Insanity Acquittees with Resolved Substance-Induced Psychosis

Featured Article | The Journal of the American Academy of Psychiatry and the Law  | Volume 51, Number 4, 2023, 589 - 591 

Insanity Acquittees with Resolved Substance-Induced Psychosis

Derek Stodolak, MD, JD, Resident in Psychiatry

Department of Psychiatry, Henry Ford Health, Detroit, Michigan

Andrea Brelje, MD, MA, Resident in Psychiatry

Matthew Grover, MD, Clinical Assistant Professor, Program in Psychiatry, Law, and Ethics, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan

antisocial personality disorder; substance-induced psychosis; substance use disorder; treatable mental illness

In the case of State v. Edwards (348 So.3d 1269, La. 2022), the Louisiana Supreme Court addressed the release of an insanity acquittee, Jamaal Edwards, who had been committed to forensic psychiatry treatment following the killing of his fiancée. Despite presenting clear and convincing evidence of ongoing danger to the public, Edwards' psychotic symptoms had resolved, and his primary diagnosis was antisocial personality disorder (ASPD). The trial court ordered his unconditional release, invoking Foucha v. Louisiana, a precedent stating that an insanity acquittee no longer mentally ill must be released. The Louisiana Supreme Court, bound by Foucha, reluctantly upheld the release, urging legislative action to protect the public in such cases.

Legislative Solutions: The court's call for legislative action highlights the need for clear statutory definitions, addressing conditions excluded from insanity defenses. Advocacy for legislative changes becomes crucial for professionals dealing with similar cases.

Potential Charges: Exploring felony charges for violent acts committed by insanity acquittees lacking a statutory mental illness raises questions about the intersection of legal and psychiatric considerations. Forensic mental health professionals must be aware of legal strategies impacting their evaluations.

Treatment Perspectives: Consideration of research indicating aspects of treatability in ASPD challenges traditional views. Forensic mental health professionals should stay informed about evolving treatment options for personality disorders and their implications for risk assessment.

Conditions of Release: The imposition of stringent conditions upon release underscores the challenge of managing individuals with personality disorders. Psychiatric evaluations must inform the establishment of conditions that balance public safety with the individual's rights.

Ethical Considerations: The court's reluctance in upholding Edwards' release raises ethical questions about balancing legal mandates with public safety concerns. Forensic mental health professionals must navigate these complexities while adhering to legal frameworks in their jurisdictions.

Forensic mental health professionals must navigate challenges in cases where insanity acquittees with ongoing danger lack a statutory mental illness, as exemplified by Edwards. Professionals should advocate for legislative clarity, possibly amending definitions to exclude certain conditions from insanity defenses. Prosecutors could explore felony charges for violent acts, considering ASPD as a nonmental illness. Mental Health experts should critically assess the treatability of ASPD and consider evolving research on psychosocial interventions. When releasing insanity acquittees, imposing stringent conditions and continuous monitoring might deter criminal behavior. This case underscores the importance of understanding legal precedents and statutory requirements for forensic mental health professionals dealing with complex cases.