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DES MOINES, Iowa — Cody Metzker-Madsen admitted he was responsible for a violent killing of his five year old foster brother Dominic Elkins. The crime occurred in the northwest Iowa town of Logan in August of 2013.

“I started pushing his head into the water as I was hitting him with the brick,” said Metzker-Madsen.

Whether that killing was part of the fantasy world of a mentally ill young man who believed he was being attacked by goblins or the cover up of a brutal murder was in the hands of a Harrison County judge who determined his next stop wouldn’t be prison.

“it looked like they were goblins per say, lot of them, green ugly little creatures,” Metzker-Madsen told the court.

The judge’s decision doesn’t mean Metzker-Madsen walks free. In fact, he could be institutionalized even longer than if he had been found guilty of first degree murder.

“Because he’s a juvenile, he can’t be sentenced to a life sentence. He can only be given a term of years. At some point, he’d be eligible for parole,” said Robert Rigg, Criminal Defense Program Director at Drake Law School.

Rigg says it is likely Metzker-Madsen will now spend decades or even the rest of his life in a mental health facility, beginning at the Oakdale Medical and Classification Center.

The only way to get out would be to prove to a judge and psychologist that he’s no longer a threat to himself or society. That’s an uphill battle according to Rigg considering the brutal nature of this crime.

“Due to the mental health aspects of the case I understand so far, there’s a high likelihood he’ll be institutionalized the rest of his life,” Rigg told Channel 13 News.

Rigg adds the insanity defense doesn’t end up making it to the courtroom as often as you may think.

That’s because it narrows the judge’s choices down to guilty or not guilty by reason of insanity because the defendant is often admitting they committed the crime but had a reason for it.

In both situations, the outcome is the defendant being institutionalized.