieve access to secure outdoor space. Once a patient shows clinical improvements and an ability to maintain safety, the hospital often pursues gradual release for that patient into the community.
Hinckley (whom I have never evaluated or treated) has reportedly been advancing in terms of privileges to the point of partial hospital leave since 2013. He and his lawyer are now making a widely publicized argument in court that Hinckley is safe for release into the community.
A U.S. Supreme Court case in 1992, Foucha v. Louisiana, addressed the criteria for the continued commitment of an individual who had been found NGRI. Here, the Court ruled that a person committed on the basis of an insanity defense who has regained his sanity cannot be continued to be confined on the sole justification that he remains dangerous. An insanity acquittee must remain both mentally ill and dangerous to continue to be involuntarily committed.
Consider the case of Lorena Bobbitt (which I was not involved in), who in 1993 severed her husband’s penis. She was found NGRI and after only five weeks in a mental hospital, she was released after the hospital and judge reportedly agreed that she was no longer a danger to herself or others.
Central to the issue of Hinckley’s possible release, is this question: Is he both mentally ill and dangerous?
Although I have not been involved in the Hinckley case, it appears that he and his legal team are making an argument that he does not meet the legal criteria for ongoing commitment.
Qualified psychiatrists will need to report on Hinckley’s mental state and offer an opinion regarding whether or not he has an active mental illness or one that is in remission. As for the question of being dangerous, clinicians have sophisticated tools to help determine the risk of future violence. There are limitations to these tests, however, and of course nothing can ever be guaranteed.
Although Hinckley’s past violence is a very high predictor of future dangerousness, there are other factors to consider in making a violence assessment. One risk factor, especially a non-modifiable one, cannot legally or ethically seal one’s fate. Qualified mental health professionals consider the historical risks along with modifiable risks and work with their patients to reduce chances of relapse into illness and violence.
If Hinckley is released from the psychiatric hospital, those opposed might seek some solace in this. NGRI acquittees do not experience freedom like the rest of us. Routinely, they are subjected to an intense treatment plan and very close monitoring that allows for detection of symptom reemergence and quick intervention.
