Before he sets foot in a military courtroom to be tried on 17 counts of premeditated murder, Staff Sergeant Robert Bales will face a different kind of judgment. Called a sanity board hearing, it's meant to decide whether Bales is mentally fit to stand before a jury, as well as what role (if any) his mental health played in his alleged massacre of Afghan civilians.

It happens before the trial. But it might be just as complex, and controversial, as the courtroom proceedings themselves.

Bales' lawyer, John Henry Browne, announced late last week that U.S. Army prosecutors were moving ahead with a sanity board hearing. The process, exclusive to military legal cases, is designed to accomplish two things. The military's Manual for Court Martial specifies that a sanity board is convened when there is "reason to believe that the accused lacked mental responsibility for any offense charged," and also to determine whether the accused "lacks capacity to stand trial."

So what will Bales' sanity board look like? According to experts who've participated in sanity boards, and lawyers whose clients have undergone them, Bales will be subjected to a range of psychiatric tests and interviews, designed to examine every aspect of his psyche. Furthermore, he'll face an incredibly high bar: A sanity board finds fewer than 1 in 100 defendants unfit to stand trial, and fewer than 1 in 200 not responsible for their actions by reason of mental defect. A court-martial jury agrees with even fewer of those diagnoses -- convicting defendants who've essentially been deemed insane (at least at the time of their alleged crimes) by sanity boards.

The bar for insanity is so high, in fact, that at least one defense attorney (and one expert witness for the defense) expressed concerns to Danger Room that mentally ill suspects "are slipping through the cracks" of the military's justice system. More specifically, they cite a tendency for sanity boards to convene before an adequate investigation of the alleged crimes has been completed -- and rush through hearings without examining all of the evidence. Largely, these legal defenders speculate, the intent is to minimize focus on the failings of the military's mental health system.

The alleged actions of Staff Sergeant Bales strike many as inexplicable, irrational, and, maybe, downright crazy. His sanity board, odds suggest, will conclude something different. And assuming Bales' lawyer is plotting to play the mental health card to keep him off death row, the track record of the military's sanity boards is very bad news for both of them.

Depressed, Anxious, Childlike ... and Still Fit for Trial

As a child, PFC Lynndie England suffered years of physical abuse. She was diagnosed with mutism -- an anxiety disorder wherein patients don't speak aloud in public -- as well as post-traumatic stress from those years of torment. As an adult, PFC England endured a long struggle with clinical depression.

In 2003, after she was accused of torture and prisoner abuse at Abu Ghraib prison, England underwent a sanity board hearing. She was found fit for trial, without any mental defects that may have mitigated her responsibilities for the Abu Ghraib atrocities. A psychologist working for the defense team, however, described England as "childlike" and said she'd been "thinking about suicide" when the crimes were committed.

Similar circumstances surround the cases of former Sgt. Hasan Akbar, already on death row for killing two fellow officers during the U.S. invasion of Iraq, as well as Maj. Nidal Hasan, facing the death penalty for fatally shooting 13 people at Fort Hood in 2009. Both underwent sanity board hearings, and were found fit to stand trial.

All three are paradigmatic examples of just how rigid a sanity board's requirements for insanity often are.

'Marital problems don't make somebody go out and kill 17 people.'

The boards are comprised of military personnel with expertise in psychology, psychiatry and neurology. Usually, a board consists of three people, at least one of whom is a forensic psychiatrist. The board can administer a battery of psychiatric tests. They can complete hours of interviews with the suspect over three different days. They sometimes review sworn statements from other people, along with a suspect's medical, criminal and service records.

The tests that a defendant undergoes will depend on the situation. But Capt. (ret) Dr. Thomas Grieger, a forensic psychiatrist who has consulted on more than 80 court martial cases, offers a few common examples. Among them is a psychopathy test, like the Hare Psychopathy Checklist. A list of 20 characteristics and traits, like glib, superficial charm, shallow affect, and lack of remorse, encompass the test, which is completed by a psychiatrist after interviewing the patient.

Then there's a neurocognitive assessment, most often RBANS (Repeatable Battery for Assessment of Neuropsychological Status). This one is a pen-and-paper test that asks a patient to remember lists of words, redraw geometrical figures and name pictures of objects, among other simple tasks. It's used to diagnose problems like traumatic brain injury (TBI), which Bales is alleged to have suffered and which prior research has linked to violent behavior.

Clinicians can also administer the Wisconsin card sort, a matching game widely used to diagnose schizophrenia and assess a patient's executive function. A patient receives a stack of cards, and is asked to sort them according to certain metrics, like number, design or quantity. Clinicians continue to change the sorting rules, in an effort to determine whether patients can effectively re-learn instructions.

That battery of tests is designed to boost the objectivity of the sanity board's findings. But Dr. Grieger concedes that the board's rulings inevitably depend on the opinions of its members.

"Even though these are 'objective' tests, they are still subject to the interpretation of different examiners," he acknowledges.

The rest of the sanity board hearing depends even more on the interpretations of those examiners. They'll often review sworn statements from witnesses who recount the days preceding the alleged crime, and individuals observing the suspect in detention. "We'd want to know if the suspect was acting out of the norm, if [factors like] their hygiene and social behavior were striking people as unusual," Dr. Grieger says.

The board can also look at the suspect's medical, criminal and service records. For Bales, those records leave a mixed impression: He's several times been accused of violent behavior, including one charge of misdemeanor criminal assault. But Bales is also a highly commended service-member, having received several honors during his three tours.

More interesting than what is evalsuated during a sanity board, however, might be what's not -- especially where Bales is concerned. A sanity board typically doesn't investigate a suspect's personal life, including their relationships or their financial records. Sworn statements from family members, like wives and kids, are rarely included in a board's review. So while plenty of media coverage and even military statements have emphasized Bales' marital woes and financial boondoggles, those issues won't factor into evalsuating his mental fitness.

"Marital problems," Dr. Grieger says, "don't make somebody go out and kill 17 people."

Spot the Lies

While they weigh a bevy of evidence, the board is also tasked with another overarching goal: Figuring out whether or not a defendant is lying about their psychiatric symptoms.

"You need to be very suspicious of the defendant," Dr. Grieger says, adding that in his three decades of experience, he's never run across a single defendant trying to fake a psychiatric problem. "It's in their best interest to have that insanity diagnosis."

On that last part, at least, most can agree. If Bales, or any other military defendant undergoing court martial, is found unfit to stand trial, he'll be granted a reprieve that's at least four months long. During that time, a defendant is sequestered to a psychiatric hospital in an effort to restore mental health.

Or, if a sanity board concludes that the defendant suffered mental ailments at the time of the alleged crime, the findings can bolster a defense team's efforts at achieving a reduced sentence -- years in prison rather than the death penalty, for example.

For those very reasons, some of a board's interviews with the defendant are focused on parsing truth from lies. Most sanity boards start by asking a defendant to back-track several weeks before the event in question. "How had they been sleeping, what kinds of combat experiences had they had, did they take medication?" Dr. Grieger says.

After that, the board zeroes in -- asking the defendant to take them, minute by minute, through the 24 hours preceding the alleged crime. "Where did they go, who did they talk to, even what did they eat," Dr. Grieger says. "The idea is to look for inconsistencies, between what they say and what other witnesses have said."

Sanity boards even have a test to offer lie-detection back-up. The SIRS (Structured Interview of Reported Symptoms) is an interview that's designed to catch inconsistencies, fabricated symptoms or exaggerations. For example, 85 percent of patients who experience genuine auditory hallucinations endure two kinds: Those that command them to do something, and those that don't. Someone who "alleges an isolated command hallucination" as the cause for their crime, therefore, should be "viewed with suspicion," according to a 2005 report from the Journal of Family Practice.

The intent behind those in-depth interviews and exams is two-fold. If a defendant has bizarre recollections surrounding their alleged crimes, or recollections that differ starkly from those of other witness, experts would evalsuate whether those lapses indicated a mental defect -- like an acute psychotic episode, for example. But the board members are also trying to catch downright mistruths.

"Maybe they'll say, 'I had symptom X and symptom Y'," Dr. Grieger says. "But if four other people don't recall anything out of the ordinary, then you need to seriously question the legitimacy of that defendant's testimony."

What It Takes to Be Insane

It's unusual that a sanity board will decide that a defendant isn't responsible for their crimes because of a mental defect. Getting a court martial jury to agree with that assessment of insanity? Even more unusual.

PFC David Lawrence is one example. In 2010, he was accused of murdering a senior Taliban commander who'd recently been captured by U.S. forces. Upon examination by a sanity board, it was evident that Lawrence had recently been experiencing severe mental health problems. One week before the shooting, he'd spent five days at a combat stress clinic, citing "mental anguish." He was subsequently prescribed two psychotropic medications and returned to duty.

The board concluded that PFC Lawrence suffered from schizophrenia and PTSD, and, therefore, "was unable to appreciate the nature and quality or wrongfulness of his conduct at the time of the alleged criminal misconduct."

Military prosecutors tried PFC Lawrence for premeditated murder, and he's now serving a 10-year prison sentence. "My concern is that they...put him in prison, where he won't get the treatment he needs," Brett Lawrence, the defendant's father, told the Colorado Springs Gazette.

Indeed, a court martial jury tends to hold defendants to an even higher threshold for insanity than a sanity board itself. That's somewhat surprising, because according to Dr. Grieger, the sanity board bases their assessment on the following "very tight standard."

"It comes down to whether you knew that killing people is wrong," he says. "Not just the particular people you killed. Not just those 17 Afghans. You really have to have not known what you were doing, at all."

In Bales' situation, assuming no pertinent information about his prior mental health emerges, such a scenario seems unlikely. Both of the ailments thus far linked to Bales by his lawyer -- PTSD and TBI -- are irrelevant to sanity board panelists. "Typically, [those illnesses] wouldn't render someone incompetent or insane," Dr. Grieger says. "They really wouldn't factor in for the panel."

Rather, "even if [Bales] did have psychiatric illness at the time of the killings," the Staff Sergeant still probably understood that "if you load an M4, point it at a person, and pull the trigger, that person has a good chance of dying," Dr. Grieger says. Such an understanding might be enough to send Bales to death row.

'People Do Fall Through the Cracks'

According to some experts, though, sanity boards are hardly as rigorous as they ought to be, and -- especially in high-profile cases -- are often rushed processes that rely on inadequate information. Largely, the experts allege, that's because military brass want to minimize the focus on their own failings where mental health is concerned.

"They don't want it to emerge that a defendant had undetected mental health problems," says Col. (Ret.) John Galligan, the defense attorney for Maj. Nidal Hasan. "The military doesn't want their mental health community, or their failings, to be under the microscope."

The military's mental health community has never been more closely under the microscope than in the recent case of Maj. Hasan, himself a former Army psychiatrist. In this instance, a review by a sanity board would mean Hasan was being evalsuated by his fellow military psychiatrists.

As a result, Galligan asked that Hasan's sanity board be instead comprised of civilians. "There was an undeniable bias, where sanity board members would want to take the focus away from any problems inside the military's psychiatric community. Of course. That was their own community."

Galligan's request was denied. Maj. Hasan was last year evalsuated by a panel of military experts, and found sane and fit to stand trial.

Where Bales is concerned, Galligan expressed concern that the sanity board might be moving ahead too quickly -- before an adequate number of sworn statements and testimony can be collected. "Before a board can make a full determination, they should have access to a full investigation," he says. "There's no way they already have all the data they need."

Dr. Amador agrees. In addition to serving as the psychiatrist for PFC England's defense team, he's worked with the lawyers representing Maj. Hasan and Zacarias Moussaoui, the so-called "20th hijacker" from Sept. 11th. He says he's noticed a troubling trend among sanity boards. "They take a snapshot of a defendant," he says. "They should be taking a video."

Amador often spends years evalsuating a client -- two years for PVT England, more than three for Maj. Hasan. Sanity boards, of course, can't devote that much time to each case. But Amador worries that "people fall through the cracks" when a sanity board spends merely a few days trying to make a psychiatric diagnosis.

"Sanity boards can only detect the grossest, most obvious mental illnesses, where someone can't even fake normal," he says. "The standard of evalsuation is incredibly low, but the bar for insanity is extremely high."

According to Dr. Grieger, however, detecting the grossest of mental illness is precisely the sanity board's job -- because anything less wouldn't change a defendant's culpability.

"The goal is to determine if a serious psychiatric condition was present at the time of the alleged incident," he says. "It is not to ascertain the facts of the events."