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 Georgia, the insanity defense is recognized and is based on the defendant's mental capacity at the time of the crime. The state follows a version of the M'Naghten rule, which requires the defendant to prove that, due to a mental illness or defect, they either did not understand the nature and quality of their act, or were unable to distinguish right from wrong with respect to the act. This is codified in the Official Code of Georgia Annotated (O.C.G.A.) § 16-3-2 and § 16-3-3. The insanity defense in Georgia is an affirmative defense, meaning the burden of proof lies with the defendant. If a defendant is found not guilty by reason of insanity, they are not automatically released. Instead, they may be committed to a mental health facility for treatment. The length of time spent in confinement can be equivalent to, or potentially longer than, the sentence that would have been imposed had the defendant been convicted of the crime. Federal law also provides for an insanity defense under 18 U.S.C. § 17, which aligns with the principles that a defendant must be unable to appreciate the nature and quality or the wrongfulness of their acts due to a mental condition.