[T]he public’s acceptance of the insanity defense rests upon confidence in a rational and responsible system to manage insanity acquittees.
– Stuart B. Silver & Christiane Tellefsen
More than a decade ago, Martin Smith walked into a Texas grocery store and began to violently stab the man standing in front of him in the checkout line. Smith never spoke to the man, nor made eye contact with him before assaulting him. Fortunately, the man lived. Smith was arrested and charged with aggravated assault. Psychiatrists later determined that, at the time of the offense, Smith was suffering from schizophrenia and was psychotic. Along with schizophrenia, he was diagnosed with bipolar disorder and antisocial personality disorder. Smith was found not guilty by reason of insanity (NGRI) and acquitted of aggravated assault.
After spending more than five years in a state hospital, Smith returned to his community to receive outpatient treatment. He moved into a group home. While in the group home, he received minimal treatment and had little support. He was allowed to come and go as he pleased. He was unsupervised when he was away from the home.
Within four months, Smith committed another crime and his outpatient treatment was revoked. Psychiatrists concluded that while he was living in the group home, he decompensated and began using drugs and alcohol in an effort to self-medicate his illness. The trial court revoked Smith’s conditional release due to his recidivism and substance abuse. He spent the next ten years in a state hospital. Overall, Smith has lived more than twenty-five of his forty-something years of life in psychiatric hospitals or prisons. Smith’s brief four-month conditional release ended in failure—as did Kenneth Pierott’s.
In 1997, Pierott brutally murdered his sister who suffered from cerebral palsy. The prosecutors, defense attorneys, forensic psychiatrists, and judge believed that Kenneth was not legally responsible for the crime due to his untreated paranoid schizophrenia. After a bench trial, the judge found him NGRI.
Following his acquittal, Pierott was committed to a maximum security state hospital, but he was transferred to a minimum security hospital two months later. After a short, six-week stay in the second hospital, he was conditionally released home to receive outpatient treatment. He was encouraged to continue taking his antipsychotic medication when he left the hospital. The government agency charged with overseeing NGRI acquittees was supposed to ensure Pierott took his prescribed anti-psychotic medication. However, the agency’s supervision of him was later deemed “lax” by investigators.
Pierott committed criminal acts of forgery and family-violence assault, yet his conditional release was not revoked. It appears the original trial judge had no knowledge about Pierott’s subsequent criminal offenses. Pierott’s conditional release treatment team terminated his supervision in 2003; there is no evidence the trial court was informed of this termination. One year later, Pierott murdered his girlfriend’s six-year-old son by asphyxiating him with a pillowcase and placing his body in an oven. In his second murder trial, the jury sentenced Pierott to sixty years in prison, where he remains today. Pierott’s second murder attracted media attention and public outrage. The Texas legislature would later determine that, although NGRI aftercare should be “a simple process,” it sometimes produced “aberrations” and “early releases of unstable and potentially dangerous individuals.”
Not every insanity acquittee is violent or dangerous; some are charged with misdemeanors or petty crimes. Many acquittees are able to successfully comply with conditions of release, manage their illness, and not reoffend. Yet, the aftercare system failed Smith and Pierott—not to mention the young boy Pierott murdered.
These true accounts illustrate the flaws with insanity aftercare: inadequate support, poor communication between the supervisors and agencies responsible for the acquittee, and lack of continuity of care between inpatient and outpatient care. It is time to rethink aftercare programs and conditional release.
This article examines the number of individuals acquitted or otherwise excused due to insanity. It explores the insanity aftercare process, which has remained stagnant in most jurisdictions for twenty-plus years, despite evidence-based research and treatment models that point to newer, more effective methods of treatments for mentally ill criminal offenders. This article investigates why post-acquittal conditional release is most often revoked. It considers the problems with the traditional aftercare model. By incorporating mental health courts, assertive community treatment, and programs that address criminogenic needs, conditional release programs may be able to reduce hospitalizations and arrests, as well as increase mental wellness and overall life quality. The authors hope to encourage states to consider incorporating elements of risk assessment, cooperation, and greater accountability into existing insanity aftercare programs.