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The Good, The Bad & The Mad

What happens to the mentally ill in the justice system is just crazy.

Kathy Sasak, who prosecuted Cooper for murder in Munch's courtroom a decade ago, is now the executive deputy director of the Colorado Department of Public Safety. She emits a small sigh when informed that Cooper is now permitted to leave the hospital for brief periods. "When insanity is the finding, you're not responsible for the criminal offense," she says. "Once that route is taken, the system has to provide care and treatment. These are difficult issues. I certainly support a transitional approach to bringing a person back to society."

Since the Hinckley verdict, several states have given juries the option of finding a defendant "guilty but mentally ill" — meaning the defendant could still go to prison for the crime but would have to receive mental-health treatment. A few years ago a legislative task force looked into adopting a similar measure in Colorado but rejected it. Sasak says there were some "philosophic concerns" about holding the mentally ill responsible for crimes caused by their illness, as well as practical considerations about the prison system's already strained resources. San Carlos, the state's one prison designed to house the mentally ill, has only 255 beds, reserved for the most severe cases among the thousands of inmates diagnosed with mental disorders.

The few defendants who do manage to obtain an NGRI verdict stand a pretty good chance, like Cooper, of getting their freedom back over time. Half of the 289 NGRI patients currently under the supervision of the Colorado Mental Health Institute are on some form of conditional release or community placement, and many of the rest enjoy varying degrees of privileges on or off the grounds. It's a very small club, compared to the prison population, but some experts believe that the numbers are still too high — that many of those found criminally insane in Colorado don't truly fit the legal criteria.

Thomas Espinoza complained of voices telling him to hurt people; he blames his mental problems on the fire he was in as a child.
Thomas Espinoza complained of voices telling him to hurt people; he blames his mental problems on the fire he was in as a child.
NAMI Colorado executive director Lacey Berumen wants state lawmakers to fix a breakdown in services to the mentally ill.
mark manger
NAMI Colorado executive director Lacey Berumen wants state lawmakers to fix a breakdown in services to the mentally ill.

In a recent study, Colorado psychiatrists — several of whom are affiliated with the state hospital — reviewed the case files of 104 NGRI patients admitted to the hospital over a period of six years. The team agreed with the NGRI finding in only 61 percent of the cases. Although they believed that successful malingering, or faking of insanity, was rare, they suspected that judges or evaluators sometimes push for a hospital commitment in dubious cases because the defendant needs more psychiatric help than he or she is likely to receive in prison.

Espinoza's three-year journey through the state hospital's evaluation process produced a muddle of inconsistent opinions and speculations. In 2004 a neurologist decided that the patient "is not actively hallucinating but is somewhat delusional" and might be suffering from a frontal-lobe injury or schizophrenia. A psychological work-up involving Rorschach inkblots indicated that his "reality testing appeared markedly impaired." An evaluation by a staff psychiatrist concluded that Espinoza wasn't competent to stand trial. The shrink strongly felt that he was suffering from a mental illness — a bipolar disorder with psychotic features — "that renders him incapable of understanding the nature and consequences of his act."

Seven months later, a second psychiatrist saw no "convincing evidence of a true psychotic disorder" and found Espinoza competent to go to court. She believed that the patient's paranoia and delusional thinking were attributable to a personality disorder and that he was faking other symptoms. And she was firmly convinced that he didn't have post-traumatic stress disorder as a result of being in a fire as a child.

"Individuals with PTSD have persistent avoidance of the stimuli associated with the trauma," she wrote. "Instead, the house explosion has been a major preoccupation with Mr. Espinoza, something he has wanted to discuss in detail with numerous staff members in an effort to elicit sympathy and place blame on others for his life course since that experience."

That view was echoed by yet a third psychiatrist, Matthew Goodwin, in 2006. Goodwin, an Army reservist who's worked with soldiers suffering from trauma in Iraq, wouldn't entirely rule out the possibility of PTSD, but didn't see any link between PTSD and insanity. He found Espinoza's statements about hearing voices and having hallucinations to be inconsistent and suspicious. His supposed inability to remember the murder, after giving the police so many details about it, also pointed to malingering. His lack of remorse, aggressive behavior and disinterest in treatment all suggested to Goodwin an antisocial personality disorder — something that didn't make him insane and couldn't be fixed, no matter how long he lingered at the state hospital.

"This writer observed the patient to be almost boastful of his violent acts," Goodwin wrote. "It appears that the defendant's problems with anger and aggression related to antisocial personality and substance abuse were primarily at play at the time of the alleged crime."

In finding that Espinoza was competent and sane, Goodwin also drew on other staff reports about his behavior on the maximum-security ward. A nurse had asked Espinoza why he was growing a ponytail on the side of his shaved head, and he'd cheerfully responded, "It makes me look crazy." Another patient had gone to authorities, claiming that Espinoza was boasting to others about his ability to fool the doctors and was asking for tips on how to fake insanity.

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