Most states have long recognized a form of the insanity defense, based on the defendant’s mental illness, defect, or inability to understand that the criminal act was wrong. In pleading an insanity defense, the defendant admits the criminal conduct, but asserts a lack of culpability based on mental illness. Many states still model their insanity defense on the old English rule of law (the M’Naghten rule from 1843) in which the defendant asserts he (1) did not know the nature and quality of the act, or (2) did not know that it was wrong.

And it is an affirmative defense to a prosecution under any federal statute (federal law) that, at the time of the offense, the defendant was unable to appreciate the nature and quality of his acts, or the wrongfulness of his acts. See 18 U.S.C. §17.

When a defendant is found not guilty by reason of insanity it does not mean he necessarily goes free. States often have requirements for treatment or institutionalization after such a finding. And some states require, at a minimum, confinement in a treatment institution or facility for the length of time the person would have received if convicted—so a defendant may end up spending more time confined than if he did not raise such a defense.

The law regarding the availability, definitions, and nature of the insanity defense vary from state to state, and are usually located in a state’s statutes.

In Hawaii, the insanity defense is recognized and allows a defendant to assert that they are not culpable for their criminal actions due to mental illness or defect. Hawaii follows a version of the M'Naghten rule, which requires the defendant to prove that at the time of the offense, they were suffering from a physical or mental disease, disorder, or defect that either prevented them from knowing the nature and quality of their wrongful act, or from understanding that their act was wrong. This is codified in Hawaii Revised Statutes §704-400. It is an affirmative defense, meaning the burden of proof is on the defendant to establish the defense by a preponderance of the evidence. If a defendant is found not guilty by reason of insanity, they are not automatically released. Instead, they may be committed to a psychiatric facility for treatment. The length of confinement can be equivalent to, or sometimes longer than, the sentence that would have been imposed had the defendant been convicted of the offense. Federal law also provides for an insanity defense under 18 U.S.C. §17, which similarly allows a defendant to claim they were unable to appreciate the nature and quality or the wrongfulness of their acts due to a mental condition at the time of the offense.