Locked Away Forever? Inside the Secret World of the Criminally Insane
What happens when the justice system deems someone too mentally ill for prison—but too dangerous for society? For some, it means being locked away indefinitely in a maximum-security psychiatric hospital, where the walls are just as confining as a prison cell, and freedom is nothing more than a distant memory.
Mikita Brottman, a former college professor, got a rare glimpse inside this hidden world when she volunteered to run a book club at the Clifton T. Perkins Hospital Center, a state-run forensic psychiatric hospital in Maryland. There, she met Brian Bechtold—a man who, in 1992, admitted to gunning down both of his parents in their suburban home. Diagnosed with paranoid schizophrenia, he was declared not criminally responsible and sent to Perkins for treatment.
That was 27 years ago. He’s still there.
Brottman, captivated by Brian’s story, delved into his case and the shadowy reality of life inside forensic psychiatric hospitals in her book, Couple Found Slain: After a Family Murder. She uncovered shocking truths about the system—where patients aren’t serving sentences, yet some will never leave.
A Life Sentence Without a Trial
Unlike prison inmates, the people confined to forensic psychiatric hospitals haven’t been convicted of crimes. Instead, they have been found incompetent to stand trial or declared not guilty by reason of insanity. Some are there for evaluation, while others, like Brian, are held indefinitely, awaiting a release that may never come.
The biggest difference between prison and these hospitals? Inmates have an end date. Patients do not.
“You’re trapped in this limbo,” Brottman explains. “The hope that if you behave a certain way, you’ll get out—it grinds people down.”
A Day in the Life of the Criminally Insane
A typical day inside these institutions is a monotonous cycle of therapy groups, medication, and waiting. Patients wake early, eat meals with plastic spoons, and fill their time with supervised activities—if they’re lucky. Some take on jobs inside the facility, like janitorial work or medical record keeping, earning a small wage. Others spend their time watching TV or playing cards, confined to common areas, unable to retreat to their rooms except at designated hours.
Visitation is allowed, but rare. Since COVID-19, most patients only see loved ones through a screen.
For Brian, life inside Perkins has been anything but stable. Early on, he attended therapy sessions, took his medication, and did everything required of him. But when he began refusing the medication—citing severe side effects like impotence and incontinence—his relationship with doctors soured. Over the years, he has witnessed patient-on-patient murders, survived cancer, and even attempted an escape, taking a hospital worker hostage before being shot by police.
Now, he’s been there longer than most of the staff.
Prison vs. Psychiatric Hospital: Which is Worse?
While forensic hospitals offer therapy and treatment, they also share disturbing similarities with prisons—high fences, guards, solitary confinement, and, at times, outright abuse. However, Brian and others like him argue that prison might actually be better.
“In prison, at least you’re treated like a person,” Brottman says. “You can choose when to eat, when to go outside, when to stay in your room. Here, everything is interpreted as a symptom. You’re never just a person making a choice—you’re always a patient under a microscope.”
Even more distressing is the fact that many of these patients, including Brian, don’t know if they’ll ever be released. Their fate is determined by an overburdened psychiatric system with no clear roadmap to freedom.
The Dark Truth About the ‘Insanity’ Defense
Contrary to popular belief, the insanity defense is incredibly rare—and even when it succeeds, it doesn’t mean freedom. A study of eight U.S. states found that the defense is used in less than 1% of all criminal cases, and of those, only 26% are successful. Even then, 90% of those defendants had a prior history of mental illness.
In reality, pleading insanity is not a ‘get out of jail free’ card—it often leads to a lifetime behind hospital walls.
The Hidden Abuse Behind Locked Doors
Forensic hospitals are shrouded in secrecy, and with little oversight, abuse is rampant. While some mistreatment is overt—guards fired for violent behavior, patients attacking one another—other forms are more insidious. Overworked doctors become desensitized. Patients are overmedicated into submission. Unusual behavior is punished rather than treated. Restraints, forced drugging, and isolation are common, yet classified as ‘treatment.’
“It’s easy to see these people as monsters,” Brottman says. “But many are just victims of a broken system, lost in the cracks of justice and mental health care. The line between perpetrator and victim isn’t always as clear as we think.”
The Tragic Pattern of Family Murders
Brian’s crime—killing both his parents—falls into a chilling pattern known as ‘schizophrenic crimes.’ These cases often involve middle-class families, hidden histories of abuse, and mentally ill children who finally snap. Psychiatric research shows that in many of these cases, the murders are unplanned and occur during routine activities—preparing dinner, watching TV, going to bed—shocking those who thought the family was normal.
Brian’s case was no exception. But now, nearly three decades later, he remains locked away, caught between a past he cannot undo and a future he may never reach.
A System in Desperate Need of Change
Forensic psychiatric hospitals exist in a gray area of justice—meant to heal, but often becoming life sentences in disguise. With no agency tracking how long patients are held or why, many, like Brian, are simply forgotten.
Is there a way out? For some, yes. But for others, the walls of these institutions are just as permanent as prison bars, and their fate is sealed the moment they walk through the doors.
The only difference? They never know when—or if—they’ll ever walk back out.
