Mental Health Issues in a Criminal Case

If you are charged with a criminal offense in Massachusetts, your mental health can impact the outcome of your case in many ways. Depression, Bi-polar disorder, addictions, and other diagnoses are important to the understanding and resolution of criminal cases.

If your lawyer understands mental health and treatment, he can often obtain a more positive outcome that recognizes the impact of your mental health issue. He often can help you obtain treatment, or better treatment, that can make a lasting positive impact on your entire life.


In the course of your case, a court may consider evidence related to your mental health at several different stages of the proceedings. Medical history, diagnosis of any mental illness, medications you are prescribed, and the opinions of treatment providers and expert witnesses may all be relevant to your case.  

Often, presenting prosecutors with evidence of mental health diagnoses and treatment will help in obtaining agreements for reduced sentences and even reduced charges.

There may be a question of whether you were legally responsible for your actions at the time of the offense due to a mental health issue. The court may also determine whether or not you are mentally competent to participate in your own defense. These are complicated issues that involve expert opinions and testimony, and require a defense lawyer who is well-versed in mental health, both in the clinical and legal realms.

Therefore, it’s important to hire an experienced attorney who understands the complexities of mental health diagnosis and treatment, and how they affect criminal cases.

Competency to Stand Trial

Competency is about a defendant’s mental state during a criminal proceeding. Before a case can proceed to trial, if there is a questions about your mental status the court must find that you are competent to stand trial. To be mentally competent to stand trial, you must:

  • Be able to understand the nature of the charges against you;
  • Be able to understand he role of the jury, judge, prosecutor, and your criminal defense attorney; and
  • Be able to effectively consult with and understand the advice of your defense attorney.

If a defendant is found not competent, the case might be delayed, and he might be ordered to undergo treatment to see if he can be restored to competency.  In addition, competency to stand trial can change as the case progresses. This means it can be determined that you can be incompetent on one day and competent on the next.

Competency can also vary depending on factors such as counseling, medication, or a significant change in mental health status. Because of this, if the court decides someone is not competent for trial, a case may remain open for a period of time to see if the defendant will become competent.

Criminal Trials, "Criminal Responsibility" and “Insanity”

In Massachusetts a person cannot be held responsible for a crime if they have a “mental disease or defect,” and as a result of that condition they are "substantially unable to appreciate the wrongfulness of their conduct or they are substantially unable to conform their conduct to the requirements of the law." In other words, the defendant’s mental condition must have rendered them unable to realize that their behavior was wrong or unable to make themselves behave lawfully. While lawyers and judges in the Commonwealth refer to this as “criminal responsibility,” it is more popularly known as an “not guilty by reason of insanity.”

Unlike competency to stand trial, criminal responsibility is only concerned with your mental health at the time the offense was committed.

When there is a question of criminal responsibility, a defense lawyer will have his client assessed by a forensic psychologist. If he or she gives an opinion that the person was not "criminally responsible" for their actions, based on their review of case information, medical records, and clinical evaluations of the accused, the lack of criminal responsibility can be a defense at trial.

At trial, the forensic psychologist gives their opinion as to whether the accused was criminally responsible. The jury or judge decides the verdict: guilty, not guilty, or not criminally responsible due to mental illness. Often these cases are tried before a judge rather than a jury, especially if the prosecution is not challenging the forensic opinion with an expert of its own.

A person found not guilty by reason of insanity does not have a criminal record. They havebeen found not guilty and therefore cannot be sentenced to a correctional institution orplaced on probation. However, the judge can order a 40-day period of hospitalization forfurther evaluation. During that time, the institution may choose to move for civil commitmentif they believe that the patient is a danger to themself or others. That type of commitment issubject to a separate court proceeding unrelated to the criminal case.

In many cases, the person found not criminally responsible has received medical treatmentsince the date of offense and is not at risk of having further hospitalization ordered.

Get Help from a Massachusetts Criminal Defense Attorney Today

Your mental health can significantly impact the outcome of your case. If you or a loved one has been accused of a crime, contact H. Ernest Stone. We understand mental health issues and how they affect criminal cases, and have experience in cases involving mental health issues, lack of competency and criminal responsibility. We also have an extensive network of trusted professionals we work with and refer clients to. Perhaps most importantly, we are here to support and guide you through the experience of being charged with a crime, and we will get you through this. Contact us today or call us at (978) 969-2890 for a case evaluation.

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