According to this, in Utah, the official verdict is "guilty but insane" and treatment is discretionary,
not mandatory.
http://www.pbs.org/wgbh/pages/frontline/shows/crime/trial/states.html
What happens in states where there is no insanity defense?
Three states -- Montana, Idaho, and Utah -- do not allow the insanity defense. Defendants must still be found competent to stand trial, and they may introduce evidence of a mental disease or defect as evidence that they did not possess the requisite intent or state of mind (mens rea) to be found guilty.
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http://www.law.umkc.edu/faculty/projects/ftrials/hinckley/hinckleyinsanity.htm
Because psychiatric testimony played a large role in Hinckley's trial and ultimate verdict, the reliability of using such testimony came under attack in the wake of the trial. The American Psychiatric Association (APA) issued a statement after the trial acknowledging public skepticism of "the nature and the quality of psychiatric testimony in insanity trials." The APA also stated that it would not oppose laws restricting the use of such testimony in insanity cases. In 1984, Congress enacted a statute stating that:
"No expert witness testifying with respect to the mental state or condition of a defendant in a criminal case may state an opinion or inference as to whether the defendant did or did not have the mental state or condition constituting an element of the crime charged or a defense thereto. Such ultimate issues are for the trier of fact alone."
By 1986, three states had abolished the use of the insanity defense altogether. These states, Montana, Idaho, and Utah, continue to admit evidence of mental disorder
for the restricted purpose of disproving mens rea, or, in other words, proving that a defendant did not possess the special knowledge or intent required for conviction under the charged offense. The American Medical Association supports the abolition of the insanity defense.
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An article that defends the use of the insanity defense.
http://digitalcommons.pace.edu/cgi/viewcontent.cgi?article=1325&context=lawfaculty
"Guilty But Mentally Ill":
The Real Verdict is Guilty
Linda C. Fentiman
Pace University School of Law,
LFentiman@law.pace.edu
Assistant Professor of Law, Suffolk University Law School; B.S. Cornell University 1970, J.D. State University of New York at Buffalo Law School 1975, L.L.M. Harvard University Law School 1983.
Even before the verdict was reached in the Hinckley trial, public concern in recent years that the insanity defense was being used as a loophole by which the guilty were escaping punishment had persuaded two state legislatures, in Montana and Idaho, to eliminate the insanity defense altogether. Moved by the same concern, twelve states - Alaska, Connecticut, Delaware, Georgia, Illinois, Indiana, Kentucky, Michigan, New Mexico, Pennsylvania, South Dakota, and Utah - enacted statutes providing for an alternative verdict of "guilty but mentally ill" whenever a defendant asserts the insanity defense.
