Spokane, Wash. ? 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.

David Weston, chief of Washington’s Department of Social and Health Services’ 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.