The laws were passed in 11 states, including Pennsylvania, after John Hinckley was found not guilty by reason of insanity in the shooting of then- President Ronald Reagan in 1981.
A guilty but mentally ill verdict holds the defendant criminally responsible. An insanity verdict does not. Treatment of the guilty but mentally ill can be ordered as part of a sentence, but it is not required.
Legal experts and mental health groups say they fear the laws are denying treatment for many of the truly sick.
"It's not rational to me to send somebody to prison if they really were ill," said Janet Leban, executive director of the Pennsylvania Prison Society. "I'm not comfortable with it from a moral point of view."
Studies have shown that defendants found guilty but mentally ill often receive longer than average sentences. Some never are sent to hospitals for treatment of their mental illness; for those who are, hospital stays tend to be short. No special treatment is afforded them in prison.
More than a quarter of those found guilty but mentally ill under the Pennsylvania law received no hospital treatment, according to a 1988 study. More than half of the hospitalizations that did occur lasted less than six months, the study said.
Pennsylvania state prisons have no special provisions for inmates judged guilty but mentally ill, said Ben Livingood, spokesman for the Department of Corrections. "Somebody who comes in GBMI would be treated just like any other inmate," he said.
Nine guilty but mentally ill convicts were in state mental hospitals in Pennsylvania as of last July 1, the most recent date for which figures were available. An additional 49 were inmates in state prisons, and an unknown number were in county jails.
"It makes you suspicious that the thing's not working," criminal justice professor John M. Burkoff said about the numbers.
Burkoff, of the University of Pittsburgh, helped write the 1982 bill allowing verdicts of guilty but mentally ill.
"Here's my fear: The GBMI statute was aimed at making sure that certain kinds of crazy people get treatment, and they're not getting it," he said.
Few experts see change in the offing.
Arthur Donato, a lawyer who lectures on insanity defenses at Villanova Law School, said revision of the statute seemed unlikely "in these times, when the war on crime has become a war on the Constitution."
"Who would introduce that bill now to have it abolished?" asked Ingo Keilitz, director of the Institute on Mental Disability & the Law at the National Center for State Courts in Williamsburg, Va. He also cited a national get-tough-on-crime mood. "My sense is that once something's on the books, it's going to take an incredible event to take it off the books."
"I don't know what would work better," said Jay Centifanti, a Pennsylvania mental health advocate, "other than a wrinkle that they can't go back into prison without a due process hearing . . . so they don't get dumped out the back door into prison."
The first state to allow guilty but mentally ill verdicts was Michigan, in 1975. Eleven other states - Alabama, Delaware, Georgia, Indiana, Illinois,
Kentucky, New Mexico, Pennsylvania, South Carolina, South Dakota and Utah - enacted similar statutes as the uproar after the Hinckley verdict echoed.
The laws were meant to cut down on insanity pleas, to avoid jury confusion over the role of mental illness in crime, and to get treatment to mentally ill offenders, Keilitz said.
The treatment goal "was a sugar coating to make a rather bitter pill easier to swallow (for mental health advocates)," Keilitz said. But he and others question whether any of the aims have been met.
"It's really no different than a guilty verdict," said Sue Dickinson, forensics chair for the National Alliance for the Mentally Ill, which opposed the statutes.
The 1988 Pennsylvania study, published in The Journal of Psychiatry & Law, said jail sentences given to guilty-but-mentally-ill convicts tended to be as long or longer than those given to the just plain guilty.
A commission studying the issue for the National Mental Health Association in 1983 had warned against the guilty-but-mentally-ill option. The commission said people convicted as guilty but mentally ill would be no more likely to receive treatment than anyone else sentenced to prison.
What psychiatric treatment inmates get is generally short-term, according to William Faust, a Pennsylvania mental health advocate. Mentally ill prisoners, if they are offered medication, often refuse it, and prison life worsens their conditions, Faust and others said.
"It's sort of like giving a guy open heart surgery and then sending him out to run a marathon; the progress automatically fades," Donato, the Villanova professor, said.
But the Pennsylvania law's sponsor, state Sen. Michael Fisher (R., Allegheny), said it had done its job.
While there has been no "full assessment" of its effects, Fisher said, those found guilty but mentally ill "are getting treatment in Pennsylvania and, most importantly, society is getting protection from them."
One well-known person who was ruled guilty but mentally ill said the verdict has worked well in her case.
Sylvia Seegrist, who killed three people and wounded seven others in a psychotic shooting rampage at the Springfield Mall in 1985, said in a recent interview that she was thriving in prison, where she is serving three consecutive life sentences.
"All I know is, I'm in a better place," Seegrist, 30, said, comparing jail to Norristown State Hospital, where she was before being transferred three years ago to the penitentiary for women at Muncy. She remains on voluntary doses of anti-psychotic and anti-manic medications.
Though she feels her sentence "should be lessened somehow," Seegrist said she was happy that she could work in the prison laundry and study, and that she only had to see a psychiatrist for 15 minutes each month.
But Seegrist's attorney is not convinced she is where she ought to be.
"The jury believes that the person is going to get more treatment than they actually receive," said Ruth Shafer, who defended Seegrist at trial. Shafer still contends that the "appropriate verdict" for Seegrist would have been not guilty by reason of insanity, which could have led to an indefinite commitment to a psychiatric facility.
What has happened to 17-year-old Eric VanZant of Northeast Philadelphia was certainly not what was intended by the jury that found him guilty but mentally ill in the 1988 stabbing death of a neighbor.
VanZant, who received a life sentence, has received no psychiatric treatment, according to his attorney, Gilbert Scutti.
"We were hoping he'd get treatment, that he'd be incarcerated but would receive the treatment he needs," one juror had explained at the end of VanZant's 1989 trial.
Instead, according to Scutti, VanZant is "lost in a no-boy's land," housed in the state maximum-security prison at Huntingdon.
VanZant was born addicted to heroin and was adopted at 8 months of age, according to court testimony. He was labeled paranoid schizophrenic by a defense psychiatrist.
But a prosecution psychiatrist disagreed, saying VanZant was a sociopath ''but not commitable," said prosecutor Joel Rosen. Common Pleas Court Judge William J. Manfredi decided VanZant did not need to be hospitalized.
"It's not up to the jurors," Rosen said.
In prison, where he is segregated from the general population because of his age, VanZant remains with his demons, but is outwardly calm, Scutti said. That makes it unlikely he will receive help, Scutti added.
"He never really got any treatment. . . . The verdict of the jury was nullified," the lawyer said.
Fred Pisano's parents had spent years trying to get proper treatment for their son and had become leaders within the community of mental health advocates.
Pisano killed his mother, Jean, in the basement of the family's Mechanicsburg home June 19, 1989, after an argument over loud music and his medication.
Pisano's father, Charles, said he fears for his son in prison.
"They claim they do have treatment facilities, but basically I don't think it's appropriate or good," he said.
Charles Pisano said his son should have been found not guilty by reason of insanity and institutionalized. He pleaded guilty but mentally ill to third- degree murder to avoid a trial and possible first-degree murder conviction.
He has not been sentenced and a hearing on whether he should receive treatment has not yet been held.
Lawyer Samuel Stretton of West Chester, who has represented several clients found guilty but mentally ill, said the law is no good, but "the public isn't going to care about that."
The public, he said, thinks: "We got bad guys off the street. If they live, they live. If they die, if they get hurt, who cares."