Aurora theater shooting suspect James Holmes in court in Centennial, Colo., on Tuesday, June 4, 2013. Holmes was allowed to change his plea to not guilty by reason of insanity. (AP Photo/The Denver Post, Andy Cross, Pool)
CENTENNIAL, Colo. (AP) — James Holmes, the former neuroscience graduate student accused of the deadly Colorado movie theater shootings, is headed to the state mental hospital for an evaluation of his sanity.
A judge accepted Holmes' long-awaited plea of not guilty by reason of insanity Tuesday and ordered the mental evaluation, which is required by law.
But that won't begin until a mental-health professional at the Colorado Mental Health Institute in Pueblo has a chance to review the evidence in the case, which prosecutors say now approaches 40,000 pages.
Holmes is charged with more than 160 counts of murder and attempted murder in the July 20 rampage, which left 12 people dead and 70 injured in a bloody, bullet-riddled movie theater in suburban Denver. Prosecutors are seeking the death penalty.
It's unclear when Holmes' evaluation will begin or how long it will take. Judge Carlos Samour Jr. set a tentative Aug. 2 deadline for the exam to be completed, but said he would push it back if hospital officials request more time. Samour indicated he still hopes to begin Holmes' trial in February.
Defense lawyers signaled in a motion made public Tuesday that they will seek a change of venue because of pretrial publicity.
Reviewing the official records is a standard first step in examining a criminal defendant's sanity, said Howard Zonana, a professor of psychiatry at Yale University and medical director of the American Academy of Psychiatry and the Law.
Zonana estimates he has done about 200 such examinations.
"Sometimes it's real easy, sometimes it's not," he said.
Evaluators also review the defendant's medical and psychiatric records, interview friends and family, look for any physical medical problems and administer standardized behavioral tests, Zonana said.
When Zonana interviews a defendant, he starts with general questions that don't relate to the crime. Then, he said, "You slowly work up to issues surrounding the charges, and you get his version of things."
Some defendants try to fake mental illness, but anti-psychotic medications can trip up the pretenders, he said. They might put a mentally healthy person to sleep but barely faze someone who is mentally ill.
The findings of the evaluation will become evidence in Homes' trial, but they are not the final word on whether he was legally insane at the time of the shootings. The jurors will determine that.
If their verdict is not guilty by reason of insanity, Holmes would be committed to the Mental Health Institute indefinitely. He could theoretically be released one day if doctors determine his sanity has been restored, but that is considered unlikely.
If their verdict is guilty, jurors would then decide whether Holmes will be executed or spend the rest of his life in prison without the possibility of parole.
Colorado law defines insanity as the inability to distinguish right from wrong caused by a diseased or defective mind.
Also Tuesday, the judge also granted prosecutors access to a hotly contested notebook that Holmes sent to a psychiatrist shortly before the July 20 rampage.
Prosecutors first sought access to the notebook when its existence was made public days after the shooting. Holmes had mailed it to Dr. Lynn Fenton, a University of Colorado, Denver psychiatrist who had treated Holmes. Holmes had been a graduate student in neuroscience at the university.
The notebook's contents have never been officially made public, but media reports have said it contains drawings depicting violence.
The defense argued the notebook was protected by doctor-patient privilege. But Samour ruled Tuesday that under Colorado law, Holmes waived that privilege when he entered the insanity plea.
Prosecutors said that in addition to reviewing the contents of the notebook, they would ask police to do unspecified "additional processing" of it.
Holmes, 25, shuffled into court Tuesday with his wrists and ankles shackled, wearing a long, bushy beard and dark, curly hair that was slicked back.
Samour read Holmes a five-page list of consequences of the insanity plea and asked if he had any questions.
"No," Holmes answered in a clear, firm voice. It was only the second time since his arrest that he has spoken in court, other than occasional whispered exchanges with his attorneys.
Associated Press writer Nicholas Riccardi contributed to this report.
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