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 Florida, the insanity defense is recognized and allows a defendant to assert that they were not culpable for their criminal actions due to mental illness. Florida's approach to the insanity defense is influenced by the M'Naghten rule, which requires the defendant to demonstrate that, at the time of the offense, they either did not understand the nature and consequences of their actions or did not understand that their actions were wrong. This is codified in Florida Statutes Section 775.027. If a defendant successfully pleads insanity, they are not simply released. Instead, they may be committed to a mental health treatment facility. The period of commitment can be equivalent to, or sometimes longer than, the prison term that would have been imposed if the defendant had been convicted of the offense. The specifics of the insanity defense, including the burden of proof and the management of defendants found not guilty by reason of insanity, are detailed in Florida's statutes and case law.