Facts About the Death Penalty: Execution of Prisoners with Severe Mental Illness

In 2002, a Gallup poll found that 75% of Americans opposed exe­cut­ing indi­vid­u­als who have severe men­tal ill­ness­es. Many peo­ple believe that the U.S. does not exe­cute peo­ple who suf­fer from seri­ous mental illness. 

This is only partially true. 

In fact, the Constitution bars the exe­cu­tion only of peo­ple who are legal­ly deemed ​“insane” or men­tal­ly incom­pe­tent. But the legal stan­dard for demon­strat­ing men­tal incom­pe­tence is high and exemp­tions from exe­cu­tion for men­tal incom­pe­tence are rare. Given this, it is not sur­pris­ing that there are many exam­ples of pris­on­ers with seri­ous men­tal ill­ness who have nev­er­the­less been executed. 

Fact: The United States Supreme Court has deter­mined it is uncon­sti­tu­tion­al to exe­cute some severe­ly men­tal­ly ill indi­vid­u­als, often referred to as the Ford bar to exe­cu­tion. 

In 1986, the Supreme Court ruled in Ford v. Wainwright that it is cru­el and unusu­al to exe­cute men­tal­ly incom­pe­tent pris­on­ers. The defen­dant in that case, Alvin Bernard Ford, was con­vict­ed of mur­der and sen­tenced to death in 1974. There was no sug­ges­tion at the time that Mr. Ford was incom­pe­tent to stand tri­al. Subsequently, how­ev­er, Mr. Ford’s men­tal health start­ed to decline and by 1982 he was obsessed with the delu­sion that the Ku Klux Klan had tar­get­ed him ​“to force him to com­mit sui­cide.” In his con­cur­ring opin­ion, Justice Powell artic­u­lat­ed what became the legal stan­dard for deter­min­ing men­tal incom­pe­tence: a pris­on­er can­not be exe­cut­ed if they are not ​“aware” of the fact they will be exe­cut­ed and the rea­sons for the exe­cu­tion. Mr. Ford was found incom­pe­tent to be exe­cut­ed. The Court large­ly left pro­ce­dur­al deci­sions about the process for eval­u­at­ing a prisoner’s com­pe­ten­cy for exe­cu­tion in the hands of the states. 

The Court did not weigh in again on com­pe­ten­cy and the death penal­ty until the 2007 case of Panetti v. Quarterman. In 1995, Texas offi­cials declared Scott Panetti com­pe­tent to stand tri­al despite a long his­to­ry of men­tal ill­ness and a court-appoint­ed psychiatrist’s report that Mr. Panetti expe­ri­enced severe delu­sions and hal­lu­ci­na­tions. After Mr. Panetti was per­mit­ted to rep­re­sent him­self at his tri­al, he attempt­ed to sub­poe­na Jesus Christ, the Pope, and John F. Kennedy as wit­ness­es. State and fed­er­al courts sub­se­quent­ly reject­ed Mr. Panetti’s claims that he was incom­pe­tent to be exe­cut­ed under the Ford ​“aware­ness” stan­dard. But the Supreme Court inter­vened, stay­ing his exe­cu­tion and hold­ing that a pris­on­er sen­tenced to death must be more than just ​“aware;” he must ratio­nal­ly under­stand the fact that he is being exe­cut­ed and the rea­sons for his exe­cu­tion. Because Mr. Panetti had fixed delu­sion­al beliefs about why he was being exe­cut­ed, he was found to be men­tal­ly incom­pe­tent for exe­cu­tion and lat­er died in prison of natural causes. 

In the 2019 case of Madison v. Alabama, the Supreme Court clar­i­fied the legal stan­dard regard­ing com­pe­ten­cy to be exe­cut­ed. Vernon Madison had been on death row for over 30 years after he killed a police offi­cer, and his health had seri­ous­ly declined. After a stroke, Mr. Madison was diag­nosed with severe vas­cu­lar demen­tia. His lawyers argued he was incom­pe­tent to be exe­cut­ed because he could no longer remem­ber the crime. The Court ruled that a state may exe­cute a pris­on­er who has no mem­o­ry of his crime — but may not exe­cute him if he has no ratio­nal under­stand­ing of why he is being exe­cut­ed, whether caused by demen­tia or men­tal ill­ness. The Court sent Mr. Madison’s case back to the low­er courts to reassess his com­pe­ten­cy, but Mr. Madison died before he could be reassessed. 

Fact: There have been few suc­cess­ful Ford claims. 

The legal stan­dard set by the Court has proven dif­fi­cult to meet in prac­tice: a diag­no­sis of severe men­tal ill­ness (SMI, includ­ing schiz­o­phre­nia, schizoaf­fec­tive dis­or­der, bipo­lar dis­or­der, and delu­sion­al dis­or­ders) does not guar­an­tee some­one will be found ​“incom­pe­tent” and shield­ed from exe­cu­tion. In a 2014 study, Cornell Law Professor John H. Blume iden­ti­fied 141 Ford claims brought between 1986 and mid-2013, only 21 of which result­ed in a stay of exe­cu­tion — a less than 15% suc­cess rate. In a sub­se­quent study, released in 2025, Professors I‑An Su, Blume, and Stephen J. Ceci found that just 28 peo­ple in total had brought suc­cess­ful Ford incom­pe­ten­cy claims since 1986, or only sev­en new suc­cess­ful claims in the twelve years between 2013 and 2024. All 28 men had been diag­nosed with SMI: 24 with schiz­o­phre­nia, and 22 with more than one SMI. 

One researcher, Anna Hunt, stud­ied a num­ber of these claims and posits that the legal sys­tem is infused with a strong ​“pre­sump­tion of com­pe­ten­cy,” mak­ing it dif­fi­cult even for pris­on­ers with SMI to suc­cess­ful­ly raise Ford claims. She notes that this pre­sump­tion pre­vents courts from appre­ci­at­ing the pos­si­bil­i­ty that exten­sive time on death row itself can lead to men­tal health dete­ri­o­ra­tion, includ­ing SMI, regard­less of the individual’s men­tal state when they entered prison. 

Fact: Many pris­on­ers with severe men­tal ill­ness have been exe­cut­ed. 

Substantial rates of men­tal ill­ness have been report­ed among peo­ple on death row. Professor Frank Baumgartner and Betsy Neill found that 43% of the peo­ple exe­cut­ed between 2000 and 2015 had been diag­nosed with a men­tal ill­ness. They note this like­ly under­es­ti­mates the num­ber of men­tal­ly ill death row pris­on­ers by ​“nec­es­sar­i­ly leav­ing out those who are undi­ag­nosed, or for whom a diag­no­sis was not pre­sent­ed at tri­al or in the sources we reviewed.” In a 2005 study, Professor Blume found almost 88% of death row pris­on­ers who waived their appeals and vol­un­teered for exe­cu­tion suf­fered from men­tal ill­ness and/​or sub­stance use dis­or­der. He writes that there is an espe­cial­ly strong link between ​“vol­un­teerism” and men­tal ill­ness. Of the ​“vol­un­teer” exe­cu­tions he reviewed, 14 involved schiz­o­phre­nia and sev­er­al more report­ed delu­sions that may reflect schiz­o­phre­nia. Depression and bipo­lar dis­or­der account­ed for at least 23 oth­er cas­es, and post-trau­mat­ic stress dis­or­der was present in anoth­er 10. At least 30 of those who ​“vol­un­teered” for exe­cu­tion had pre­vi­ous­ly attempted suicide. 

John Ferguson had a long, doc­u­ment­ed his­to­ry of seri­ous men­tal ill­ness­es: mul­ti­ple pro­fes­sion­als diag­nosed him with para­noid schiz­o­phre­nia through­out the 1970s. He spent ten years in and out of men­tal insti­tu­tions after a trau­mat­ic brain injury when he was 21. He was sen­tenced to death in 1978 for the mur­ders of 6 peo­ple in 1977, and for the mur­ders of Brian Glenfeldt and Belinda Worley in 1978. Mr. Ferguson’s coun­sel raised a com­pe­ten­cy claim in 1995, but a U.S. District Court deter­mined after an evi­den­tiary hear­ing that he ​“had a fac­tu­al and ratio­nal under­stand­ing of the rea­sons for his sen­tence.” Florida offi­cials and judges repeat­ed­ly found Mr. Ferguson com­pe­tent despite evi­dence of long­stand­ing men­tal ill­ness and delu­sions. He was exe­cut­ed in 2013. His last words at the time of his exe­cu­tion were, ​“I am the Prince of God and I will rise again.” 

Jeffrey Glenn Hutchinson spent over 10 years in the U.S. Army and was a Gulf War vet­er­an. While serv­ing dur­ing the Gulf War, Mr. Hutchinson was exposed to sarin gas and mul­ti­ple gas injuries, which led a diag­no­sis of Gulf War Illness and per­ma­nent neu­ro­log­i­cal and psy­cho­log­i­cal dam­age. He expe­ri­enced para­noia and delu­sions after return­ing to civil­ian life, believ­ing ​“gov­ern­ment agents were tar­get­ing him for his clas­si­fied knowl­edge.” He was sen­tenced to death in 2001 for the 1998 mur­der of his girl­friend Renee Flaherty and her three chil­dren. He main­tained his inno­cence and said the gov­ern­ment was try­ing to exe­cute him ​“to hide long­stand­ing coverups.” In post-con­vic­tion pro­ceed­ings, his attor­neys prof­fered for­mer attor­neys, inves­ti­ga­tors, a board-cer­ti­fied psy­chol­o­gist, and a board-cer­ti­fied psy­chi­a­trist — all of whom tes­ti­fied that Mr. Hutchinson was incom­pe­tent to be exe­cut­ed. The psy­chol­o­gist and psy­chi­a­trist tes­ti­fied that Mr. Hutchinson suf­fered from long­stand­ing fixed delu­sions and that he did not ratio­nal­ly under­stand why the state was exe­cut­ing him. But the Florida Circuit Court held that Mr. Hutchinson did not pro­vide enough evi­dence to prove he was incom­pe­tent; he was exe­cut­ed on May 1, 2025.