Not guilty by reason of insanity: What this controversial verdict means

This spring, a man charged with murdering a pregnant Seattle woman was found "not guilty by reason of insanity."

Three years after Cordell Goosby fired a gun into a car, killing Eina Kwon and her unborn daughter and injuring her husband, two mental health experts determined that Goosby was insane when he committed the act.

The verdict was a controversial decision that's rarely made in Washington courts: finding someone criminally insane.

While many people charged with crimes in Washington are found to have mental health conditions, the bar for "criminal insanity" is high and specific, requiring proof that the person did not understand their actions or the harm they caused.

After multiple evaluations by mental health professionals and court proceedings that can mirror that of a standard criminal trial, a person believed to be "not guilty by reason of insanity" will enter the care of the state. NGRI" patients typically spend the time in the state's psychiatric hospitals or other mental health facilities rather than prisons.

Patients are required to enter ongoing mental health treatment and remain under court supervision.

Though rare, these cases are often highly publicized due to the nature of the incidents - typically homicides or other serious felonies. Legal and medical experts in Washington spoke to The Seattle Times about what it means for a person to be found NGRI.

How is someone found 'not guilty by reason of insanity?'

A defendant and their lawyer must make the decision that they want to pursue an "NGRI defense."

The finding is an "affirmative defense," meaning the suspect's defense team doesn't deny the suspect committed the act they're charged with, but argues that other circumstances should keep them from being convicted.

The defense must then find a forensic psychologist or psychiatrist to evaluate the person's mental abilities.

Jessica Hart, a private forensic psychologist, said Washington law requires her to look for two things when she evaluates a patient: First, she must assess whether a person's mental illness at the time of the offense affected them to the point that they were unable to perceive the "nature and quality" of the act, or whether they knew what they were doing. Second, she must assess whether they were able to tell right from wrong.

"For example, if there's a stabbing, did they know that they were holding a knife? Did they know that they were using that knife to injure someone? Did they know that the person could get seriously injured or that they could die as a result of those actions? That's the kind of thing we're looking for," she said.

If that person is found to meet the legal standard, the prosecutor must have their own clinician evaluate the person, usually someone from the state's office of forensic mental health services. If the two sides agree the defendant was criminally insane, the suspect must enter an "NGRI plea" before a judge.

The person will agree to be committed to the care and custody of DSHS and stay under court supervision.

If the two sides don't agree on the person's condition, the case will likely go to a jury trial.

How does NGRI differ from other types of mental health institutionalization?

Most of the time, when someone charged with a crime is believed to have a mental illness, they go down one of two paths.

They may be sent to short-term treatment to restore them to a basic level of competency, which allows them to aid in their own legal defense. After this brief stint in "competency restoration," usually at the state hospital, they'll be sent back to jail and proceed through the criminal system.

If the person is found to have more chronic mental health issues, or found not competent to proceed with the criminal case, they could be sent instead for treatment through the civil system - such as a long-term stay in a psychiatric hospital.

A person must be deemed competent to stand trial before they can be considered NGRI, said Chloe Merino, an attorney with Disability Rights Washington who often works with NGRI patients. That means that at the moment they're entering legal proceedings, they have a basic understanding of the crime they're charged with, and what it means to be in court for it.

To be found "not guilty by reason of insanity," a person must have been found to not understand the crime they're charged with - at the time they committed it.

While those two things may seem at odds, Merino said they're not mutually exclusive. Competency restoration relates to a person's mental state at the time of legal proceedings, while NGRI considers a person's mental state at the time the crime was committed. The bar for competency restoration is also lower, Merino said.

"With competency, you're really just asking, can you assist in your own defense? Do you understand what is going on here? It doesn't mean that there are not still some mental health symptoms," Merino said.

How common are NGRI findings?

It's extremely uncommon for someone to be found "not guilty by reason of insanity.

In King County, "it's probably five evaluations a year," said Gabrielle Charlton, a senior deputy prosecuting attorney who chairs the county's felony competency and mental health unit.

Statewide, the Department of Social and Health Services said there were 267 NGRI patients as of April. Of those, 95 are living in the community on "conditional release" - meaning they have some privileges but are subject to court supervision and rules. Another 80 live at Western State Hospital, and 52 live at the Maple Lane Behavioral Health and Treatment Center in Centralia. Another 40 live at Eastern State Hospital.

These patients make up a small fraction of the state's behavioral health patients.

How long are NGRI patients institutionalized?

Depending on the nature of the crime and the court's decisions, NGRI patients face five-year, 10-year or maximum life sentences under state supervision. That doesn't necessarily mean they'll stay at the state hospital for that whole time. But for that period, they will have to be assessed regularly by clinicians, as well as a state board, to track their progress through treatment.

Many times, patients have already spent years in the system waiting for evaluations or going through competency restoration before they can be considered for a criminal insanity plea. There is also no requirement for how quickly a person must be evaluated for criminal insanity, Charlton said.

Currently, she said, it's not uncommon to see evaluations by the state take more than six months.

State data shows that of the 267 patients in Washington's NGRI system currently, 237 are serving life sentences.

What protections exist for the victims of NGRI patients?

When people are found NGRI, there's often concern for the safety of those who were affected by their crimes.

The prosecutor's office will meet with victims before a person enters an NGRI plea to let them know what's happening. Victims can sometimes speak at the hearing where a person pleads NGRI. It may not have an impact on the sentence, but it may be the only chance victims have to share their story, Charlton said.

David Talley, an NGRI victims advocate for the King County prosecuting attorney's office, said much of his job involves explaining to victims what "not guilty by reason of insanity" means.

"It's a very niche area of the law, and a lot of people don't know about it until they unfortunately have to experience it," Talley said.

Recent protections have been implemented for victims, such as allowing the court to issue no-contact orders for victims against NGRI patients.

Still, Talley said, the system can be difficult for people who've been harmed.

"Victims are not a monolith," Talley said.

Some view the system as "not punitive enough." Others, he said, "do recognize that people come to get better, and they're happy to see it and they wish it would happen sooner."

Once someone is found NGRI, what does treatment look like?

After someone is found NGRI, they'll typically be sentenced to institutionalization in the state hospital or another facility.

They'll be assigned a treatment team, including a care coordinator, clinicians such as a therapist or psychiatrist, a social worker and an officer from the state Department of Corrections' special needs unit. Jennifer Bartlett of the Washington office of public defense said the treatment for patients can vary.

"Their mental health is so individualized, and their treatment program should be individualized," Bartlett said.

Typical treatment includes two hours of group therapy a day, and at least one individualized treatment session a week, Bartlett said.

But advocates have raised concerns that patients aren't always getting the treatment they're supposed to.

This January, an NGRI patient at the state hospital died by suicide. The patient's attorneys had filed complaints against the state, saying they removed him from trauma therapy.

Bartlett said delays in treatment could be due to various factors, such as staffing issues and limited state resources.

For things like substance use disorder treatment and trauma treatment, patients may need a court order to get care at local facilities.

How are people assessed to go back to the community?

As NGRI patients continue to receive treatment, they may become eligible for reduced restrictions. That could include unescorted time on facility grounds, or leaving the facility for brief visits. Eventually, it could mean they can live in the community on "conditional release," under requirements like not using drugs or alcohol or court orders to stay away from their victims.

To get these increased privileges, patients must be evaluated by doctors in the facility for their risk of committing another crime.

They're also evaluated by the "Risk Review Board," a panel of state hospital staff, and the "Public Safety Review Panel," an external board that includes a psychiatrist, psychologist, prosecutor, law enforcement representative, a consumer and family advocate representative and a public defender.

If a patient is showing significant progress, they may be able to request "unconditional release," which allows them to live in the community and lifts all restrictions.

Advocates say they've had concerns that privileges are revoked due to things outside patients' control, and without going through the court process.

"Patients don't have a lot of recourse to challenge those privilege holds or restrictions because they weren't taken through a formal process," said Merino, the DRW attorney.

How well does the system work?

Those who work with NGRI patients have varying views on how well the system works.

Some advocates express concerns about patients' access to treatment, and say the system is another form of punishment, rather than restoration.

Prosecutors say they've seen things work well.

Charlton, the King County prosecutor, said she keeps a board in her office tracking the number of NGRI cases in the county. She also tracks the number of people who've been unconditionally released since she started her role in 2018. That list has grown, she said.

"I have little stars on them to remind me that this can work, and that people are not necessarily their worst moments," Charlton said.

Merino said she hopes people will understand how strict the NGRI system is.

"Some people can think the NGRI system feels like people got away with something," she said. "But I think it's important to acknowledge there's a very strict system … before not only an increase in privileges but before it's even deemed safe to get out."

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