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(In the US) There is an insanity defense, but it is lengthy - time and money consuming - and juries, by-and-large, are not very receptive to it.

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Some states have a legal policy of "Guilty but insane". If convicted the offender must be incarcerated in a mental hospital until (if ever) they are declared sane - then they go on to serve the rest of a conventional prison sentence.

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