That evening in her jail cell, not knowing whether she would live or die, Yates penned a letter apologizing to her family and eulogizing her five dead children. She wrote of inquisitive Noah; John, with the cute grin; precious Paul; Luke, who tried to keep up with his brothers, and little Mary, a loving baby with beautiful blue eyes. “I regret that this illness brought me to a place where I was capable of killing my own children,” wrote the 37-year-old mother. “I thank God I was blessed with such a precious family.”

The trial may be over, but the questions it raises about how society and the legal system deal with the mentally ill are just beginning. The same jury that spent less than four hours to reject Yates’s insanity defense took just 35 minutes to spare her life, sentencing her instead to a minimum of 40 years in prison before she is eligible for parole. Yates’s family and supporters were still devastated by the outcome. “It’s a travesty. Prison is the last place she’ll have any chance of becoming whole,” says Michael Faenza, president of the National Mental Health Organization. Even the prosecution qualified its victory. As Assistant District Attorney Joseph Owmby said after the sentencing: “We take no joy in this result or any result that may have occurred.”

Yates’s case has put the insanity defense itself on trial. No one disputes that the young mother was suffering from mental illness when she drowned her five children in the family’s Houston home. But the Texas statute on insanity is coldly narrow. Based on a 19th-century English law called the McNaughton Rule, it requires the jury to focus not on whether a person is delusional, but on whether those delusions prevented the defendant from knowing right from wrong at the time of the crime. The law used to allow acquittal for defendants whose illness prevented them from stopping themselves, even when they knew their actions were wrong–a provision that could have allowed the jury to acquit Yates. But the law was rewritten, as were insanity statutes in many states, after John Hinckley was found not guilty by reason of insanity for trying to kill President Ronald Reagan in 1981. Now roughly 25 states enforce some variation of the McNaughton law. And five states have abolished the insanity defense altogether.

In the Yates case the judge was barred from telling the jury what would happen to Yates if acquitted. “If you know what’s going to happen if you find her guilty, then you should know what’s going to happen if you find her not guilty,” one juror told NEWSWEEK, adding that it would not have made a difference. Asked if he thought the guidelines for judging Yates were fair, the juror hesitated and answered, “I’m still struggling with that even as we speak.”

Some states, including Michigan, Georgia and Utah, have instituted “guilty but mentally ill” verdicts. But such decisions still lead, most often, to prison, not psychiatric treatment. A better option, say mental-health professionals, are laws such as those in Connecticut and Oregon, where mentally ill defendants are sent to treatment under jurisdiction of a state review board, in most cases for a length of time equal to the maximum prison sentence for their crimes.

The country–and the family–will be grappling with fallout from the case for years to come. Yates’s husband, Rusty, in a press conference after the sentencing, blamed the medical and insurance industries for his family’s fate and said he will likely sue. Others, including some of Andrea’s friends and family, would like to see Rusty held accountable in some way, perhaps charged with child endangerment (a tough and unlikely case, says the D.A.). Most of all, those whose lives have been forever changed by this tragedy pray that from their anguish may come heightened awareness and change. “A sick person has been sent to prison for 40 years,” said Andrea Yates’s brother Patrick Kennedy. “We hope in the future because of the attention this case has received, other defendants in her condition will receive compassion… and the justice we think she deserves.” Or at least laws that allow for that possibility.

CORRECTION

In our March 25 story on the Andrea Yates case (“A Crazy System,” Justice), we misstated the title of the National Mental Health Association.