In March, Adam Kelly Ward became the fifth person executed by the state of Texas–the ninth in the country–in 2016. Ward had been recognized as mentally ill by some of the appeals courts who heard his case, but his defense team was ultimately unsuccessful.

In 2005, Ward, then 24, shot and killed a Commerce, Texas housing and zoning code enforcement officer named Michael Walker. According to Joel McCullough for the Texas Tribune, the house had been cited for failure to comply with city codes numerous times, and Ward was in the driveway washing his car when Walker arrived at the property to take pictures documenting the code violations.

The men argued, and Ward reportedly sprayed Walker with the garden hose he was using to wash the vehicle. Ward then went into the house, at which time his father suggested to Walker that he should leave. Ward returned from the house carrying a loaded .45 caliber pistol, chased Walker around the city truck as he tried to escape, ultimately shooting him nine times, causing his death.

Ward was charged with murder while in the process of obstruction or retaliation, which made it a capital murder case. He pleaded not guilty, although notably did not make use of an insanity plea for which he would certainly have been eligible given his long, well-documented history of mental illness. Instead, he went for a self-defense angle. He was convicted in 2007.

The case involving Adam Ward & mental illness is interesting and certainly not without precedent. The insanity defense is complex and risky, so it’s understandable that Ward’s defense team opted to present evidence of his mental illness as a mitigating factor rather than a complete defense. In Texas, particularly, insanity defenses in capital murder trials are generally not met with sympathy: just ask Andrea Yates.

Even with his conviction, there is still legal precedent that prohibits the execution of a mentally ill person. Kevin Fenner writes in The Houstonian that Ward was on three antipsychotic medications at the age of three, having once spent over two months in inpatient treatment when he was just four years old.

Medications used to treat psychotic disorders, like clozapine, can have severe side-effects and are typically not administered to young children except in the most extreme cases. The treatment protocols Ward underwent at such a young age both speak to the severity of his condition and raise concerns about the long-term effects this may have had on his neurological development.

By second grade, his school had built a padded isolation room for him. He was diagnosed with bipolar disorder, and his issues with episodic unmanageable rage, paranoia, and delusions continued to plague him throughout his life.

Ward’s lawyers argued in their appeals that his mental illness made him constitutionally ineligible for execution, and there are Supreme Court decisions that support this. The high court, however, refused to hear his case last October, and the Fifth U.S. Circuit Court rejected his appeal, according to NewsweekAfter failing to obtain a stay of execution, Ward was put to death by lethal injection.