Luigi Mangione will assert psychiatric defense in murder case in
UnitedHealthcare CEO's killing
[June 18, 2026]
By MICHAEL R. SISAK
NEW YORK (AP) — Luigi Mangione plans to assert a psychiatric defense at
his state murder trial, claiming he was suffering from extreme emotional
disturbance when he gunned down UnitedHealthcare CEO Brian Thompson, a
judge said Wednesday. It wouldn't absolve him of the Dec. 4, 2024,
killing, but could free him from prison sooner.
If a jury accepts that defense, the panel would convict Mangione of
manslaughter and he would face up to 25 years in prison. Alternatively,
the jury could reject the extreme emotional disturbance defense and
convict him of murder, which carries a potential life sentence. That
defense isn’t available in his federal case.
Judge Gregory Carro announced the decision in court Wednesday, two weeks
after holding a secret hearing on the matter at the defense's request.
He said he will release a transcript from that hearing and other records
once redactions are made.
‘Nothing is going to be a surprise,’ judge warns
Carro said Mangione’s lawyers first notified him in a sealed letter last
September that they planned to pursue a psychiatric defense and
confirmed the decision at the June 3 hearing.
But, the judge warned, they're “coming close to not being able to put
forth that defense” after prosecutors complained that Mangione's lawyers
had yet to give them details about what they say triggered their
client's extreme emotional disturbance. Prosecutors need to know that
before they have their own psychological expert evaluate him, Carro
said.
“Nothing is going to be a surprise,” Carro told Mangione’s lawyers. “I’m
not going to let you surprise the People on the eve of trial. So, get it
done.”
Carro said he didn’t expect the development to delay Mangione’s trial,
which is scheduled to start Sept. 8. The federal trial, which involves
stalking charges, is set to begin on Oct. 13.
Mangione, 28, has pleaded not guilty in both cases.
Sitting between his lawyers and wearing a blue suit, he tried to block
his face with a large envelope as news photographers crowded near him at
the start of Wednesday's hearing. He didn’t appear to have any reaction
as Carro spoke about the planned psychiatric defense.
At a February hearing, Mangione had railed against the prospect of two
trials, telling Carro: “It’s the same trial twice. One plus one is two.
Double jeopardy by any commonsense definition.”
An emotional disturbance defense is not the same as a not guilty by
reason of insanity defense, which would allow a defendant to go to a
psychiatric facility instead of prison.
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Luigi Mangione appears for a pre-trial hearing at Manhattan Criminal
Court in New York, Wednesday, June 17, 2026. (AP Photo/Angelina
Katsanis, Pool)
Circumstances of case could hamper defense, expert says
To establish an emotional disturbance defense, Mangione’s lawyers
must demonstrate that the disturbance was so extreme it robbed him
of self-control; that, in his mind, there was a reasonable
explanation for the disturbance; and that it influenced him to kill
Thompson.
Heather Cucolo, a New York Law School professor and expert in mental
health law, said Mangione's lawyers could try to accomplish that by
having a psychologist testify about his mental state at the time of
the killing and the extent of any trauma, abuse or emotional
instability he's suffered. But, she said, they aren't required to
show any proof of a mental illness or show he was in danger.
The circumstances of Mangione's case could make it tough for his
lawyers to convince jurors to accept a defense that people often
associate with crimes of passion or a sudden outburst where someone
is given shocking information that evokes a strong response, Cucolo
said.
Prosecutors say Mangione planned the attack, wrote in a notebook
about wanting to “wack” a health insurance executive and traveled
from out of state to ambush Thompson, 50, as the CEO walked to a
Manhattan hotel for an investor conference. “Delay,” “deny” and
“depose” were written on the ammunition, police said, mimicking a
phrase describing how insurers avoid paying claims.
“People want to view this within a relatively short period of time
and they want it to be simply laid out,” Cucolo said, giving the
example of a spousal killing over infidelity. As time passes, she
said, “people are not as willing to accept this emotional response
that ends up in the death of a human being.”
Mangione’s lawyer, Karen Friedman Agnifilo, protested Carro's
decision to unseal materials related to his psychiatric defense,
saying it will be “prejudicial to his defense to the exact same
facts” in his federal case.
Last month, Carro ruled that the notebook and a 3D-printed pistol,
which prosecutors say matches the gun used to kill Thompson, can be
used as evidence against Mangione. But he said a loaded gun magazine
and other items were seized during an “improper warrantless search”
when he was arrested in Pennsylvania five days after the killing.
On Wednesday, Carro dismissed a charge related to the magazine.
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