United States federal laws governing defendants with mental diseases or defects

United States federal laws governing offenders with mental diseases or defects (18 U.S.C. §§ 4241–4248) provide for the evaluation and handling of defendants who are suspected of having mental diseases or defects. The laws were completely revamped by the Insanity Defense Reform Act of 1984 in the wake of the John Hinckley verdict.

A defendant can be found incompetent to stand trial if he is unable to understand the nature and consequences of the proceedings against him and to assist properly in his defense. In such a case, he is involuntarily committed until his competency is restored. The Supreme Court has ruled that the government has a legitimate interest in bringing defendants to trial and that therefore incompetent defendants can be forcibly medicated under certain circumstances. See Sell v. United States. Time served while waiting to be restored to competence generally counts as "dead time," because it is not official detention but rather is (in theory) devoted to treatment. The Supreme Court has ruled that an insanity acquittee can be held indefinitely. Statements made by the defendant in the course of his evaluation cannot be admitted as evidence against him on the issue of guilt.

Between 1940 and 1984, the law provided for a board of examiners to be established for each federal and penal correctional institution that would consist of three medical officers, one appointed by the warden or superintendent of the institution; another by the U.S. Attorney General; and another by the U.S. Public Health Service. The pre-1984 law did not have the same stringent 30- and 45-day time limits for examinations, but merely provided that "For the purpose of the examination the court may order the accused committed for such reasonable period as the court may determine to a suitable hospital or other facility to be designated by the court." The law provided that even if mental competency was not raised as an issue before conviction, if a board of examiners found probable cause to believe the defendant had been incompetent at the time of his trial, the court could vacate the judgment of conviction and grant a new trial.

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