The ‘Black Hole’ of Insanity Pleas

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Had it not been for his insanity plea, Sean The ‘Black Hole’ of Insanity Pleas Cory Carter might have served just 10 days in jail for hitting a mental health worker in the eye in 1992.

That’s all the time the Missouri state prosecutor recommended in the misdemeanor case.

Instead, his plea has placed him in what some call a “black hole” — one that is sapping what little hope the 43-year-old has of a life outside of secure mental health facilities.

His lawyer is now challenging the case, saying a public defender messed up nearly 24 years ago. Carter should be freed, the lawyer recently argued in court.

But there’s much more to Carter’s situation. The plea of not guilty by reason of insanity isn’t what first landed him in state mental institutions.

In fact, he has pretty much spent his whole life in one.

For decades, Carter has lived in the custody of the Missouri Department of Mental Health, at the gray intersection of medicine and law.

In Carter’s lifetime, society has moved on to a better understanding of mental illness and options for treatment.

But Carter’s case has continued to languish.

He came of age during the Prozac era, a time when mental illness became less of a stigma and more people were being treated in the community instead of inside wards.

NGRI pleas

The use of not guilty-by-reason-of-insanity (NGRI) pleas—once more popular in courthouses and television dramas— has plummeted as a defense. Patients often end up spending much more time in treatment than the maximum prison sentence for the alleged crime.

And popular culture has raised doubts about an insanity defense in which the defendant must strike the odd balance of also being found competent to stand trial.

Carter has continued in a state of limbo, stuck in a system that lacks the resources to appropriately address the needs of some of the state’s most vulnerable residents.

Doctors say he’s still a danger to himself and others because of his mental disease or defect. Even without the insanity plea hanging over him, he likely would not be released.

“They say I get mad easily,” Carter said by telephone, before a session of group therapy that he says he’s bored with.

Still, some mental health advocates and lawyers who know him see an injustice. Were it not for the questionable insanity plea, they say, Carter would have a stronger chance of transitioning out of institutional treatment to a less-restrictive environment.

“Having an NGRI plea creates an additional barrier,” said Susan Eckles, managing attorney for Missouri Protection and Advocacy Services, a federally funded nonprofit disability rights firm familiar with Carter’s case.

Carter’s public defender, Justin Carver, says the case is particularly troublesome because it stems from a misdemeanor. The vast majority of insanity pleas are for felonies.

These days, Carver said, public defenders would almost never use insanity as a defense for misdemeanor offenses.

“It seems like there has to be something less restrictive, something better for him, even if it’s a group home or community-based alternative,” he said…

A shrinking group

The plea led Carter down a peculiar path.

Today, he’s part of a dwindling group of nearly 800 people who have been acquitted of a crime in Missouri after insanity pleas, and are being held in a state hospital or conditionally released to the community for treatment.

The criminal plea has been decreasing in use in recent decades. Eighty-seven people were added to the program in 1987, compared to four in 2013.

Amid that shrinking group, Carter stands out.

He’s locked up for treatment along with murderers and rapists who tend to hallucinate — yet are mostly nonviolent on medication. Carter, in contrast, has been diagnosed with ADHD, mild mental retardation, obesity and anti-social and intermittent explosive disorders — but never psychosis.

Misdemeanor offenses such as Carter’s are rare in his population. Of the 781 patients studied in 2013, just 28 had committed misdemeanors.

What’s more, about two-thirds of this population is now treated in the community, a move that gained momentum around 2004.

Carter has made numerous unsuccessful attempts to be released or treated in the community. Now, he has filed a lawsuit asking that the old insanity ruling be thrown out — removing one major barrier to his release.

He claims ineffectual counsel and says his plea was involuntary. Carver, his current defense attorney, said the terms of the insanity plea weren’t clearly explained to Carter, including the fact that his 10 days served in jail back in 1992 could have settled the matter.

“He’s been in there 22 or 23 years now,” Carver said before a recent hearing in the case. “It is just staggering.”

 ‘A terribly sad story’

Should Carter get the old insanity plea thrown out, he would still have to convince the system that he’s fit for the community. But with his history of bad behavior in confinement, he could be his own worst enemy.

Public records say Carter was averaging 25 to 30 “acts of physical aggression” a year, including 17 in 2012. More recently, his attorney said, Carter had to be restrained Christmas Day after a patient took a token gift from him and Carter took it back.

“Is that because he doesn’t understand, or that there’s not a way out for him and he’s frustrated?” Carver said of the aggressive acts.

Shawn de Loyola, executive director of Missouri Protection and Advocacy Services, said it’s the latter. He has visited with Carter mainly by telephone for two decades—so long that Carter calls him “Pops.”

“I have just seen an individual with developmental disabilities,” said de Loyola. “He started out in the wrong places. There should have been specialized treatment for him.”

He said he thinks Carter is in a “black hole” and part of a “broken system.”

“I believe that if he was born out in the community then he would have gone in special education,” de Loyola said. “He would have had moments in the system when he had trouble with folks. It wouldn’t have turned out this way.”

Matt Decker, 32, another public defender, said working on Carter’s case in recent years was so frustrating it helped motivate him to switch career paths. Decker is now a medical student at the University of Missouri-Kansas City.

“I don’t think medicine and law understand each other very well,” he said. “Law deals in absolutes. Medicine is ‘most likely,’ or ‘evidence suggests this.’ In medicine, you will never say something that is absolute.”

Jesse Bogan, a 2014-2015 John Jay/Langeloth Mental Health & Justice Reporting Fellow, writes for the St. Louis Post-Dispatch. The above is an abridged version of a story published in the Post-Dispatch February 1. For the full version, please clickHERE. Jesse welcomes comments from readers.

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