Mental Illness and the Death Penalty

Key Supreme Court Cases Addressing Mental Illness, Insanity, and the Death Penalty
Background Information on Mental Illness
Background Information on Insanity
Mental Illness Issues in the Aileen Wuornos Case
Related Links

Key Supreme Court Cases Addressing Mental Illness, Insanity, and the Death Penalty

Ford v. Wainwright

In 1974 Alvin Ford was convicted of murder and sentenced to death. In early 1982 he began to show changes in behavior, indicating a mental disorder. After a psychiatrist concluded Ford did not understand why he was being executed and made no connection between the murder he had committed and his death sentence, Ford’s counsel invoked Florida's procedures for determining a condemned prisoner's competency. The Governor appointed a panel of three psychiatrists to evaluate whether Ford had "the mental capacity to understand the nature of the death penalty and the reasons why it was imposed upon him." The psychiatrists disagreed on the exact diagnosis but agreed Ford was sane under this definition. The Governor, without commenting on the panel’s findings or communicating with Ford’s attorneys, signed a death warrant for Ford's execution.

Ford’s attorneys unsuccessfully sought a hearing in state court to determine his competency and then filed a habeas corpus petition seeking an evidentiary hearing in the U.S. District Court. The federal district and appellate courts denied relief.

The United States Supreme Court granted certiorari review to determine (1) whether the Eighth Amendment prohibits the execution of the insane, and, if so, (2) whether the district court should have held a hearing on Ford's claim. With respect to the first issue, the Court held the Eighth Amendment prohibits inflicting the penalty of death upon a prisoner who is insane and not aware of his impending execution and the reasons for it. The rationale for this conclusion, found in English common law, is that such an execution has questionable retributive value and no deterrent value, and thus “simply offends humanity.” (Ford v. Wainwright)

As to the second issue, the Court concluded that Florida's procedures for determining the sanity of a death row prisoner were not "adequate to afford a full and fair hearing" on this critical issue. Because the determination of Ford’s sanity would decide whether he lived or died, the Court required “no less stringent standards than those demanded in any other aspect of a capital proceeding,” and found three problems with the procedures followed in Ford’s case: he had no chance to provide evidence relevant to his sanity, he was denied the opportunity to "challenge or impeach the state-appointed psychiatrists' opinions," and the procedure placed the ultimate decision wholly within the executive branch.

The Court found that Florida's inadequate procedure denied Ford his constitutional right to due process. Accordingly, Ford was entitled to a new evidentiary hearing in federal district court on the question of his competence to be executed.

The Court also ruled “the States could satisfy due process by providing an impartial officer or board that can receive evidence and argument from the prisoner's counsel, including expert psychiatric evidence. Beyond these requirements, the States retain substantial discretion to create appropriate procedures.”

Panetti v. Quarterman

Scott Panetti was allowed to defend himself in his Texas trial, despite his schizophrenia and 14 stints in mental hospitals. He said the devil had compelled his actions when he committed his crime. The U.S. Court of Appeals for the Fifth Circuit held that Panetti's awareness that he had committed a crime and was to be punished for it was sufficient to establish his competency. The question presented to the Supreme Court was whether mere awareness of one's acts can be equated with mental competence, or whether a person also needs to rationally understand what is about to take place.

On June 28, 2007, the Court ruled (5-4) that Panetti deserved a rehearing on his claim of mental incompetence. The Court held that the Fifth Circuit had used an overly restrictive definition of insanity, and that the Texas state court had failed to provide Panetti with the review of claims of mental incompetence guaranteed under the Constitution. Based on the Ford case, the Court held “at a minimum, that a court allow a prisoner's counsel the opportunity to make an adequate response” to the state’s evidence of the prisoner’s competency to be executed.

Writing for the majority, Justice Kennedy stated:

Gross delusions stemming from a severe mental disorder may put an awareness of a link between a crime and its punishment in a context so far removed from reality that the punishment can serve no proper purpose. It is therefore error to derive. . . a strict test for competency that treats delusional beliefs as irrelevant once the prisoner is aware the State has identified the link between his crime and the punishment to be inflicted.

The Court did not, however, set forth its own definition of insanity, stating, “we do not attempt to set down a rule governing all competency determinations.”

Background Information on Mental Illness

When the U.S. Supreme Court decided in Ford v. Wainwright (1986) that the Eighth Amendment prohibits the execution of a person who is insane and not aware of his execution or the reasons for it, relatively few people who suffered from mental illnesses were within that ruling. When the Supreme Court ruled in Atkins v. Virginia (2002) that executing defendants with mental retardation was unconstitutional, it did not address the constitutionality of executing persons with mental illness.  

Mental illness differs from intellectual disability (previously “mental retardation”). Intellectual disability is measured by subnormal intellectual development with various cognitive deficiencies, usually appearing at an early age. The National Alliance on Mental Illness defines mental illnesses as "medical conditions that disrupt a person's thinking, feeling, mood, ability to relate to others and daily functioning."

Many death row inmates suffer from mental illnesses, including schizophrenia, bipolar disorder, delusions, and other impairments. Some were mentally ill before the crime for which they were convicted. For some, the mental illness developed or worsened in prison, a stressful environment not conducive to mental health.
Examples of mentally ill inmates who have been executed include:

• Charles Singleton, whose paranoid schizophrenia caused him to believe his victim was still alive and his cell was inhabited by demons. He was forcibly medicated in order to make him mentally competent for his execution in Arkansas on January 6, 2004.

• Monty Delk's lawyer claimed Delk had become insane while on death row. He described Delk's behavior as "long periods of psychotic thought punctuated by grandiose delusions, incoherent ramblings, and smearing himself with his own feces, interspersed with brief moments of lucidity and compliance." Delk was executed in Texas on February 28, 2002.

• Thomas Provenzano suffered from delusions, believed he was Jesus Christ, and thought he was being executed because people hate Jesus. Florida executed Provenzano on June 20, 2000.

On August 8, 2006, the American Bar Association passed Resolution 122A (see resources), recommending that individuals with severe mental illness be exempt from the death penalty. An almost identical resolution was approved by the American Psychological Association, the American Psychiatric Association, and the National Alliance on Mental Illness for the mentally ill. The resolution addresses the various points in capital cases where the defendant's mental illness can be relevant: the defendant's intent when the crime was committed; the defendant’s ability to assist in his or her defense at trial and post-conviction proceedings; the defendant's competency to waive appeals; and the defendant’s mental condition at the time of execution. It recommends exempting from execution those defendants whose mental illness "impaired their capacity (a) to appreciate the nature, consequences or wrongfulness of their conduct, (b) to exercise rational judgment in relation to conduct, or (c) to conform their conduct to the requirements of the law." It also suggests exempting those who cannot effectively assist counsel or understand the punishment they are to receive: "A sentence of death should not be carried out ithe prisoner has a mental disorder or disability that significantly impairs his or her capacity (i) to make a rational decision to forgo or terminate post-conviction proceedings available to challenge the validity of the conviction or sentence; (ii) to...assist counsel...or (iii) to understand the nature and purpose of the punishment, or to appreciate the reason for its imposition in the prisoner's own case."

Background Information on Insanity

"Insanity" is a legal term, not a medical diagnosis. The term "incompetency" is also sometimes used as an alternative to "insanity." It refers to any mental illness severe enough to affect the defendant's ability to understand the crime he or she is committing, the trial proceedings, or the punishment for the crime of which he or she was convicted. Insanity can affect a capital case at three points.

First, if the defendant was insane at the time of the crime, he or she can be found not guilty by reason of insanity. In most states, the burden of proof falls on the defense to show that the defendant was insane. The jury must decide, based on testimony by psychiatric experts and other evidence presented during the trial. When the jury hands down a verdict of not guilty by reason of insanity, the defendant is committed to a mental institution. Four states (Kansas, Montana, Idaho, and Utah) do not allow a verdict of not guilty by reason of insanity.

Second, if the defendant is incompetent at the time of the trial and cannot understand the legal proceedings or cooperate with his or her counsel, then he or she can be found incompetent to stand trial. In most states, a judge makes this determination. If such a finding is made, the defendant is sent to a mental institution to be treated until he or she regains competency.

Finally, a defendant who is insane as his or her execution approaches can be found incompetent to be executed. Under Ford v. Wainwright, it is unconstitutional to execute an inmate who does not understand his or her punishment or the reason for it. However, if the inmate's competency is later restored, he or she can then be executed.

Mental Illness Issues in the Aileen Wuornos Case

The case of Aileen Wuornos highlights some of the legal hurdles mentally ill capital defendants can face during their trial and appeals. Wuornos was never found legally insane, but her mental illness played a role in mitigation during her trial, and in her decision to waive her appeals.

Mental health experts linked Wuornos' mental illness to the serious abuse she suffered in childhood. Court documents detail the mistreatment she endured: her mother abandoned her as an infant; her father committed suicide in prison while serving time for child molesting; she suffered physical abuse by her grandfather (who also committed suicide); and she had a sexual relationship with her brother at a very young age. When she was in junior high school, school officials treated her by administering mild tranquilizers. After being raped by a family friend at age 14, Wuornos was blamed by her family for the resulting pregnancy and forced to give the child up for adoption.  

Borderline Personality Disorder
Mental health experts have pointed to a history of such abuse as a trigger to the development of Borderline Personality Disorder. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition defines Borderline Personality Disorder as marked by "a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity." When Dr. Harry Kropp examined Wuornos in July of 1992, the year of her trial, he found her to be suffering from a “full blown delusional system” and having a “Borderline Personality Disorder with Paranoid Features.”

Based on a review of Wuornos' records, psychologist Dr. Jethro Toomer stated,

[The] totality of the data is consistent with a diagnosis of a borderline personality disorder, the existence of which is life-long and has adversely impacted Ms. Wuornos’ overall functioning and adaptive capacity…This disorder is characterized by a pervasive pattern of instability in mood, affect, identity and interpersonal relationships present in a variety of contexts and situations.  She has exhibited transient periods of bizarre behavior, irrational impulses and delusional thoughts.  Her overall functioning has been characterized by the existence of mini-psychotic episodes, where reality is blurred and she is unable to adequately test reality.  Her condition is chronic and unpredictable… Predispositional family history [of BPD] is characterized by early trauma and nurturance deprivation consistent with the above diagnosis and serves to negate the stability and predictability of life necessary for acquiring a consistent pattern of behaving and thinking.

Experts later testified about the disorder’s symptoms, including delusional thoughts, bizarre behavior, and mini-psychotic episodes that might have influenced both her decision to confess to the murders to legally protect her lover Tyria Moore, and, more important, to commit the murders out of a (possibly delusional) fear of being raped.

At trial the defense presented evidence of Wuornos’ diagnosis of Borderline Personality Disorder and Antisocial Personality Disorder. The State’s expert agreed with the Borderline Personality Disorder diagnosis. The defense tried to show how the disorders related to the inconsistencies in her confessions, and that she wasn’t “lying” in conventional terms, which prosecution witnesses disputed.  The defense also tried to show evidence of brain damage from childhood and that her disorders impaired her ability to conform her conduct to the requirements of the law.

During the sentencing trial, the jury found the only mitigating factor to be Wuornos’ diagnosis of Borderline Personality Disorder. The judge found she had Antisocial and Borderline Personality Disorders.

Trauma and the Trial
Wuornos later argued on appeal that at trial she was not allowed to introduce evidence of the traumatic effects of rape on her mental health and decision-making.  She had always maintained the first victim, Richard Mallory, had violently raped her and she shot him in self-defense. The courts found “post traumatic prostitution stress disorder” is not accepted by medical science. When convicted, Wuornos yelled out, “I’m innocent. I was raped! I hope you get raped! Scumbags of America!” Journalists later discovered that Mallory had served time in prison for the rape of another woman, but this information, not known at the time of the trial, was not introduced in her defense.

Impact of Mental Illness on Wuornos’ Appeals

Attorneys' Difficulty Working With Wuornos
Mental illness continued to be a dominant issue in the case after Wuornos was sentenced to death. Her mental health significantly deteriorated during her time on death row. Numerous attorneys appealed to the courts on her behalf, citing her bizarre and delusional behavior. The defense lawyer who defended Wuornos in her trials, Billy Nolas, told the press, “She is the most disturbed individual I have represented. As she has gotten older and older, she has gotten worse and worse. She is like a kid,” who pouted and stomped around when Nolas tried to work with her.  

In a letter to the Florida Supreme Court, Wuornos' appeals lawyer, Raag Singhal, explained, “In Court and at the jail, she exhibits bizarre behavior, laughing and crying at inappropriate times and obsessing on points having no importance to her cases.”

Delusional Claims of Abuse in Prison
Wuornos herself wrote to the courts with apparently delusional claims of abuse by prison staff that included pressurizing chambers with “head shrinking” devices, harassment, and food cooked in dirt. She accused the staff of waging psychological and physical warfare against her. As one of her attorneys, Charles Kaplan, wrote in a petition, “Petitioner’s claims of prison abuse and mistreatment are either true or false.  They are clearly believed to be true by Petitioner based upon her writings and behavior in Court on July 12, 2002.  If true, Petitioner’s claims must be resolved and corrected.  If false, Petitioner’s claims further support previous expert findings that she is delusional and mentally ill.”

In this October 8, 2002 interview with documentary filmmaker Nick Broomfield, Wuornos describes the abuse that she claims she suffered in prison.

Waiving Appeals
Wuornos began to refuse to meet with mental health experts or her attorneys. She persistently filed petitions to waive her appeals and volunteered for execution in long rambling letters. A legal battle ensued over her competency to waive her appeals. Governor Jeb Bush ordered a 30-minute mental health assessment, conducted simultaneously by three experts. Her attorneys disputed that a 30-minute examination conducted by three experts simultaneously and without a comprehensive review of her records, could adequately assess her condition. As one petition asserted, “A person with a borderline psychosis is not continuously openly psychotic, but might be psychotic in, for her, special traumatic situations. In a 30-minute interview with many people attending, there is no chance that the psychiatrists may be able to find her psychotic dilemmas.” Nevertheless, the three psychiatrists concluded Wuornos was competent to waive her appeals.

In her last statement before execution, Wuornos said, "I'd just like to say I'm sailing with the rock, and I'll be back like Independence Day, with Jesus June 6. Like the movie, big mother ship and all, I'll be back."

Questions for Further Analysis:

• Should defendants with severe mental illness be exempt from the death penalty? Why or why not?
• What difficulties do attorneys encounter in working with defendants who are severely mentally ill? Should attorneys be obligated to work with clients who verbally abuse them, mistreat them, or are uncooperative? What should happen if court-appointed attorneys are permitted to decline representation in such circumstances?
• Should mentally ill death row inmates be allowed to waive their appeals and be executed?
• Who should determine an inmate’s mental competency, and how should they do so? Should there be an adversarial hearing? What should it entail?
• Should attorneys file appeals on behalf of mentally ill clients who wish to waive them? Should they be required to do so? Consider the ethical implications for proceeding, or not proceeding, under such circumstances.
• Many mentally ill people do not exhibit their symptoms all the time. If a person sometimes seems to be completely normal and at other times extremely disturbed, how should an accurate assessment be conducted?
• What do you think about the practice of giving a condemned prisoner drugs or other treatment so that s/he can reach the degree of mental health necessary to carry out a legal execution? What do you think should be done in these cases?

Related Links

Intellectual Disability and the Death Penalty
Mitigation in Capital Cases
The Case of Aileen Wuornos