By reason of insanity

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Ketema Ross came to Yale with a dream of changing the world as a civil rights lawyer. But during his first year as a law student, Ross lost his faith in the law as a tool for social justice. He also lost his grip on reality.

The State Department started AIDS as a plot against black people, Ross told a friend that winter. By the summer, he believed the CIA was tapping his brain with a satellite. In his third semester, immediately after 9/11, he attended a single class, then withdrew and dropped out of sight, eventually returning to his hometown of Pullman, Washington.

Early one morning in 2007, Ross heard President George W. Bush ’68 telling him that his next-door neighbors were traitors who needed to be gotten rid of. Ross broke into the elderly couple’s apartment and beat them with a broom handle. (They both survived the attack.) Charged with assault, he pleaded not guilty by reason of insanity.

Now Ross says he has recovered his sanity. And, after seven years of confinement in a psychiatric hospital, he has regained his freedom, mostly: by court order, he was conditionally discharged on January 11.

What’s more, Ross has recovered some of his belief in the power of lawyers and the law to make the world a better place. With that renewed faith in civil rights law, he has teamed up with Yale College alum Andrew Biviano ’97 on a federal lawsuit challenging the state’s approach to patients like him.

Washington State’s approach to those found not guilty by reason of insanity, a 2014 report found, is unusually severe. Patients are confined to a locked ward, needing a court order even to walk the hospital grounds, let alone for supervised therapeutic outings. The state can hold them indefinitely. Ross and Biviano believe this approach is grounded in fear, ignorance, and stigma. It turns patients into prisoners, they argue—often for far longer than people imprisoned for similar offenses. Ross, for example, says he could have accepted a plea bargain and been out of prison in three years—less than half the time he spent confined in the hospital.

The suit, Ross v. Inslee, is an unusual collaboration for this pair of Yalies: Ross is the lead plaintiff and Biviano, with a law degree from Spokane’s Gonzaga University, is the lead attorney.

Also unusual is Ross’s decision to put himself in the public eye as a person with mental illness. He is using his full name rather than a pseudonym or initials in the federal lawsuit; he’s granting interviews, with photos of himself; he appeared in a video on YouTube and has former law school classmates helping to publicize the cause.

He has also done months of research, recruited other patients as plaintiffs, and helped draft a complaint, Biviano says. And because any victory in the federal suit would come too late to help Ross’s own cause—he has already been released—“the story here is Ketema’s braveness and selflessness,” Biviano says. “He recognized that he has to be the one to do this. He’s so intelligent and articulate that he’s much more persuasive than any legal arguments I can make.”

“I’m doing it for the patients who’ve been here 10, 20, 30 years and have no hope” of being discharged, Ross said in a phone interview late last year, when he was still confined to a forensic ward of Eastern State Hospital in Medical Lake, Washington. The legal challenge, he says, gives those patients “a grain of hope that they’ll be able to leave this place and start their lives over.”

One man’s demons

But wait, you say. Ross admits that he committed violence against two innocent senior citizens. Even if we accept the notion that he was not in his right mind and therefore not criminally responsible, how do we know he won’t do it again?

“It’s not a fair question,” Ross responds. During more than an hour of conversation, it’s the only time his calm, rational voice takes on a note of urgency.

“People get out of prison every day,” he continues. “They have a 65 percent recidivism rate compared to ours, which is 0.6 percent. The average citizen is as likely to commit a crime as a patient in the forensic ward of this hospital. It’s a 99.4 percent chance that I won’t.”

A consultant’s report to the Washington State Department of Social and Health Services bears out Ross’s statistics, adding that insanity acquittees who are discharged commit less violence than the general population. While nationwide statistics don’t exist, the available state data show acquittee violence rates ranging from 0 percent to 0.5 percent in recent years, Neil Gowensmith—an author of the report and a psychology professor at the University of Denver—says in an e-mail. By contrast, the overall national rate of violent crime in 2013 was 2.3 percent, a historic low.

Numbers aside, “I don’t have to prove that I’ll never, ever, ever, ever, ever commit any, any, any criminal act,” Ross declares, “because I’m still a citizen of this country.”

Raised mostly in Pullman—south of Spokane and home of Washington State University—Ross decided by age 16 that he wanted to become a civil rights attorney and, eventually, a Supreme Court justice. After graduating from Colorado College, he enrolled at Yale Law School in the fall of 2000.

That first year was “disillusioning,” Ross recalls. “I had all these grand aspirations of using the law to achieve all these social justice goals.” But as he learned about the American legal system, “It became clear pretty quickly that it was going to be a much more difficult row to hoe.”

“I was really angry, hurt, like the world was cheating me out of something.” Ross fell into a suicidal depression, seeking help from Yale Health. (He says they put him on a months-long waiting list, by which time the crisis had passed.)

That first year, Ross didn’t experience symptoms of schizophrenia, he says. But his friend and classmate Elisabeth Steele Hutchison ’03JD recalls a dinner conversation in which he told her that the State Department had hatched AIDS to infect African Americans.

“I remember being taken aback, really surprised and off-put,” says Steele Hutchison, who is now admissions director at the University of Hawaii law school. “I always admired him. He’s so smart.” But his AIDS comment caused her to back away from the friendship. When he disappeared the next fall, she assumed he had transferred to another law school.

Instead, Ross had decided “I didn’t want to be an attorney, didn’t want to be at Yale,” he relates. “In my defiant mood” and suffering from paranoia, delusions, and hallucinations, he believed the CIA was after him because of his political activism. After leaving Yale, he “bounced around from place to place”—his father’s, his mother’s, Thailand—entangled in drugs, alcohol, “bad relationships, the whole nine yards.” He got in fights and cycled in and out of psych wards. With a diagnosis of schizoaffective disorder—later changed to chronic paranoid schizophrenia—he would take his medications for a week or two after leaving the hospital, then stop because he considered medication an admission of weakness.

In 2007, Ross returned to Pullman “to make a new start.”

“I thought I’d be facing my demons,” he says. But it didn’t work.

“My delusions about the CIA were really strong,” Ross recalls. “I thought my next-door neighbors were traitors” and that the president was ordering him to get rid of them. He doesn’t like to talk about the assault, referring me to an account in the Inlander, a weekly publication that has written extensively about Ross and other patients found not guilty by reason of insanity. It says that he broke into his neighbors’ apartment, “stark naked and deeply psychotic, and hit them repeatedly with a broken broom handle.”

“If he didn’t listen to the things he heard, he believed he’d be killed,” the Inlander continues. “He left five minutes later, his neighbors bruised and beaten, but alive.” Ross called the police himself, the Inlander reports. But even after his arrest, he says now, “I thought army rangers would break me out of jail.” It took about a month and a half in the county jail, under consistent medication, before his delusions became clear to him.

“To this day it’s very difficult” to think about what he did, Ross says by phone. “You go from feeling really good about yourself to feeling really bad about yourself in a heartbeat. For me, that heartbeat was going from thinking I was a secret agent to realizing that I had assaulted my elderly neighbors.”

That’s why he doesn’t regret using the insanity defense instead of accepting a plea bargain: without hospitalization and treatment, there’s no knowing what would have happened. “Would I have taken a life? Committed rape?”

Don’t look for Ross to praise the hospital, however.

Within six months or a year, “my treatment records started to reflect the fact that I’d stabilized on medications,” he says. “You would think that the hospital would take that and say, ‘okay, this person’s probably ready for release.’ But the hospital doesn’t care about recovery as much as you would think.”  

As in prison, “any infraction sets you back,” Ross complains. “It could be something as small as bringing coffee into your room, when coffee is considered contraband. Or being alone with a female peer in a room with the light off, when it was 4 o’clock in the afternoon. There’s many ways to get set back, but only one way to get out, and that’s a court order.”

An escape and a lawsuit

Ross and Biviano trace Washington State’s high anxiety about patients who pleaded not guilty by reason of insanity—known as NGRI—to 2009. That’s when an NGRI patient from Eastern State Hospital walked away from a supervised outing to a county fair, deciding that he wanted to go home.

After a three-day manhunt, the patient was captured. No one was hurt. But 22 years earlier, during a psychotic episode, the man had killed an elderly woman. Although the hospital CEO called him “a fairly model patient,” the ease with which he slipped away from the outing—and the violence he committed decades earlier—caused panic among the public and politicians. One columnist branded him a “homicidal loon.”

The next year, the legislature passed laws cracking down on NGRI patients. Before, patients who were stable could leave the hospital for family visits and supervised trips to stores, parks, and ball games. Now they need a court order even to leave the locked forensic ward and walk on the hospital grounds. To be deemed well enough for discharge, they need the approval of a “public safety review panel,” on which mental-health professionals are outnumbered by representatives of law enforcement, corrections, and prosecutors.

The law had immediate consequences for many patients, including Ketema Ross, who had “substantially recovered” from his symptoms and “consistently demonstrated fully responsible behavior” on hospital outings. He lost all of his community privileges, which were integral to his treatment plan, the suit says.

“The citizens of Washington are now safer,” state representative Matt Shea declared after the legislation passed unanimously. Calling the escaped patient “a dangerous and violent man who . . . should have never been taken out of the mental hospital,” Shea said: “This legislation is meant to ensure that dangerous forensic patients remain separated from the public except under very specific circumstances,” such as medical emergencies.

In a 2014 report to the state’s Department of Social and Health Services, Gowensmith and other consulting psychologists call Washington “clearly an outlier” in its approach to NGRI acquittees. “Such lengthy hospitalization is unnecessarily expensive and restrictive,” the report continues. “The goals of public safety, financial stewardship, and patient recovery would all be better achieved by inpatient treatment that is briefer but more specialized.”

The restrictions are “devastating to patients,” hindering their recovery and depriving them of “dignity, respect, and worth,” the suit says. It argues that the state laws violate the Americans With Disabilities Act as well as the constitutional rights to equal protection, minimally adequate treatment, and freedom from ex post facto punishment.

In legal filings, Washington State responds that its treatment of NGRI patients is appropriate and legal. “Treatment professionals . . . exercise care and consideration when evaluating patients for a change in level,” which determines their privileges and restrictions, the state says.

Far from being arbitrary, “a patient’s progress through treatment largely depends on that patient’s behaviors, motivation, and other factors within the patient’s control,” the state continues. Under the current system, patients are “able to seek further privileges and freedoms, up to and including full discharge,” through the state courts, without intervention by the federal judiciary—and Ross has done so, the state notes. The Washington attorney general’s office declines to comment further.

In October, a federal judge denied Ross’s motion for a preliminary injunction, saying he hadn’t provided enough evidence that the state-court procedures are unconstitutionally slow and burdensome.

Using those state-court procedures, another plaintiff won final discharge last year—a development that Biviano attributes to the federal litigation. “We feel like it has definitely had an impact and has been worth the effort,” he says in an e-mail. He says they’re now negotiating in an effort to settle the suit.

“The next civil rights issue”

Elisabeth Steele Hutchison met Ketema Ross 15 years ago, at a Yale Law School event for people of color who’d been admitted and were considering whether to enroll. They formed an “instant connection,” she says, but lost touch when he withdrew.

Then last year, a Law School classmate committed suicide, and Steele Hutchison was asked to let other class members know. She tracked Ross down on Facebook, sent him a message, and eventually heard back from him—with a link to the Inlander article about him. It was the first she knew about the turn Ross’s life had taken since his Yale days.

They reconnected by phone. She told him that she developed depression during her first year at the Law School, was misdiagnosed, and spent years struggling with mental illness.

“What struck me as so sad was: [our classmate] was suffering, I was suffering, Ketema was suffering, and we couldn’t talk about it,” Steele Hutchison says. “We could talk about racism, but we just didn’t have the vocabulary” to talk about mental illness.

Why?

“Oh, stigma. Nobody says ‘Hi, I’m so-and-so and I suffer from major depression.’ I kind of think this is the next civil rights issue,” she says. “We’ve kind of gotten through race, sexual orientation, gender—we haven’t solved any of them,” but have made a lot of progress. Mental illness, she says, will remain taboo until more people “come out of the closet” and disclose their personal struggles.

Ross and Steele Hutchison are not outliers. More than 18 percent of American adults—43.7 million people—suffered from mental illness in 2012, according to the National Institute of Mental Health. Nearly 10 million had what is considered serious mental illness. The statistics are even more sobering at Yale Law School: a recent survey found that 70 percent of students face mental health challenges, and many say they can’t find the treatment or support they need.

“What Ketema’s done, which is so brave, is say, ‘This is who I am, and I am getting the care that I need to get,’” Steele Hutchison says. “This is a difficult path. I wouldn’t recommend it to him. I work at a law school now and I said, ‘What are you doing?’”

To which Ross responds: “Transparency’s kind of become a way of life for me. I really don’t have too much to hide. If people want to judge me by it, they will. If they want to give me a chance, they will.”

Beautifully boring

In his first two weeks out of the hospital, Ketema Ross found an apartment in Spokane, set up his mental health benefits and a bank account, bought groceries and pots and pans—“just the little things that people take for granted, but I certainly don’t at this point,” he says.

In the immediate future, he plans to take a one-week training course and get certified as a peer counselor, which he hopes will bring swift employment working with mental health patients in the community. In the longer term, Ross will probably apply to law school next year, perhaps at Gonzaga. But he’s uncertain whether he’ll enroll: “I want to figure out where I can have the most benefit for mental health advocacy.”

Being in charge of his own schedule and whereabouts after seven years of confinement “is definitely an adjustment,” Ross notes. “It’s awesome.”

Still, because his hospital discharge is conditional, “there’s a whole list of conditions that I have to abide by,” he says: no firearms, no drugs or alcohol, regular check-ins, random drug testing. After six months he’ll be eligible to go back to court and request final discharge. “

It sounds kind of boring,” he says in describing his new life. “But believe me, I don’t mind.”

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The Yale Alumni Magazine is published by Yale Alumni Publications Inc., an alumni-based nonprofit that is not run by Yale University. Its content does not necessarily reflect the views of the university administration.