Courts needs to be particularly careful in accepting a guilty plea from a defendant known to be mentally ill. There are twin dangers in such cases. First, the plea may not be knowing, intelligent, and voluntary. Second, the mental illness might negate the crime charges.

Thus, in People v DeWolf (155 AD2d 995 [4th Dept 1989]), the Appellate Division, Fourth Department held that where the court was aware when guilty plea was entered that defendant pleading guilty to manslaughter was under medication for treatment of schizophrenia and had frequently suffered hallucinations and paranoid delusions, and further evidence of defendant's lengthy history of mental illness was submitted in support of defendant's motion to withdraw his plea, defendant should have been permitted to withdraw plea.

Without citing DeWolf,the Fourth Department, in People v Mox (2011 NY Slip Op 03759 [4th Dept 5/6/11]) has again held that a court erred in denying a motion to withdraw a guilty plea from a mentally ill defendant. The Court explained that

"Although the contention of defendant that his plea was not knowingly, intelligently and voluntarily entered survives his valid waiver of the right to appeal, defendant failed to preserve that contention for our review by failing to move to withdraw the plea or to vacate the judgment of conviction on the ground[] now raised" (People v VanDeViver, 56 AD3d 1118, 1118, lv denied 11 NY3d 931, 12 NY3d 788; see People v McKeon, 78 AD3d 1617, 1618; People v Johnson, 60 AD3d 1496, lv denied 12 NY3d 926). We agree with defendant, however, that this is one of those rare cases in which preservation is not required because "the defendant's recitation of the facts underlying the crime pleaded to clearly cast[] significant doubt upon the defendant's guilt or otherwise call[ed] into question the voluntariness of the plea" (People v Lopez, 71 NY2d 662, 666). County Court therefore had a "duty to inquire further to ensure that defendant's guilty plea [was] knowing and voluntary" (id.), and we conclude that the court failed to fulfill that duty. "[A]t a minimum the record of the . . . plea proceedings must reflect . . . that defendant's responses to the court's subsequent questions removed the doubt about defendant's guilt" (People v Ocasio, 265 AD2d 675, 678). Here, defendant's plea allocution did not remove such doubt with respect to the intent element of manslaughter in the first degree (§ 125.20 [2]; see People v McCollum, 23 AD3d 199). Indeed, defendant's plea allocution suggested that his underlying schizoaffective disorder, for which he was unmedicated, caused him to be in a "psychotic state" at the time of the crime. Thus, defendant's plea allocution in fact negated the element of intent, and the court should not have "accept[ed] the plea without making further inquiry to ensure that defendant [understood] the nature of the charge and that the plea [was] intelligently entered" (Lopez, 71 NY2d at 666).