This Term in Hall v. Florida the Supreme Court held a portion of Florida’s death penalty statute unconstitutional under the Eighth and Fourteenth Amendments.1 Specifically, the Court invalidated Florida’s rigid system for determining whether a capital defendant is intellectually disabled and therefore categorically ineligible for the death penalty.2 Before Hall was decided, if a Florida capital defendant had an IQ of above 70 points, then his attorneys were prohibited from presenting any evidence of his intellectual disability.3 This created a system in which someone who, like Mr. Hall himself, had an IQ score of 71 but nevertheless exhibited myriad other signs of intellectual disability was automatically eligible for execution.4 I use the Court’s reasoning in Hall to argue, as others have,5 that severely mentally ill defendants should be categorically barred from execution.

The Court’s opinion in Hall found fault with Florida’s inflexible system for defining intellectual disability, and in so doing emphasized several unique aspects of death penalty jurisprudence.6In particular, the Court highlighted the importance of individualized sentencing in capital cases and the need to avoid “rigid rule[s]” that might create an “unacceptable risk that persons with intellectual disability will be executed.”7 Further, the Eighth Amendment bars executing someone with an intellectual disability because all persons with intellectual disabilities have diminished culpability and, due to their limitations, are unable either fully to understand their crimes or to be deterred effectively.8 Therefore, the goals of neither retribution nor deterrence can justify executing someone with an intellectual disability. In many ways, the Hall decision thus echoes concerns first raised in Atkins when the Court outlawed the execution of intellectually disabled persons. Next, the Hall Court wrote that intellectually disabled persons “face a special risk of wrongful execution”9 because “they are more likely to give false confessions, are often poor witnesses, and are less able to give meaningful assistance to their counsel.”10 This concern relates to the fairness of a capital trial with a cognitively limited defendant. Capital defendants with an intellectual disability are vulnerable to an inadequate trial, in part because of the complexity of the sentencing phase,11 and therefore are subject to an increased risk of unconstitutional execution.

The Court in Hall thus ruled that unduly rigid definitions of intellectual disability are unconstitutional and strengthened the categorical prohibition against executing intellectually disabled people. However, Hall did not address a question that advocates and scholars have been asking for years: Why does the Eighth Amendment bar a death sentence for an intellectually disabled person, but not for someone with a severe mental illness?12 Though “the parallels between the severely mentally ill and the individuals protected by Atkins. . . are remarkable,”13 severely mentally ill defendants are eligible for death sentences. The number of severely mentally ill persons who have been executed is too numerous to count or document systematically.14 Andre Thomas, for example, is on death row in Texas; he was convicted of cutting out his children’s organs before attempting suicide.15 While in prison, he gouged out both of his eyes and ate one of them because he thought the government could otherwise read his thoughts.16 On August 5, 2013, Florida executed John Ferguson, who had a diagnosis of paranoid schizophrenia and thought he was the “Prince of God.”17 He also believed he “had powers drawn from the Sun.”18

The law of competency, rather than the culpability-based reasoning in Hall and Atkins, governs the execution of mentally ill prisoners. The Supreme Court’s current jurisprudence on competency to be executed does little to assist profoundly mentally ill defendants such as Thomas and Ferguson.19 This is in part because the law of competency deals with whether or not a person understands the reason for his execution, not whether a person’s psychiatric illness caused him to be less culpable for the underlying crime itself. This competency jurisprudence originated in 1986 with Ford v. Wainwright, in which the Court held that the Eighth Amendment “prohibits the State from inflicting the penalty of death upon a prisoner who is insane.”20 The Supreme Court later affirmed Ford v. Wainwright and held that a capital defendant must only have a “rational understanding of the reason for the execution.”21 The “rational understanding” requirement is distinct from the categorical prohibition against executing intellectually disabled defendants. It focuses not on the defendant’s diminished culpability (even if he was mentally ill at the time of the crime), but rather on the retributive importance of a death row prisoner’s understanding of the reasons for his punishment.22 Retribution is not served by executing someone who does not understand his punishment because he cannot “recognize at last the gravity of his crime.”23 The competency standard therefore focuses on the prisoner’s mental state at the time of his execution in an attempt to ensure that only those who understand the “law’s most severe sentence”24 will receive it.

The extensive litigation leading up to John Ferguson’s execution provides a useful illustration of the difference between the culpability-based categorical bar and the competency-based standard, which focuses only on the defendant’s understanding of the proceedings against him. The Florida Supreme Court acknowledged that “Ferguson suffers from mental illness,” and yet it upheld the trial court’s “determination that Ferguson’s mental illness does not interfere with his rational understanding of the facts of his pending execution.”25 According to the Florida Supreme Court, Ferguson “understands what is taking place and why” and “the Eighth Amendment requires only that defendants be aware of the punishment they are about to receive and the reason they are to receive it.”26 The low standard applied by the Florida court merely addresses the issue of whether the defendant currently understands his legal situation, not the defendant’s blameworthiness for the crime itself.27Ferguson, of course, could have introduced evidence of his mental illness during the sentencing phase of his trial in order to argue that he was not sufficiently culpable to receive the death penalty,28 but the ultimate decision about his sentence still rested with the jury. Ferguson’s diminished culpability due to his mental illness therefore did not result in a categorical bar against his execution.

The myopic focus on the question of whether the defendant understands his legal situation makes little sense in light of the Court’s broader death penalty jurisprudence, including the Hall decision. Since all of the reasons for not executing intellectually disabled people set forth in Hall—reduced culpability, ineffective deterrence, and the risk of an unfair trial29—apply equally to profoundly mentally ill defendants, it is both unjustifiable and inconsistent for the Court to allow those with a severe mental illness to be executed.30 First, mentally ill defendants who suffer from delusions and other psychoses are less culpable because they often cannot fully comprehend their actions, or they act without a full understanding of the consequences.31 A person who, like John Ferguson, thinks he is the “Prince of God,” apparently misunderstands the nature of his crime and its consequences.32 As many scholars have argued, the general characteristics of severe mental illness – the inability to conform one’s actions to society’s moral standards, the fact that a person with a mental illness can understand that his actions are wrong but may still commit a crime despite that understanding due to that illness, among others – render defendants like Ferguson less culpable than those without mental illnesses, even though their crimes may be some of the most horrific (perhaps because of the very mental illnesses at issue in their cases). Second, the death penalty does not effectively deter those who suffer from severe mental illness.33 The same inability to understand reality prevents a person with paranoid schizophrenia from being deterred by possible punishments. Finally, like intellectually disabled people, mentally ill defendants risk an unfair trial because they are unable to participate in their own case as effectively as defendants without psychiatric disorders.34

There is one especially important way in which mentally ill defendants are vulnerable to an unfair trial: though defendants often present mental illness as a mitigating circumstance that weighs against imposing the death penalty, many juries view mental illness as an aggravating circumstance favoring execution.35 This is especially important in states like Texas,36 which require the jury to find that a capital defendant is a “future danger” to society in order to execute him.37According to the American Bar Association’s 2013 recommendations for capital punishment reform, the Texas system puts future dangerousness “at the center of the jury’s punishment decision” because the issue of future violent behavior is a threshold question in a capital sentencing procedure.38 Capital sentencing juries therefore often “appear to equate mental illness with future dangerousness, thereby viewing mental illness as an ‘aggravating’ rather than a mitigating factor in sentencing.”39

Criminal defense attorneys are therefore forced to make a “tactical decision” concerning whether to present evidence of their clients’ mental illnesses in mitigation.40 In John Ferguson’s case, the Eleventh Circuit rejected a claim of ineffective assistance of counsel and upheld his attorney’s decision not to present “damaging information . . . regarding . . . [his] anti-social personality disorder.”41 Thus, even though evidence of a defendant’s mental illness should be viewed as a mitigating factor, instead it is a “double-edged sword” in that juries often consider “stigmatizing” evidence of mental disorders as aggravating factors.42 Surely this creates an “unacceptable risk”43 that a severely mentally ill defendant will be unconstitutionally executed, since the very reason for his diminished culpability is likely to be viewed as an aggravating circumstance favoring death. As a result, severely mentally ill defendants are often unable to present a persuasive and comprehensive case for mitigation.44 The Hall Court wrote that the Eighth Amendment prohibits the execution of intellectually disabled persons because such a prohibition “protect[s] the integrity of the trial process.”45The trial process is similarly compromised by the execution of severely mentally ill inmates who face great dangers in their mitigation cases, and the resulting “special risk of wrongful execution”46 calls for a categorical bar on execution of severely mentally ill prisoners.

In sum, the reasoning in Hall further solidifies what advocates have been arguing since the Supreme Court outlawed the execution of intellectually disabled defendants: the Court’s reasons for the categorical bar apply with equal force to severely mentally ill inmates. The Court relied on “established medical practice” and a persuasive consensus of state legislatures47 to rule that Florida’s rigid procedures for determining intellectual disability violated the Eighth Amendment. In contrast, the Court has declined to hear cases in which defendants argue that the intellectual disability exemption should be expanded to include severely mentally ill defendants;48 indeed, “no state court has extended the [intellectual disability] rationale to severe mental illness.”49 Perhaps courts have resisted confronting this constitutional problem because of the sheer number of severely mentally ill prisoners who are on death row and the challenging task of protecting the rights of those who commit some of the most heinous crimes. Other difficulties abound and require further research and scholarly discussion. For example, the issue of defining a severe mental illness is no easy task. Some state legislators have drafted laws to prevent the imposition of the death penalty on severely mentally ill defendants, and have defined severe mental illness as “schizophrenia, schizoaffective disorder, bipolar disorder, major depression, and delusional disorder.”50 Though this may seem like a straightforward list, evaluating defendants to determine who is suffering from one of these disorders may also yield uneven results, just as Florida’s IQ tests did in Hall. Nonetheless, the Court must exercise its “independent judgment,” rely on medical science, and discern our evolving understanding of severe mental illness as it did in Hall51with respect to intellectual disability and revisit the issue of whether it is constitutional to execute someone with a severe mental illness.

Lise E. Rahdert is a member of the Yale Law School J.D. Class of 2015. The author would like to thank Professor Stephen Bright for his helpful comments, Marc Bookman for his suggested edits, and Matt Sipe and the editors of the Yale Law Journal for their feedback.

Preferred Citation: Lise E. Rahdert, Hall v. Florida and Ending the Death Penalty for Severely Mentally Ill Defendants, 124 Yale L.J. F. 34 (2014), http://yalelawjournal.org/forum/hall-v-florida-and-ending-the-death-penalty-for-severely-mentally-ill-defendants.