Again, whether this restriction narrows the test in
practice is an open question because few defendants
suffering from less serious mental disorders were pre-
viously found not guilty by reason of insanity.
Perhaps the most important part of the IDRA was
placing the burden of proof on the defendant, which
makes it harder for the defendant to succeed. Placing
the burden of proof on the defendant is constitutional
because legal insanity is an affirmative defense rather
than part of the definitional criteria for criminal
offenses, and the Supreme Court has held that the
prosecution must only prove the definitional criteria
beyond a reasonable doubt. Jurisdictions are therefore
free to impose the burden of proof for affirmative
defenses on the defendant.
Later empirical research has confirmed that plac-
ing the burden of proof on the defendant is more
successful in hindering insanity acquittals than nar-
rowing the standard for legal insanity itself. This
innovation is often criticized as unfair because it cre-
ates too much risk that a defendant who is genuinely
legally insane will nonetheless by convicted, but it is
constitutional, and Congress shows no inclination to
change this rule.
The last sentence of the federal test quoted above
has generally been interpreted by lower federal courts
to mean that in federal criminal trials, evidence of
mental disorder can also be used to negate the mental
state required by the definition of most crimes, mens
rea. Negation of mens rea using mental abnormality
evidence is not considered an affirmative defense, so
this interpretation is not inconsistent with the legisla-
tion. The Supreme Court held in Clark v. Arizona
(2006) that jurisdictions are under no constitutional
obligation to permit defendants to use evidence of
mental disorder to negate mens rea, but most federal
courts do permit this as a result of statutory interpreta-
tion of the IDRA.Stephen J. MorseSee alsoCriminal Responsibility, Assessment of; Criminal
Responsibility, Defenses and Standards; Mens Rea and
Actus ReusFurther Readings
Clark v. Arizona, 548 U.S. ____ 126 S. Ct. 2709 (2006).
Morse, S. J. (1985). Excusing the crazy: The insanity defense
reconsidered. Southern California Law Review,
58,777–836.Steadman, H. J., McGreevy, M. A., Morrissey, J., Callahan,
L. A., Robbins, P. C., & Cirincione, C. (1993). Before and
after Hinckley: Evaluating insanity defense reform.New
York: Guilford Press.INSTITUTIONALIZATION AND
DEINSTITUTIONALIZATION
As recently as the mid-20th century, the U.S. public
mental health system consisted largely of the state
hospitals. These hospitals, originally constructed for
the humane asylum and “moral treatment” of those
deemed mentally ill, had evolved into overcrowded,
understaffed, and inadequate responses to the general
welfare burden of society. Since that time, there have
been many attempts to change the world of psychi-
atric treatment, including the use of medication and
deinstitutionalization. Unfortunately, most of the
efforts to change the treatment of persons with mental
illness have not been successful. Although policymak-
ers have promised changes in the current mental
health system, meaningful changes are not going to
happen until it is realized that community-based care
is necessary and there is no “quick fix.” For deinstitu-
tionalization to be successful, there must be ade-
quately funded community alternatives—other than
jail, prison, homelessness, or early death—for indi-
viduals diagnosed as mentally ill.Historical Progression
of Hospitalization of
Persons With Mental Illness
Through the first half of the 20th century, state hospi-
tals provided care, housing, employment (usually
unpaid), and social control of people deemed unable
to meet life’s daily demands. Mental illness, alco-
holism, mental retardation, advanced age, or chronic
somatic illness, or a combination of these factors,
were all reasons for admission. The census nationally
peaked at 553,000 in 1955 and is today less than 10%
of that number.
The evolution from small pastoral asylum to large,
multiburdened institution—Pilgrim Psychiatric Center
in New York had more than 14,000 patients in 1955—
was less the result of a conscious, articulated social
policy than a drift in policy by a relatively young374 ———Institutionalization and DeinstitutionalizationI-Cutler (Encyc)-45463.qxd 11/18/2007 12:43 PM Page 374