God will be the judge as to those whose mental illness is so severe it exempts them from being accountable to God. We have all known people who are born with mental disorders such as severe “Down Syndrome,” where they are unable to develop mentally and emotionally. As a result, they have difficulty thinking and understanding the difference between “right and wrong” or “the concept of God and being accountable to Him.” We often say they are like “little children” and the Bible teaches us that little children, who have not reached “the age of accountability,” go to heaven. This is borne out in Matthew 18:10-11, 14: “Take heed that you do not despise one of these LITTLE ONES, for I say to you that in heaven their angels always see the face of My Father who is in heaven. For the Son of Man has come to save that which was lost…Even so it is not the will of My Father who is in heaven that one of these LITTLE ONES should perish.” King David understood this truth and when his infant child died, he said, “But now he is dead; why should I fast? Can I bring him back again? I SHALL GO TO HIM, but he shall not return to me” (2 Samuel 12:23). David knew his child was in heaven and that someday he would “go to him”; in other words, he would join him in heaven.

When it comes to severe mental illness later in life (as in the case of dementia or Alzheimer’s disease), the person is responsible for their actions before God prior to contracting the mental illness. God is going to “judge all responsible people” for their actions when they knew the difference between right and wrong and yet they willfully sinned. God will also consider the “light” (knowledge) they had been given by God and yet had failed to act on that light. We have three examples of this in Romans chapters 1 and 2 where God draws the heathen, the moralist, and the religionist into His holy court and proves they are indeed accountable to Him and will be judged.

1) In 1:18-25 we have those who HAVE THE LIGHT OF CREATION BUT REFUSE TO ACKNOWLEDGE GOD AS THE CREATOR. We read in verses 18-21, “For the wrath of God is revealed from heaven against all ungodliness and unrighteousness of men, who SUPPRESS THE TRUTH in unrighteousness, because what may be known of God is manifest in them, FOR GOD HAS SHOWN IT TO THEM. For since the creation of the world His invisible attributes are clearly seen, being understood by the things that are made, even His eternal power and Godhead, so that THEY ARE WITHOUT EXCUSE.” These people may say, “I never had the knowledge of God so I’m exempt from being judged by God.” God will say, “You are without excuse, for I gave you all the knowledge you needed to know Me by the things I created.

2) In 2:1 & 3 we have those who JUDGE THE SINS OF OTHERS BUT EXCUSE THEIR OWN SINS. Those verses read, “Therefore YOU ARE INEXCUSABLE, O man, whoever you are who judge, for IN WHATEVER YOU JUDGE ANOTHER YOU CONDEMN YOURSELVE; FOR YOU WHO JUDGE PRACTICE THE SAME THINGS….And do you think this, O man, you who judge those practicing such things, and doing the same, that you will escape the judgment of God?” Those who are judging the sins of others surely “know the difference between right and wrong,” yet they refuse to judge their own sins. They too are “without excuse” and “will NOT escape the judgment of God” (which means they won’t go to heaven).

3) In 2:17-29 we see those who KNOW AND TEACH GOD’S LAW (verses 17-20), yet they fail to obey the law themselves (verses 21-22). God says to them in verses 23-24, “You who make your boast in the law, do you dishonor God through breaking the law? For the ‘name of God is blasphemed among the Gentiles because of you, as it is written.” These are the guiltiest of all, for they have THE LIGHT OF GOD’S WORD yet they fail to obey it. They too “are without excuse.”  (DO)  (641.1)