The Times Investigates US Insanity pleas

A plea for sanity

Raymond Gregory was incarcerated after pleading insanity to a minor criminal offence in 1972. Within four years his doctors thought he was safe to release. For the next 39 years, the system didn’t agree.

Reporting: Billy Kenber

Photographs: Evelyn Hockstein

Development: Sam Joiner

Forty-four years ago, on a damp April night in Washington DC, Raymond Gregory found shelter in a half-built house after an evening drinking.

The unemployed father-of-one was discovered by a builder and picked up by police the following morning. Although nothing was stolen, the 36-year-old was charged with destruction of property, burglary and possession of a dangerous weapon — a small penknife in his pocket.

Had a jury convicted him of those crimes he would have been likely to spend no more than two or three years in jail.

Mr Gregory was not found guilty of any offence but four decades would pass before he won his freedom. For a man now aged 80, that's been more than half his lifetime.

Now battling lung cancer and diabetes, he was finally granted an unconditional release last December.

“I’ve missed out on everything,” he said in a recent interview. “I’ve missed out on my whole life.”


The number of NGRI patients at St Elizabeth’s, with a median average stay of 12 years 2 months, down from 13 years and 11 months in 2013.

Mr Gregory’s mistake, taken, he said, on the advice of his state-appointed lawyer, was to enter a plea of not guilty by reason of insanity (NGRI) when he appeared in court a year after the incident.

It was March 1972, three months before Watergate and three years before the fall of Saigon. Babies would be born, become parents and see their own children leave school before he was next free.

The unusual plea is generally associated with high-profile cases such as that of John Hinckley, Jr., who attempted to assassinate President Reagan outside the Washington Hilton Hotel in 1981. James Holmes, the Colorado gunman currently facing the death penalty for allegedly shooting dead 12 people at a cinema in Aurora in July 2012 is also seeking to rely on an insanity plea.

But US lawyers and law professors say that there are dozens if not hundreds of cases like Mr Gregory’s where minor, non-violent offenders entered NGRI pleas on the assurance that they would be in and out of a mental institution in a matter of months.

In the District of Columbia there are currently 81 NGRI detainees, of which around one-fifth are thought to be for low-level crimes.

In a sizeable number of these cases, often dating back to the 1970s or 1980s, people have languished in secure psychiatric units for decades — far, far longer than they would ever have spent in jail.

Mr Gregory has spent most of the past 44 years incarcerated at Saint Elizabeth’s hospital, an imposing red-brick building perched on a hill overlooking the Potomac and Anacostia Rivers.

The main campus, which dates back to the 1850s, is being knocked down to make way for new headquarters for the Department of Homeland Security. For the past five years patients have been housed in a smaller, modern glass-fronted facility on its eastern edge.

During a 90-minute interview there in September 2013, Mr Gregory, a slim man with grey stubble and a wide, toothless grin, described his predicament. On April 20, 1971, he had been unemployed for 14 months after losing his job working in a hospital kitchen.

That night, he drunkenly stumbled across an under-construction house on 17th Street in the southeast of the city and decided to sleep off a hangover there.

One of the builders working on the house called the police the following morning and he was caught trying to leave through an upstairs window shortly after 8am.

Police recorded that “ten pounds of sheet plaster were destroyed” and that Mr Gregory had a 5-inch pocket knife on him, according to court documents.

“I was drinking at the time. I just wanted somewhere to lay down at,” he explained.

I went along with it. He said you won’t be locked up no longer than six months. That’s what he told me.

It was the latest miscalculation in a troubled life. Born in DC in 1935, the fifth of six children, Mr Gregory had an unhappy childhood and began drinking at an early age.

No job would last long and he had recently lost contact with his girlfriend and daughter. But life was about to get a whole lot worse.

Mr Gregory told the lawyer assigned to defend him against three charges that he had been hearing voices for at least a couple of years but hadn’t acted on anything they’d said.

His lawyer recommended he enter an NGRI plea, which was accepted by the prosecutor and the court.

“I went along with it,” Mr Gregory said. “He said you won’t be locked up no longer than six months. That’s what he told me.”

Once in hospital he was diagnosed with paranoid schizophrenia and put on three antipsychotic medications.

He responded well to treatment and within four years of his insanity plea in March 1972, Mr Gregory’s doctor at Saint Elizabeth’s had concluded he had recovered sufficiently for him to recommend an unconditional release. Doctors would recommend that he be freed on at least two future occasions.

Their advice would not be followed by the hospital. At Saint Elizabeth's, Mr Gregory had entered a world in which the normal rules of medicine, and of natural justice, no longer seemed to apply.

He was not alone. NGRI detainees may not have been found guilty of any crime, but under US law someone entering a secure psychiatric institution can be held indefinitely.

In DC, they can only be released with the approval of a judge in the Superior Court.

Unlike so-called ‘civil committees’, where someone is admitted to an institution like Saint Elizabeth’s at the request of police officers or family doctors, there is no requirement for an NGRI case in Washington DC to be reviewed again after a year and the presumption is in favour of continued detention — rather than requiring the government or hospital to prove why someone should not be released.

‘Civil committees’ can be discharged by doctors without any court involvement.

But for an NGRI detainee to secure an unconditional release, a high bar has to be cleared. A judge must be persuaded that they are either no longer mentally ill, or that they do not pose a danger to themselves or others.

In effect, the court is asked to predict their future behaviour. To make a decision, the judge considers recommendations from the hospital and a prosecutor at the US Attorney’s office.

In his four decades at Saint Elizabeth’s, not once was Mr Gregory violent. Not once did he reoffend.

NGRI patients can bring their own application for unconditional release but it is invariably a futile process.

Lawyers at the mental health division of the District of Columbia’s Public Defender Service (PDS) said they were not aware of a single case where such a move had succeeded without the support of the government or the hospital.

Unlike so-called ‘civil committees’, there is no requirement for an NGRI case to be reviewed again

Hadley Truettner, Mr Gregory’s lawyer, said the PDS regularly wins the release of ‘civil committees’ over the opposition of the authorities but this has never happened with NGRI cases.

“It’s insurmountable,” she said. “Clients have to prove that a negative; that they will not be dangerous in the future. The fact that I am unaware of a client being able to do this speaks volumes.”

For many years, Saint Elizabeth’s contribution was a terse letter from the head of the hospital simply stating that “it is our opinion . . . he is likely to injure himself or others if released into the community.”

More recently, it argued that he would be “likely to endanger himself” because of his age, his health problems and fears he wouldn’t take prescribed medication.

Although Mr Gregory still hears voices, his medication had long been reduced to a small dose and even when he didn’t take it doctors accepted that he wasn’t dangerous. A risk assessment completed in March 2001 after hours of interviews concluded that “even on those occasions . . . when he had failed to take his psychiatric medication or was intoxicated, he did not become violent.”

Nevertheless, the seasons passed and Mr Gregory remained behind bars at Saint Elizabeth’s.

Under the regime at the hospital, patients gradually build up privileges and demonstrate that they are able to cope with increasing levels of freedom, usually over a period of years.

In 2013, describing life inside, Mr Gregory said: “I’ve been bored ever since I’ve been here. They handle you like a bunch of kids [and] the food’s lousy.”

Dressed smartly in a three-piece suit, a dark Stetson hat and polished brown brogues, he said he had spent the years inside listening to the radio, attending treatment classes and playing cards.

Unlike others, he never lost hope. “People are just laying around to die in the hospital,” he said. “There are people the ward who were here before I was. They will never talk about going home.”

Within a year of his NGRI plea, Mr Gregory was considered well enough to be permitted to explore the hospital’s grounds unaccompanied and to receive other privileges.

But frustrated by the slow speed of the process, he developed what would become a life-long habit of absconding.

Over the past four decades, Mr Gregory went on ‘unauthorised leave’ around 40 times, walking away from hospital grounds or failing to return from trips into the city. “He developed a pattern of earning privileges, eloping from the hospital, being sent back to maximum-security, and then commencing the cycle again,” his clinical record states.

Asked during an interview at Saint Elizabeth’s in 2013 why he kept absconding, Mr Gregory said that he was visiting his mother in the early years. More recently, since her death in the mid-1980s, he has been going for “a little taste of freedom, a little taste of something else”. “I go out and visit friends,” he said. “I like to talk to people. The longest I was out was for eight months, I was panhandling here in Washington.”

During the absences, generally lasting days but sometimes several months, Mr Gregory didn’t break the law or act violently, his record shows.

Alert, cooperative, friendly and symptom-free

Joseph T. Smith, a medical officer in the psychiatry department at Saint Elizabeth's, describes Mr Gregory in 1983

After one absence a few years ago, staff recorded that he was “alert . . . and did not evidence any signs of psychosis”.

But the unauthorised leaves were still considered by the hospital to be evidence that he was not yet ready to live in the community and the slow process of securing his release was reset.

Early on, some doctors realised that there was only one way to break the cycle and avoid holding a non-violent patient for the rest of his life. On at least three occasions, in 1976, 1981 and 1983, his treatment team argued for him to be cut loose and receive an unconditional release.

Making this recommendation in 1983, Joseph T Smith, a medical officer in the psychiatry department, wrote that Mr Gregory wouldn’t be “dangerous to himself or others in the reasonable, medically foreseeable future”.

He reported that the patient was “alert, cooperative, friendly and symptom-free” on and off-medication. “His ties with the hospital should be completely severed,” he continued. “Otherwise, the only course that can be predicted is that he will remain at the hospital for the rest of his life, eloping from time to time and never achieving what would ordinarily be considered a stable enough adjustment to entitle him to an [unconditional release].”

It is not clear from the surviving clinical and legal files whether Mr Smith’s recommendation was blocked by the hospital review board or simply set aside when Mr Gregory next absconded, but as with the other two, it was never placed before a judge.

Instead, the future Mr Smith foresaw became a reality.

From his earliest years, Mr Gregory’s life was not easy.

He frequently played truant from school, occasionally stole from local shops and began drinking alcohol at the age of 11, following in the footsteps of his alcoholic father who died in 1961, court records show.

After dropping out of high school in seventh grade, he worked at various times as a short order cook, a painter, a landscape worker and a dishwasher.

He also ran into trouble with the law, serving a total of just over six years for separate incidents of forgery, assault and attempted burglary, according to his clinical record.

In the 1960s he moved with his partner to York, Pennsylvania, where his mother and brother lived. They had a daughter, but the relationship subsequently broke down and he has had no contact with either for decades.

“I was living with a girl [in Pennsylvania] and she jumped up and ran to Washington so I came and followed her,” he said. “I was looking for her [when I was arrested].”

The sole blemish in Mr Gregory’s record after entering Saint Elizabeth’s is a reference, repeated in many documents, to a day in 1978 when it was alleged that, after absconding to Pennsylvania, he had threatened his mother and brother with a butcher’s knife while intoxicated.

Although the incident is cited in many subsequent clinical assessments, at the time a judge considering an application to alter Mr Gregory’s detention conditions ruled that there was insufficient evidence it had taken place. There were no police records or statements from his relatives to substantiate the allegation, court records show.

Mr Gregory hasn’t committed another crime while on unauthorised leave, nor has he behaved violently at any point since his incarceration, according to records

Ms Truettner, Mr Gregory’s lawyer, criticised Saint Elizabeth’s unyielding step-by-step approach.

“The system is absolutely rigid and in a case like Mr Gregory’s I think the hospital’s inflexible system — when you mess up you’re back to square one and it takes years to win the hospital’s support to resume privileges or be released — never taught him to live in the community,” she said.

“And I think the hospital’s really at fault for that.

“In all the time he’s been on UL [unauthorised leave] he’s never re-offended but it’s immaterial because the hospital only gauges progress as to whether he makes it in their system.”

In an interview while Mr Gregory was still locked up, Kylee Ann Stevens, then director of forensic services at Saint Elizabeth’s, and Stephen T Baron, then acting director of the DC Department of Behavioural Health, declined to comment on the case specifically because of patient confidentiality.

Dr Stevens said that “each situation is looked at individually; there is no set recipe for how to get out of the hospital” but acknowledged that “we think about things in a graduated fashion” and that the original offence “is only one component that we look at”.

Asked if he was satisfied that Saint Elizabeth’s wasn’t detaining people for longer than was necessary, Mr Baron said: “I’m confident that we’re abiding by the process, that we are look at people [and] their clinical needs and we’re reporting that to the courts.”

“It’s not a place for warehousing,” he added.

There are 81 NGRI patients at Saint Elizabeth’s, with a median average stay of 12 years 2 months, down from 13 years and 11 months in 2013.

On three occasions between 2005 and 2009, Mr Gregory was allowed to leave the hospital on conditional release and live in a group home.

Each placement broke down after a few weeks and he returned from one stint in 2009 after being attacked by youths on the street outside the home.

“You’ve got some very sick patients who live out in them homes,” Mr Gregory said. “You don’t know who like you and who dislike you. I’d rather get out [of there] than get hurt.” Mr Gregory was on his fourth such placement, which began in November 2013, when he was granted an unconditional release.

Mr Gregory’s legal files contain dozens of handwritten notes which he personally wrote to the judges in charge of his case, imploring them to grant his release. In a typical letter, written in January 1984 in capital letters under the heading “IMPORTANT”, Mr Gregory wrote that he didn’t consider himself dangerous.

He requested either a complete release or a ‘civil commitment’ so he could “go into society, get a job + learn to adjust in society and support myself, my family + live a new life.

“I am a middle age [sic] man + need the chance to prove to myself all these things.”

Another, written to a judge the following month, added: “Since I’ve been here I’ve not had no problem with the staff or doctors.

“Sir, I have not been a threat to nobody.”

He said he continued to hear voices but had never acted on what they said. “They never stopped, I just don’t pay them no mind,” he said. A letter from the hospital in 1990, contained in Mr Gregory’s legal files, showed that his doctors concurred. They noted that he has heard voices for many years but that “there is no indication that he hallucinates to a point that is observable or that it interferes with his behaviour”.

“Generally, he is very pleasant, co-operative and gracious,” it added.

Mr Gregory has spent far longer under the control of Washington’s legal system than the maximum jail term for the crimes he was charged with, a position he shares with the majority of NGRI cases, according to legal experts.

The legality of this was challenged three decades ago by lawyers for Michael Jones, a Washington DC resident who pleaded NGRI after being charged with attempting to steal a coat from a local department store.

In a quirk of fate, a judge who heard one of Mr Gregory’s applications for freedom had previously represented Mr Jones.

Judge Frederick H Weisberg, speaking during a different NGRI case in 2013, said: “[The Jones] case went all the way to the Supreme Court of the United States [in 1983] on the issue of whether somebody could be confined [NGRI] for longer than he could have been confined had he been found guilty of the offence.

“And I almost got into a fistfight with the Assistant United States Attorney on the other side who argued that he could.”

Ultimately, however, Jones lost the case and remained institutionalised for another 22 years.

“Michael Jones was not a very dangerous character,” his former lawyer, Harry Fulton, said in a telephone interview. “They eventually just gave up and let him go.”

Mr Fulton, who retired in July 2011, said Jones “should never have used” an NGRI plea.

“The insanity defence should be used for just the most serious cases even if you’re eligible for it,” he said. “For shoplifting, Michael spent many, many decades incarcerated in St [Elizabeth’s].”

I want to die a free man. They at least need to give me that – that I die a free man

It is a view other lawyers and legal experts share.

Liza Gold, a forensic psychiatrist who carries out NGRI case reviews and teaches at the Georgetown University Medical Center in Washington DC, said she had come across many cases where clients had spent years in secure institutions after committing a misdemeanour.

“They get nailed,” Dr Gold said. “I don’t know that the attorneys understand how hard it is to get out.”

Speaking in Saint Elizabeth’s, Mr Gregory said: “If I had a choice between this place and prison I’d choose prison because at least I known when I’m going home,” he said. “You can die for a misdemeanour charge in here.”

In recent years, Ms Truettner made fresh applications for Mr Gregory's unconditional release every six months.

Turning down one such bid in late 2013, Judge Weisberg ruled that while he poses no danger to others, “he would be likely to endanger himself”.

“While the court fully appreciates Mr Gregory’s desire to be free of the Hospital constraints after [more than 40 years], the danger he is likely to pose to himself if his tie to the Hospital is severed prematurely is too great,” he wrote in his ruling.

Ms Truettner said that she kept going because her client repeatedly told her: “I want to die a free man. They at least need to give me that – that I die a free man.”

It appeared all but inevitable that Mr Gregory would die in a psychiatric institution, powerless to persuade a court he could be safely released without the hospital’s support.

Then, wholly unexpectedly, staff there performed an abrupt U-turn last winter and gave his latest application their blessing.

“We were shocked when the doctors backed down and offered a letter of support. When that happened, I asked the government if it would consider talking to our experts,” said Ms Truettner.

“The Assistant US Attorney on the case spoke to both at length and then she sent me an email saying that she would no longer oppose it. And then I wept.”

Ms Truettner said there had been no noticeable relaxation in the hospital’s opposition to the release of other NGRI detainees.

“I think what it finally came down to is Mr Gregory is 80 and he’s sick and we weren’t going to back down,” Ms Truettner said.

Phyllis Jones, chief of staff at DC’s Department of Behavioural Health, said Mr Gregory was detained for so long “because of his mental illness and he required that level of treatment to recover so that he could live in the community and continue his treatment with appropriate supports”. Bill Miller, a spokesman for the US Attorney’s Office for the District of Columbia, said: “We typically do not comment on cases beyond our court filings.”

On December 2 last year, the day when Chief Judge Satterfield handed down the brief three-page document confirming Mr Gregory’s unconditional release, PDS mental health lawyers held a party. “Everything was on paper. I didn’t hardly believe what she was saying,” Mr Gregory said.

In a video shot that morning, he is dressed for the occasion in a grey pinstripe suit and pink shirt with a white contrast collar.

His voice cracking, the former detainee describes his gratitude to Ms Truettner, his social worker-turned-lawyer and friend for more than 20 years.

“A long time, and thank you a lot for being here,” he says. “She showed me that somebody really cared for me all that time.”

Reflecting on his predicament in a recent interview, Mr Gregory said: “I’ve missed out on everything. Even my mother, she died when I was in the hospital. It still hurts. They wouldn’t put me out to see her, they kept me there until she died.”

He said that after so many years he didn’t feel anger. “I’m not angry because I’m out. I’ve got freedom. Freedom to do as you please.”

Mr Gregory is now sharing a room in a group home, a tall, white terraced house in north-eastern DC. He takes bus rides across the city, buys McDonald’s meals and hangs out with friends who were long ago discharged from Saint Elizabeth’s. “I’ll be walking around the street and people come up and say how good I look,” he said.

When his health allows and he has saved enough he hopes to make one last trip back to the Pennsylvanian town where he grew up, although he has a lingering fear.

“It’s been so long,” he said. “I want to go but I’m worried I can’t find nobody there I really know.”