The legal argument is purely about whether he knew what he was doing at the time of his crime and so had the "mens rea" (guilty mind) necessary to be convicted. So basically did he know what he was doing and do it on purpose. It's a pretty low bar.
He has to be "legally insane" which bears very little relation to being psychiatrically insane. Most psychiatrically insane people are still legally responsible for their actions.
If they find he was insane in a way that means he genuinely did not know he was shooting people (i.e. so delusion he thought they were demons from hell, sleepwalking or something) then he would be put in a psychiatric facility until deemed sane, or he dies--whichever comes first.
IMHO given the degree of planning shown, it is hard to see how an insanity defense would prevail in this case.
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