SPOKANE, Wash. (AP) - Phillip A. Paul in 1987 was declared criminally insane for killing an elderly woman after voices in his head told him she was a witch.
Instead of being straitjacketed and locked away as might be depicted by film or fiction, Paul in the past two decades has spent time living and working in downtown Spokane, fathered a child, created music videos and racked up $85,000 in credit card bills.
His escape during a recent field trip to a county fair exposed a little known truth: the criminally insane often live among us, with little or no supervision.
"Why was he allowed to take such a trip?" an incredulous Gov. Chris Gregoire demanded. "Why did they go to a location that was so heavily populated with families?"
That's a question many in Washington are asking after the Sept. 17 escape, including the escapee's own brother.
"He is in a bad mental state," said Tom Paul of Sunnyside. "Why would you load him up on a bus and take him to a fair?"
The cops who spent three days hunting and finally catching Paul 200 miles away are also upset.
"I can tell you there was an extreme amount of anger in the law enforcement community," said Spokane County Sheriff Ozzie Knezovich, who plans to bill the state $37,000 for his department's expenses.
But no one should be surprised. Thousands of people have been declared criminally insane in the United States over the decades, and at any given time large numbers of them are not in custody. Paul was among 31 patients from Eastern State Hospital on the field trip to the fair. All were from the forensics unit, meaning they had been committed to the hospital because of a crime. All such field trips, which were common, are now suspended in Washington.
The field trip was possible because people found not guilty by reason of insanity are legally patients, not prison inmates. They have no sentence to serve. The goal of mental hospitals is to cure them and return them to society. Better treatment, including psychotropic drugs, plus a focus on patients' rights, have resulted in many being released in just a few years.
Thomas Gergen, for example, was found not guilty by reason of insanity in 2003 for killing his pregnant wife and their unborn child. The King County man spent five years at Western State Hospital before doctors concluded he had responded well to medication for schizophrenia and he was released.
The number of people found not guilty by reason of insanity in the United States each year is not readily available, although the figure is thought to be small. In Washington, the number is between 25 and 35 a year. No one compiles national statistics on such cases, or on how long people remain in custody, said Dr. Paul S. Appelbaum of Columbia University, a past president of the American Psychiatric Association.
There are also no nationwide statistics on whether the criminally insane who are released commit new crimes of violence, he said.
A 1996 study of 43 forensic patients at an outpatient treatment program in Chicago found that eight had been arrested or commited new crimes after being released from a mental hospital.
While the notion of criminally insane killers escaping from hospitals to go on killing sprees is a staple of slasher movies, there are few instances where that actually occurred.
More common is the story of Phillip Paul. He was found not guilty by reason of insanity for the 1987 slaying of a 78-year-old woman in Sunnyside, during a period when he could not control his schizophrenia.
He was sent to Eastern State Hospital in Medical Lake, a suburb of Spokane. Paul escaped in 1990, but was immediately recaptured. He attacked and severely injured the deputy who was booking him back into jail.
Yet in 1992 he was considered well enough to attend classes at Spokane Falls Community College, and to work in retail stores for up to 30 hours per week.
In 1998, he left the hospital for two-week visits with his family in Sunnyside, and in June 2000 was allowed to move in with them. By October he was ordered back to the mental hospital because of delusional behavior.
In 2005, he was granted conditional release by a judge to move into an assisted living center called The Carlyle in downtown Spokane. He dated a woman, who eventually bore him a son. But he was back in the mental hospital within four months for refusing his medications.
In 2007, Paul was again released into the community, but in January of this year was ordered back to the mental hospital because of erratic behavior.
During his various releases, Paul wrote songs and created music videos for his band, "Philly Willy and the Hillbillies." Many of the songs - with titles like "Rock n Roll in the mental institution" and "Nut Hut," were about mental illness. He obtained several credit cards and went on shopping sprees that led to a bankruptcy filing.
In interviews after his capture, Paul, 47, has said he was just looking for some "sunshine."
"I knew it was the wrong thing to do. I just wanted my freedom so bad," Paul told a television station. "I didn't hurt nobody and wasn't planning on doing that."
In Washington, the Department of Social and Health Services operates two units for the criminally insane, at Eastern State and Western State Hospital in Lakewood. There are 359 patients in the two forensics units.
In the last fiscal year, 11 were discharged from Eastern State, where the average length of stay was three and one-third years. At Western State, 17 patients were discharged, and the average stay was three and two-thirds years.
Escapes from the forensics units are rare, according to DSHS.
Since 1999, there have been only four escapes from Eastern State, and only one escape from Western State, the agency said.
David Weston, chief of the agency's Office of Mental Health Services, said people should not be surprised that killers live among them. Many people who are actually convicted of murder serve their time and are released, Weston said.
Also, it is wrong to believe that people who suffer from mental illness are more dangerous than criminals who are sane.
"The stereotype that these are the most dangerous people in society is simply not true," Weston said. "They are much less dangerous than many routine criminals."
Authorities must balance protecting the public from any future violence, while treating the patient and preparing them to return to society, Weston said.
Jennifer Stuber, who studies mental health stigma at the University of Washington, said coverage of Paul's escape raised many negative stereotypes, especially terms like "insane killer."
"Some of the headlines were really upsetting," she said. "They imply that a diagnosis of schizophrenia is associated with violence."
"This was an escape, not a murder," she said.