Due to an unfortunate event outside of his control, "Juan" temporarily goes insane. Due to his insanity, he commits an extremely heinous crime (say, for example, a school shooting.) Still a raving lunatic, he surrenders to the police.

While awaiting trial, Juan receives medical treatment that causes him to stop being insane.

Legally speaking, what happens? From what I understand, an insanity plea results in being committed to a mental institution indefinitely. However, Juan is no longer insane and doesn't require further treatment.

N.B. This question was originally worded quite differently. My revision was primarily to remove unnecessary details; the core of the question remains the same.

  • 1
    In my jurisdiction,NOT USA, Juan would plead guilty to manslaughter, to avoid the "insane" verdict. Because "by reason of insanity" would result in an even longer period of involuntary supervision in a locked residential facility, followed by indefinite supervised release. By policy, you don't get indefinite committal, but you don't get early release. The forensic psychiatrists aren't entirely happy with this, but they work for the government.
    – david
    Aug 11, 2023 at 8:12

3 Answers 3


If is is still insane, he can't be tried. If Juan is competent to stand trial (is cured), he may enter an "insanity plea". Following Washington law, that means per RCW 10.77.030 that within ten days of arraignment (or more with court permission), he files written notice of the intent to rely on that defense. If he provides satisfactory evidence that he was insane at the time, he is acquitted. The jury must also determine whether Juan is a current danger, and since by the hypothetical he is no longer insane, he will not be committed to a mental hospital. The jury answers a series of questions, following RCW 10.77.110: is the defendant a substantial danger to other persons unless kept under further control by the court or other persons or institutions? If so, does the defendant present a substantial likelihood of committing criminal acts jeopardizing public safety or security unless kept under further control by the court or other persons or institutions, and is it in the best interests of the defendant and others that the defendant be placed in treatment that is less restrictive than detention in a state mental hospital?

There is no automatic indefinite commitment to a mental institution for entering an insanity plea (in fact, committing him is only possible after an acquittal, and cannot be the result of merely entering a plea).

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    – Pat W.
    Aug 29, 2023 at 20:42

The terminology in Canada "not criminally responsible reason on account of mental disorder" (NCRMD) (Criminal Code, s. 16). A finding of NCRMD is a special verdict that results in the accused being placed under the jurisdiction of the Review Board.1

Assuming for the sake of analysis that such an outcome is made out in the circumstances that you've described (much would depend on the expert evidence), such an outcome would not necessarily lead to indefinite detention.

The options available are:

  • absolute discharge;
  • conditional discharge; or
  • detention in custody in a hospital

And even when in detention in a hospital, there is a regular review and the person is released when detention is no longer necessary for public safety.

The burden is not on the detained to show that the chance of a repeat is essentially zero. That would be a great exaggeration of the barrier to release and incorrectly reverses the burden. Instead, the Review Board must find evidence that there is a significant continuing risk to the public, at the time of the hearing, in order to keep the person in custody. There is no burden on the accused or on anyone to rule out future occurrences with any certainty.

Latimer and Lawrence explain:

The Supreme Court of Canada further clarified in R. v. Winko that Section 672.54 does not create a presumption of dangerousness. In other words, while the protection of society is paramount, there must be clear evidence of a significant risk to the public before a court or Review Board can maintain control over an accused through the imposition of a conditional discharge or detention order.

Some extracts from Winko:

Restrictions on his or her liberty can only be justified if, at the time of the hearing, the evidence before the court or Review Board shows that the NCR accused actually constitutes such a threat

there is never any legal burden on the NCR accused to show that he or she does not pose a significant threat to the safety of the public

A past offence committed while the NCR accused suffered from a mental illness is not, by itself, evidence that the NCR accused continues to pose a significant risk to the safety of the public.

1. This is one major difference between NCRMD and the defence of automatism, which is a defence based on negation of the elements of the offence and would result in a standard acquittal if successful, with no jurisdiction for the Review Board to impose detention or conditions.


There are a number of different mental disorders - and related defences - recognised in law, but to focus on the OP's question concerning insanity which has a specific meaning...

The defence of insanity can only be successful after a trial (i.e. it cannot be accepted by the prosecution) and only applies when the jury determines the defendant not guilty by reason of insanity according to the M'Naghten rules, i.e. "did the defendant know what he was doing, or, if so, that it was wrong?"

This finding is called a Special Verdict under section 2(1), Trial Of Lunatics Act 1883:

2 Special verdict where accused found guilty, but insane at date of act or omission charged, and orders thereupon.

(1) Where in any indictment or information any act or omission is charged against any person as an offence, and it is given in evidence on the trial of such person for that offence that he was insane, so as not to be responsible, according to law, for his actions at the time when the act was done or omission made, then, if it appears to the jury before whom such person is tried that he did the act or made the omission charged, but was insane as aforesaid at the time when he did or made the same, the jury shall return a special verdict that the accused is not guilty by reason of insanity.

For awareness, a person deemed insane in this way is not necessarily "committed to a mental institution indefinitely."

Instead, sentencing is determined on a case-by-case basis under section 5(2), Criminal Procedure (Insanity) Act 1964

5 Powers to deal with persons not guilty by reason of insanity or unfit to plead etc.


(2) The court shall make in respect of the accused—

  • (a) a hospital order (with or without a restriction order);

  • (b) a supervision order; or

  • (c) an order for his absolute discharge.

  • 4
    Although tagged united-states, I have answered according to the LawSE Help Centre: "we expect and encourage answers dealing with other jurisdictions ... please tag your answer using the tag markdown: [tag: some-tag]"
    – user35069
    Aug 9, 2023 at 22:06
  • 3
    Related: I know in cases of less severe crimes a trial of the facts can lead to a hospital order, after the accused is found to have committed the act but not to be criminally responsible (England). There the court determines the unfitness for a normal trial early in the process. I don't know if that would be likely to happen in a murder case.
    – Chris H
    Aug 10, 2023 at 7:53

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