Title: State v. Dennis H.

State: wisconsin

Issuer: Wisconsin Supreme Court

Document:

2002 WI 104 
 
 
 
SUPREME COURT OF WISCONSIN 
 
 
 
 
 
CASE NO.: 
01-0374 
 
 
COMPLETE TITLE: 
 
 
In re the Commitment of Dennis H., 
 
State of Wisconsin,  
 
Petitioner-Respondent, 
 
v. 
Dennis H.,  
 
Respondent-Appellant. 
 
 
 
 
ON CERTIFICATION FROM THE COURT OF APPEALS 
 
 
OPINION FILED: 
July 12, 2002   
SUBMITTED ON BRIEFS: 
        
ORAL ARGUMENT: 
May 1, 2002   
 
 
SOURCE OF APPEAL: 
 
 
COURT: 
Circuit   
 
COUNTY: 
Milwaukee   
 
JUDGE: 
Victor Manian   
 
 
 
JUSTICES: 
 
 
CONCURRED: 
ABRAHAMSON, C.J., concurs (opinion filed). 
BABLITCH and BRADLEY, JJ., join concurrence.   
 
DISSENTED: 
        
 
NOT PARTICIPATING:         
 
 
 
ATTORNEYS: 
 
For the respondent-appellant there were briefs by Ellen 
Henak, assistant state public defender, and Thomas K. Zander, 
Milwaukee, and oral argument by Ellen Henak. 
 
For the petitioner-respondent the cause was argued by 
Thomas J. Balistreri, assistant attorney general, with whom on 
the brief was James E. Doyle, attorney general. 
 
An amicus curiae brief was filed by Theresa M. Hottenroth 
and Whyte Hirschboeck Dudek S.C., Madison, on behalf of the 
Treatment Advocacy Center, and there was oral argument by Mary 
Zdanowicz. 
 
An amicus curiae brief was filed by Mary Dianne Greenley, 
Madison, on behalf of the Wisconsin Coalition for Advocacy, Inc. 
 
 
 
2
An amicus curiae brief was filed by Robert Theine Pledl and 
Schott, Bublitz & Engel, S.C., Brookfield, on behalf of the 
American Civil Liberties Union of Wisconsin Foundation. 
 
An amicus curiae brief was filed by Michael J. Bachhuber, 
Milwaukee, on behalf of the Grassroots Empowerment Project, Inc. 
 
An amicus curiae brief was filed by Richard G. Niess and 
Coyne, Niess, Schultz, Becker & Bauer, S.C., Madison, and 
Kenneth J. Kress, Iowa City, Iowa, on behalf of Kenneth J. 
Kress. 
 
An amicus curiae brief was filed by Herbert S. Bratt, 
Milwaukee, and Mark L. Adams  and Melanie E. Cohen, Madison, on 
behalf of the Wisconsin Psychiatric Association, Inc., and the 
State Medical Society of Wisconsin. 
 
An amicus curiae brief was filed by Mary Dianne Greenley, 
Madison, on behalf of the Wisconsin Coalition for Advocacy, 
Inc., and the Judge David L. Bazelon Center for Mental Health 
Law. 
 
 
 
2002 WI 104 
NOTICE 
This opinion is subject to further 
editing and modification.  The final 
version will appear in the bound 
volume of the official reports.   
No.  01-0374  
(L.C. No. 
00 ME 1299) 
STATE OF WISCONSIN  
 
 
   : 
IN SUPREME COURT 
 
 
In re the Commitment of Dennis H., 
 
State of Wisconsin,  
 
          Petitioner-Respondent, 
 
     v. 
 
Dennis H.,  
 
          Respondent-Appellant. 
 
FILED 
 
JUL 12, 2002 
 
Cornelia G. Clark 
Clerk of Supreme Court 
 
 
 
 
 
APPEAL from an order of the Circuit Court for Milwaukee 
County, Victor Manian, Circuit Court Judge.    Affirmed.     
 
¶1 
DIANE S. SYKES, J.   This case is before the court on 
certification from the court of appeals, which we accepted to 
resolve a single issue of law:  whether the fifth standard of 
dangerousness in the involuntary civil commitment statute, Wis. 
Stat. § 51.20(1)(a)2.e. (1999-2000), is constitutional.  We hold 
that it is. 
¶2 
Dennis H. is the subject of this mental health 
commitment, 
and 
he 
has 
schizophrenia. 
 
His 
father, 
his 
psychiatrist, and his case manager filed a three-party petition 
No. 
01-0374   
 
2 
 
in Milwaukee County Circuit Court seeking to commit him pursuant 
to Wis. Stat. § 51.20(1)(a) (1999-2000)1, because he was 
exhibiting 
behavior 
that 
had 
previously 
led 
to 
his 
hospitalization in critical condition for kidney failure. 
¶3 
Dennis H. moved to dismiss, arguing that the fifth 
standard of dangerousness, Wis. Stat. § 51.20(1)(a)2.e., is 
unconstitutional.2  The circuit court denied the motion, a jury 
found Dennis H. dangerous under the fifth standard, and he was 
committed.  He appealed, and the court of appeals certified the 
case to this court. 
¶4 
Dennis H. contends that the fifth standard is facially 
unconstitutional because it violates the due process and equal 
protection guarantees of the federal and state constitutions and 
is also vague and overbroad.3  More specifically, he argues that 
                                                 
1 All references to the Wisconsin Statutes are to the 1999-
2000 version unless otherwise noted.   
 
2 It was determined at the probable cause hearing that none 
of the first four definitions of dangerousness sufficient for 
commitment under Wis. Stat. § 51.20(1)(a)2.a.-d. applied. 
  
3 The Fourteenth Amendment to the United States Constitution 
states:  "No State shall make or enforce any law which shall 
abridge the privileges or immunities of citizens of the United 
States; nor shall any State deprive any person of life, liberty, 
or property, without due process of law; nor deny to any person 
within its jurisdiction the equal protection of the laws."  
Article I, Section I of the Wisconsin Constitution states:  
"All people are born equally free and independent, and have 
certain inherent rights; among these are life, liberty and the 
pursuit of happiness; to secure these rights, governments are 
instituted, deriving their just powers from the consent of the 
governed."  
No. 
01-0374   
 
3 
 
the statute is constitutionally infirm because it lacks a 
requirement of imminent dangerousness to self or others, and 
because it allows commitment upon a finding of a substantial 
probability of something less than physical harm, to wit, mental 
or emotional harm. 
¶5  A facial constitutional challenge to a statute is an 
uphill endeavor.  The state has a well-established, legitimate 
interest under its parens patriae power in providing care to 
persons unable to care for themselves, and also has authority 
under its police power to protect the community from mentally 
ill persons determined to be dangerous.  Heller v. Doe, 509 U.S. 
312, 332 (1993) (citing Addington v. Texas, 441 U.S. 418, 426 
(1979)).  The general rule, of course, is that any legislative 
enactment carries a presumption of constitutionality.  State v. 
Carpenter, 197 Wis. 2d 252, 263-64, 541 N.W.2d 105 (1995). 
¶6  Furthermore, "[w]e deal here with issues of unusual 
delicacy, in an area where professional judgments regarding 
desirable procedures are constantly and rapidly changing."  
Heller, 509 U.S. at 333 (discussing mental health commitments) 
(quoting Smith v. Organization of Foster Families for Equality & 
Reform, 431 U.S. 816, 855-856 (1977)).  "In such a context, 
restraint is appropriate on the part of courts called upon to 
adjudicate whether a particular procedural scheme is adequate 
                                                                                                                                                             
"[T]he due process and equal protection clauses of the 
Wisconsin Constitution are the substantial equivalents of their 
respective clauses in the federal constitution." State v. 
McManus, 152 Wis. 2d 113, 130, 447 N.W.2d 654 (1989). 
No. 
01-0374   
 
4 
 
under the Constitution."  Id.  We conclude that the fifth 
standard is not unconstitutionally vague or overbroad, and does 
not violate due process or equal protection. 
I 
 
¶7 
On June 23, 2000, Dennis H.'s father, psychiatrist, 
and case manager filed a petition in Milwaukee County Circuit 
Court to have him involuntarily committed for treatment under 
Wis. Stat. § 51.20(1)(a).  Dennis H. suffers from schizophrenia 
and, due to medication noncompliance, had previously been 
hospitalized in acute renal failure and electrolyte imbalance 
brought on by extreme and rapid weight loss and dehydration. 
¶8  Dennis H. sought to have the petition dismissed, 
arguing that the fifth standard of dangerousness as grounds for 
involuntary commitment, Wis. Stat. § 51.20(1)(a)2.e., violates 
the federal and state constitutions.  The circuit court, the 
Honorable Michael J. Dwyer, rejected Dennis H.'s constitutional 
challenge and denied the motion to dismiss. 
¶9  Noting that the state has a legitimate interest under 
its police and parens patriae powers in protecting society and 
the mentally ill, the circuit court concluded that the fifth 
standard 
constituted a 
"new 
description of 
dangerousness" 
sufficient to justify commitment.  The circuit court viewed the 
fifth standard's new definition as encompassing a requirement of 
present dangerousness, albeit "in a little different vocabulary" 
No. 
01-0374   
 
5 
 
than the other four.  Because the fifth standard did not 
dispense with dangerousness as a pre-condition of commitment, 
but merely defined it in a different way, the circuit court 
found it "constitutionally appropriate."4  
¶10 A probable cause hearing was held.  Following the 
testimony 
of 
two 
doctors, 
the 
first 
four 
standards 
of 
dangerousness were determined to be inapplicable, and the case 
proceeded to trial on the fifth standard only. 
¶11 A jury trial was held on July 24-25, 2000, before the 
Honorable Victor Manian.  The jury was instructed on the 
statutory elements of the fifth standard, and returned a verdict 
finding Dennis H. dangerous.  The circuit court ordered Dennis 
H. committed for a period of six months.  Pursuant to 
stipulation, this was later extended for another six months.  
Dennis H. appealed the order of commitment, and the court of 
appeals certified the case to this court. 
II 
¶12 The constitutionality of a statute is a question of 
law which this court reviews de novo.  State v. Janssen, 219 
Wis. 2d 362, 370, 580 N.W.2d 260 (1998).  The party challenging 
                                                 
4 Dennis H. asserts that Judge Dwyer recast the statute to 
require evidence of "imminent physical dangerousness."  The 
Honorable 
Victor 
Manian 
presided 
at 
trial, 
however, 
and 
instructed the jury precisely according to the text of the 
statute.  
No. 
01-0374   
 
6 
 
a statute must establish its unconstitutionality beyond a 
reasonable doubt.  State v. McManus, 152 Wis. 2d 113, 129, 447 
N.W.2d 654 (1989).  "Every presumption must be indulged to 
sustain the law if at all possible and, wherever doubt exists as 
to a legislative enactment's constitutionality, it must be 
resolved in favor of constitutionality."  Carpenter, 197 Wis. 2d 
at 263-64 (citing McManus, 152 Wis. 2d at 129 (citations and 
quotation marks omitted in original)).  A court does not 
evaluate the merits of the legislature's economic, social, or 
political policy choices, but is limited to considering whether 
the statute violates some specific constitutional provision.  
State ex rel. Hammermill Paper Co. v. La Plante, 58 Wis. 2d 32, 
46-47, 205 N.W.2d 784 (1973). 
¶13 We have previously noted that the United States 
Supreme Court has declined to prescribe "strict boundaries for 
legislative determinations of what degree of dangerousness is 
necessary for involuntary commitment," because "[s]ubstantive as 
well as procedural limitations on a state's traditional power to 
commit 
the 
dangerously 
mentally 
ill 
vary 
widely 
from 
jurisdiction to jurisdiction."  State v. Post, 197 Wis. 2d 279, 
312, 541 N.W.2d 115 (1995), cert. denied, 521 U.S. 1118 (1997) 
(footnote omitted) (citing Jackson v. Indiana, 406 U.S. 715, 
736-37 (1972)).  Because of "the uncertainty endemic to the 
field of psychiatry . . .  particular deference must be shown to 
No. 
01-0374   
 
7 
 
legislative decisions in that arena."  Id. (citing Jones v. 
United States, 463 U.S. 354, 364 n.13 (1983)).  Accordingly, 
courts generally proceed with restraint in this complex, 
delicate, and policy-sensitive area, deferring to the procedural 
scheme the legislature has chosen.  See Heller, 509 U.S. at 332; 
Smith, 431 U.S. at 855-856; Post, 197 Wis. 2d at 312. 
 III 
¶14 We start with the text of the statute at issue.  
Section 51.20 of the Wisconsin Statutes governs involuntary 
civil commitments for mental health treatment and contains five 
different definitions or standards of dangerousness for purposes 
of involuntary commitment.  The so-called "fifth standard," Wis. 
Stat. § 51.20(1)(a)2.e., was enacted in 1995, see 1995 Wis. Act 
292, and provides that "an individual, other than an individual 
who 
is 
alleged 
to 
be 
drug 
dependent 
or 
developmentally 
disabled," is considered "dangerous" if:   
[A]fter the advantages 
and disadvantages 
of and 
alternatives to accepting a particular medication or 
treatment have been explained to him or her and 
because 
of 
mental 
illness, 
evidences 
either 
incapability of expressing an understanding of the 
advantages and disadvantages of accepting medication 
or treatment and the alternatives, or substantial 
incapability of applying an understanding of the 
advantages, disadvantages, and alternatives to his or 
her mental illness in order to make an informed choice 
as to whether to accept or refuse medication or 
treatment; and evidences a substantial probability, as 
demonstrated 
by 
both 
the 
individual's 
treatment 
history and his or her recent acts or omissions, that 
No. 
01-0374   
 
8 
 
the individual needs care or treatment to prevent 
further disability or deterioration and a substantial 
probability that he or she will, if left untreated, 
lack services necessary for his or her health or 
safety and suffer severe mental, emotional or physical 
harm that will result in the loss of the individual's 
ability to function independently in the community or 
the loss of cognitive or volitional control over his 
or her thoughts or actions.  The probability of 
suffering severe mental, emotional or physical harm is 
not substantial under this subd.2.e. if reasonable 
provision for the individual's care or treatment is 
available in the community and there is a reasonable 
probability that the individual will avail himself or 
herself of these services or if the individual is 
appropriate for protective placement under § 55.06.  
Food, shelter or other care that is provided to an 
individual who is substantially incapable of obtaining 
food, shelter or other care for himself or herself by 
any person other than a treatment facility does not 
constitute reasonable provision for the individual's 
care 
or 
treatment 
in 
the 
community 
under 
this 
subd.2.e.  The individual's status as a minor does not 
automatically establish a substantial probability of 
suffering severe mental, emotional, or physical harm 
under this subd.2.e. 
Wis. Stat. § 51.20(1)(a)2.e. 
¶15 Dennis H. argues that the fifth standard: (1) is 
unconstitutionally vague and overbroad; (2) violates his right 
to equal protection of the law by allowing for commitment under 
circumstances different than those existing under any of the 
four other standards; and (3) violates his right to substantive 
due process by allowing commitment without requiring evidence of 
a risk of imminent physical harm to himself or others.  We 
disagree, 
and 
uphold 
the 
statute 
against 
his 
vagueness, 
overbreadth, equal protection, and due process challenges. 
Vagueness 
No. 
01-0374   
 
9 
 
¶16 The statute is long and complex.  Neither attribute 
makes it unconstitutional, however, for neither is the proper 
measure of a statute's constitutionality.  We have previously 
explained that: 
The principles underlying the void for vagueness 
doctrine . . . stem from concepts of procedural due 
process.  Due process requires that the law set forth 
fair notice of the conduct prohibited or required and 
proper standards for enforcement of the law and 
adjudication.  Based upon these concepts of due 
process, a statute is void for vagueness if it fails 
to give notice to those wishing to obey the law that 
their conduct falls within the proscribed area, or if 
it fails to provide those who must enforce and apply 
the law objective standards with which to do so. 
In re Commitment of Curiel, 227 Wis. 2d 389, 414-15, 597 N.W.2d 
697 (1999) (quoting State v. Popanz, 112 Wis. 2d 166, 172-73, 
332 N.W.2d 750 (1983)) (citations and internal quotation marks 
omitted). 
¶17 Our task, then, is to determine whether the statute 
provides objectively discernible standards by which commitment 
decisions can be made.  In other words, "we must determine 
whether the statute fails to be sufficiently definite to allow 
judges, juries and expert witnesses to apply (its) terms . . . 
objectively to the question before them in order to determine 
whether to commit the defendant without having to create or 
apply their own standards."  Curiel, 227 Wis. 2d at 415 (citing 
Popanz, 112 Wis. 2d at 173); see also State v. Courtney, 74 Wis. 
2d 705, 711, 247 N.W.2d 714 (1976). 
¶18 The statute identifies five elements, each of which 
must be satisfied before a person may be civilly committed.  It 
No. 
01-0374   
 
10 
 
precisely, though perhaps clumsily, identifies those to whom it 
applies.  That the statute attempted to do all of this in one 
paragraph, rather than through separate, discrete subparts, does 
not make it constitutionally infirm.  We measure the statute for 
its constitutionality, not its technique of draftsmanship.      
¶19 First, a person who is the subject of a commitment 
petition must be mentally ill.  See Wis. Stat. § 51.20(1)(a)1.5 
and § 51.20(1)(a)2.e.6  Whether a person is mentally ill is a 
medical judgment, see Humphrey v. Cady, 405 U.S. 504, 509 
(1972), made by applying the definition of mental illness in 
Wis. 
Stat. 
§ 
51.01(13)(b), 
which 
is 
applicable 
to 
all 
involuntary 
commitments 
under 
Wis. Stat. § 51.20. 
A 
determination of mental illness requires a finding of "a 
substantial disorder of thought, mood, perception, orientation, 
or memory which grossly impairs judgment, behavior, capacity to 
recognize reality, or ability to meet the ordinary demands of 
life."  Wis. Stat. § 51.01(13)(b). 
¶20 Dennis H. argues that the fifth standard's definition 
of dangerousness is essentially no more than a reiteration of 
the definition of mental illness, although in slightly different 
terms, and therefore allows involuntary commitment upon a 
finding of mental illness alone.  This is not true.  The fifth 
                                                 
5 "The individual is mentally ill . . . drug dependent or 
developmentally disabled and is a proper subject for treatment."  
Wis. Stat. § 51.20(1)(a)1. 
6 The fifth standard removes those "alleged to be drug 
dependent or developmentally disabled" from its scope.  Wis. 
Stat. § 51.20(1)(a)2.e.   
No. 
01-0374   
 
11 
 
standard's definition of dangerousness requires proof of a 
substantial probability of something more than impairment; 
section 
51.20(1)(a)2.e. 
requires 
proof 
of 
a 
substantial 
probability of a "loss of the individual's ability to function 
independently in the community or the loss of cognitive or 
volitional control over his or her thoughts or actions."  In 
this regard, the fifth standard spells out a heightened standard 
of 
impairment——beyond 
the 
threshold 
definition 
of 
mental 
illness——for 
purposes 
of 
the 
dangerousness 
determination.  
Accordingly, a finding of mental illness alone does not equate 
to a finding of dangerousness under the fifth standard.        
¶21 Second, 
the 
person 
who 
is 
the 
subject 
of 
the 
commitment petition must be incompetent to make medication or 
treatment decisions, or, more specifically, must be unable, 
"because of mental illness," to make "an informed choice as to 
whether to accept or refuse medication or treatment."  Wis. 
Stat. § 51.20(1)(a)2.e.  This must be evidenced either by an 
"incapability of expressing an understanding of the advantages 
and disadvantages of accepting medication or treatment and the 
alternatives," or by a "substantial incapability of applying an 
understanding of the advantages, disadvantages, and alternatives 
to his or her mental illness."  Id.  This must occur "after the 
advantages and disadvantages of and alternatives to accepting a 
particular medication or treatment have been explained to him or 
her."  Id.  
¶22 Third, 
the 
person 
must 
show 
a 
"substantial 
probability" that he or she "needs care or treatment to prevent 
No. 
01-0374   
 
12 
 
further disability or deterioration."  Id.  This must be 
"demonstrated by both the individual's treatment history and his 
or her recent acts or omissions."  Id.  
¶23 Fourth, the person 
must 
evidence 
a 
"substantial 
probability that he or she will, if left untreated, lack 
services necessary for his or her health or safety."  Id. 
¶24 Fifth, 
the 
person 
must 
evidence 
"a 
substantial 
probability that he or she will, if left untreated, . . . suffer 
severe mental, emotional, or physical harm that will result in 
the loss of the individual's ability to function independently 
in the community or the loss of cognitive or volitional control 
over his or her thoughts or actions."  Id.  
¶25 Only after each of these elements is proven may the 
person be considered "dangerous" under the fifth standard.  The 
statute also contains an explicit limitation on its reach: "if 
reasonable provision for the individual's care or treatment is 
available in the community and there is a reasonable probability 
that the individual will avail himself or herself of these 
services," then a substantial probability of suffering severe 
mental, emotional, or physical harm does not exist.  Id.  
However, the simple provision of food and shelter by a non-
treatment 
facility 
does 
not 
satisfy 
the 
requirement 
of 
"reasonable provision for the individual's care or treatment."  
Id.  The statute also specifies that an "individual's status as 
a 
minor 
does 
not 
automatically 
establish 
a 
substantial 
probability of suffering severe mental, emotional, or physical 
harm. . . ."  Id. 
No. 
01-0374   
 
13 
 
¶26 It is important to note that the fifth standard 
requires that these conditions be evident to a "substantial 
probability."  Id.  The "substantial probability" degree of 
proof provides a proper standard of adjudication.  See Curiel, 
227 Wis. 2d at 414-15.  The statute "is not so obscure that men 
of common intelligence must necessarily guess at its meaning and 
differ as to its applicability."  Curiel, 227 Wis. 2d at 415 
(citing Peissig v. Wisconsin Gas Co., 155 Wis. 2d 686, 699, 456 
N.W.2d 348 (1990)).  Accordingly, we reject Dennis H.'s 
contention that the fifth standard is unconstitutionally vague. 
Overbreadth 
¶27 Invalidation of a statute on overbreadth grounds is 
"strong medicine" that is "employed by the Court sparingly and 
only as a last resort."  Janssen, 219 Wis. 2d at 373 (quoting 
Broadrick v. Oklahoma, 413 U.S. 601, 613 (1973)).  "A statute is 
overbroad when its language, given its normal meaning, is so 
sweeping that its sanctions may be applied to constitutionally 
protected conduct which the state is not permitted to regulate."  
Id. (quoting Bachowski v. Salamone, 139 Wis. 2d 397, 411, 407 
N.W.2d 533 (1987)).  "A statute must be narrowly enough drawn 
that its terms can be given a reasonably precise content and 
those persons it encompasses can be identified with reasonable 
accuracy."  Post, 197 Wis. 2d at 303 (citing O'Connor v. 
Donaldson, 422 U.S. 563, 575 (1975)).  
¶28 When the legislature "undertakes to act in areas 
fraught with medical and scientific uncertainties," however, 
"legislative options must be especially broad."  Post, 197 Wis. 
No. 
01-0374   
 
14 
 
2d at 304 (quoting Jones, 463 U.S. at 370, and Marshall v. 
United States, 414 U.S. 417, 427 (1974)).  A mental commitment 
provision is overly broad only if by its terms it could 
reasonably be applied to commit mentally ill persons who are not 
in any way dangerous to themselves or others.  See id.  The 
fifth 
standard's 
focus 
is 
on 
dangerousness 
to 
self——
dangerousness of a particularly insidious nature because it is 
chronic and cyclical (measured by treatment history and recent 
acts or omissions), and brought on by mental illness that 
produces an incapacity to make medication or treatment decisions 
as well as a substantial probability of an incapacity to care 
for oneself.  The fifth standard does not apply to mentally ill 
people who are not dangerous to themselves.  Accordingly, the 
statute is not unconstitutionally overbroad.  
Equal Protection 
¶29 Dennis H. also argues that the fifth standard violates 
equal protection by allowing for commitment and involuntary 
medication under circumstances different than those existing 
under any of the other four standards.  See Wis. Stat. 
§ 51.20(1)(a)2.a.-e. and (13)(dm).   The focus of his argument 
is on the fifth standard's use of the phrase "mental, emotional, 
or physical harm," see Wis. Stat. § 51.20(1)(a)2.e., in contrast 
to the requirement in each of the first four standards of some 
form of "physical" harm.  See Wis. Stat. § 51.20(1)(a)2.a.-d.7  
                                                 
7 The first four standards define dangerousness as follows: 
Evidences a substantial probability of physical 
harm to himself or herself as manifested by evidence 
No. 
01-0374   
 
15 
 
Specifically, Dennis H. contends that the statute impermissibly 
dispenses 
with 
a 
requirement 
of 
physical 
harm, 
allowing 
involuntary commitment and forcible medication upon a finding of 
mere mental or emotional harm.   
¶30 Dennis H. reads the statute too narrowly.  The fifth 
standard requires proof of a substantial probability that "if 
left untreated," the individual will "lack services necessary 
for his or her health or safety and suffer severe mental, 
emotional or physical harm that will result in the loss of the 
individual's ability to function independently in the community 
                                                                                                                                                             
of recent threats of or attempts at suicide or serious 
bodily harm.  Wis. Stat. § 51.20(1)(a)2.a. 
Evidences a substantial probability of physical 
harm to other individuals as manifested by evidence of 
recent homicidal or other violent behavior, or by 
evidence that others are placed in reasonable fear of 
violent behavior and serious physical harm to them, as 
evidenced by a recent overt act, attempt or threat to 
do serious physical harm . . . ."  Wis. Stat. 
§ 51.20(1)(a)2.b. 
Evidences such impaired judgment, manifested by 
evidence of a pattern of recent acts or omissions, 
that there is a substantial probability of physical 
impairment or injury to himself or herself.  Wis. 
Stat. § 51.20(1)(a)2.c. 
Evidences behavior manifested by recent acts or 
omissions that, due to mental illness, he or she is 
unable to satisfy basic needs for nourishment, medical 
care, shelter or safety without prompt and adequate 
treatment so that a substantial probability exists 
that death, serious physical injury, serious physical 
debilitation 
or 
serious 
physical 
disease 
will 
imminently ensue unless the individual receives prompt 
and adequate treatment for this mental illness.  Wis. 
Stat. § 51.20(1)(a)2.d. 
No. 
01-0374   
 
16 
 
or the loss of cognitive or volitional control over his or her 
thoughts or actions."  Wis. Stat. § 51.20(1)(a)2.e. (emphasis 
added).  The legislature has thus defined dangerousness in the 
fifth standard by reference to a threat to the individual's 
fundamental health or safety and a loss of the ability to 
function independently or control thoughts or actions.  Mere 
emotional or mental harm is insufficient for commitment. 
¶31 In any event, to the extent that the differences 
between the fifth standard and the first four result in a 
classification for purposes of equal protection analysis, it is 
not a constitutionally impermissible one.  Whether a legislative 
distinction 
between 
otherwise 
similarly 
situated 
persons 
violates equal protection depends upon whether there is a 
reasonable basis to support it.  State ex rel. Jones v. 
Gerhardstein, 141 Wis. 2d 710, 733, 416 N.W.2d 883 (1987); see 
also Post, 197 Wis. 2d at 319-20 (noting that the Supreme Court 
has not explicitly required strict or intermediate scrutiny of 
involuntary commitment statutes challenged on equal protection 
grounds).  "Where the classification does not involve a suspect 
class, equal protection is denied only if the legislature has 
made an irrational or arbitrary classification."  Jones, 141 
Wis. 2d at 733. 
¶32 "[T]he state retains 
broad 
discretion 
to 
create 
classifications so long as the classifications have a reasonable 
basis."  McManus, 152 Wis. 2d at 131 (citing Graham v. 
Richardson, 403 U.S. 365, 371 (1971)).  Under the rational basis 
test, a statutory classification is presumed to be proper.  
No. 
01-0374   
 
17 
 
State v. Hart, 89 Wis. 2d 58, 65, 277 N.W.2d 843 (1979).  It 
will be sustained if the reviewing court can identify any 
reasonable basis to support it.  Matter of Care and Maintenance 
of K.C., 142 Wis. 2d 906, 916, 420 N.W.2d 37 (1988).  Any doubt 
must be resolved in favor of the reasonableness of the 
classification and the constitutionality of the statute in which 
it is made.  Racine Steel Castings v. Hardy, 144 Wis. 2d 553, 
560, 426 N.W.2d 33 (1988).  A "legislative enactment must be 
sustained unless it is 'patently arbitrary' and bears no 
rational relationship to a legitimate government interest."  
McManus, 152 Wis. 2d at 131 (citing Frontiero v. Richardson, 411 
U.S. 677, 683 (1973)).8   
¶33 The fifth standard applies to mentally ill persons 
whose mental illness renders them incapable of making informed 
medication decisions and makes it substantially probable that, 
without treatment, disability or deterioration will result, 
bringing on a loss of ability to provide self-care or control 
thoughts or actions.  It allows the state to intervene with care 
and treatment before the deterioration reaches an acute stage, 
                                                 
8 Accord Milner v. Apfel, 148 F.3d 812, 815-16 (7th Cir. 
1998).  The Seventh Circuit noted that "the uniform view of the 
courts of appeals" is that "rational basis is the proper 
standard for deciding equal protection cases" involving the 
mentally ill.  The court also noted that several Supreme Court 
cases imply or suggest the same.  See id. (citing Heller v. Doe 
by Doe, 509 U.S. 312, 321 (1993)("We have applied rational-basis 
review in previous cases involving the mentally retarded and the 
mentally ill."); City of Cleburne v. Cleburne Living Center, 473 
U.S. 432, 466 (1985); Jones v. United States, 463 U.S. 354, 363 
(1983); Jackson v. Indiana, 406 U.S. 715, 736-37 (1972); 
Baxstrom v. Herold, 383 U.S. 107, 111-15 (1966)).  
No. 
01-0374   
 
18 
 
thereby preventing the otherwise substantially probable and 
harmful loss of ability to function independently or loss of 
cognitive or volitional control.  There is a rational basis for 
distinguishing between a mentally ill person who retains the 
capacity to make an informed decision about medication or 
treatment and one who lacks such capacity.  The latter is 
helpless, by virtue of an inability to choose medication or 
treatment, to avoid the harm associated with the deteriorating 
condition. 
¶34 Mentally ill persons who meet the fifth standard's 
definition are clearly dangerous to themselves because their 
incapacity to make informed medication or treatment decisions 
makes them more vulnerable to severely harmful deterioration 
than those who are competent to make such decisions.  The state 
has a strong interest in providing care and treatment before 
that incapacity results in a loss of ability to function.  We 
conclude that any distinctions between the fifth standard and 
the first four are rationally-based.  The fifth standard does 
not violate equal protection. 
Substantive Due Process 
¶35 Finally, Dennis H. argues that the fifth standard 
violates 
substantive 
due 
process 
by 
allowing 
involuntary 
commitment without evidence of a risk of imminent physical 
dangerousness to self or others. 
¶36 "The state has a legitimate interest under its parens 
patriae powers in providing care to its citizens who are unable 
to care for themselves."  Addington v. Texas, 441 U.S. 418, 426 
No. 
01-0374   
 
19 
 
(1979).  The state also has "authority under its police power to 
protect the community" from any dangerous mentally ill persons.  
Heller, 509 U.S. at 332 (citing Addington, 441 U.S. at 426).  
The state's legitimate interest ceases to exist, however, if 
those sought to be confined "are not mentally ill or if they do 
not pose some danger to themselves or others."9  Addington, 441 
U.S. at 426 (emphasis added). 
¶37  "[E]ven if there is no foreseeable risk of self-injury 
or suicide, a person is literally 'dangerous to himself' if for 
physical or other reasons he is helpless to avoid the hazards of 
freedom either through his own efforts or with the aid of 
willing family members or friends."  O'Connor v. Donaldson, 422 
U.S. 563, 574, n.9 (1975) (emphasis added).  Substantive due 
process has not been held to require proof of imminent physical 
dangerousness to self or others as a necessary prerequisite to 
involuntary commitment.10 
                                                 
 
9 Addington also held that due process requires that the 
middle 
"clear 
and 
convincing" 
burden 
of 
proof 
apply 
to 
involuntary commitment proceedings.  Addington v. Texas, 441 
U.S. 418, 433 (1979); see also Foucha v. Louisiana, 504 U.S. 71, 
75-76 (1992). 
  
10  O'Connor held that "[a] finding of 'mental illness' 
alone cannot justify a State's locking a person up against his 
will 
and 
keeping 
him 
indefinitely 
in 
simple 
custodial 
confinement."  O'Connor v. Donaldson, 422 U.S. 563, 575 (1975) 
(emphasis added).  As we have noted, the fifth standard does not 
allow involuntary civil commitment upon a finding of mental 
illness alone.  Nor does it place the mentally ill person in 
simple 
custodial 
confinement. 
See, 
e.g., 
Wis. 
Stat. 
§ 51.20(10)(cm) (requiring the formulation of a treatment plan 
prior to commitment); Wis. Stat. § 51.20(13)(g)2d.a. (limiting 
the time a person committed under the fifth standard can spend 
in inpatient treatment to 30 days).  
No. 
01-0374   
 
20 
 
¶38 It 
is 
well-established 
that 
the 
state 
"cannot 
constitutionally confine without more a nondangerous individual 
who is capable of surviving safely in freedom by himself or with 
the help of willing and responsible family members or friends."  
Id. at 576; see also Foucha v. Louisiana, 504 U.S. 71, 78 (1992) 
(involuntary mental health commitment is improper absent a 
determination of current mental illness and dangerousness).  
This does not mean, however, that substantive due process 
requires the state to restrict the scope of its mental health 
commitment statutes to only those individuals who are imminently 
physically dangerous.  There is no "single definition that must 
be used as the mental condition sufficient for involuntary 
mental commitments." Post, 197 Wis. 2d at 304.  In this 
complicated and difficult area, the Supreme Court "has wisely 
left 
the 
job 
of 
creating 
statutory 
definitions 
to 
the 
legislators who draft state laws."  Id. 
¶39 The fifth standard permits commitment only when a 
mentally 
ill 
person 
needs 
care 
or 
treatment 
to 
prevent 
deterioration but is unable to make an informed choice to accept 
it.  This must be "demonstrated by both the individual's 
treatment 
history" 
and 
by 
the 
person's 
"recent 
acts 
or 
omissions."  Wis. Stat. § 51.20(1)(a)2.e.  It must also be 
substantially probable that if left untreated, the person "will 
suffer severe mental, emotional or physical harm" resulting in 
the loss of the "ability to function independently in the 
community" or in the loss of "cognitive or volitional control."  
No. 
01-0374   
 
21 
 
Id.  Only then may the individual be found "dangerous" under the 
fifth standard. 
¶40 The fifth standard thus fits easily within the O'Connor 
formulation: even absent a requirement of obvious physical harm 
such as self-injury or suicide, a person may still be "dangerous 
to himself" if "he is helpless to avoid the hazards of freedom 
either through his own efforts or with the aid of willing family 
members or friends."  O'Connor, 422 U.S. at 574, n.9. 
¶41 Moreover, by requiring dangerousness to be evidenced 
by a person's treatment history along with his or her recent 
acts or omissions, the fifth standard focuses on those who have 
been in treatment before and yet remain at risk of severe harm, 
i.e., those who are chronically mentally ill and drop out of 
therapy or discontinue medication, giving rise to a substantial 
probability of a deterioration in condition to the point of 
inability to function independently or control thoughts or 
actions.  See Darold A. Treffert, The MacArthur Coercion 
Studies: A Wisconsin Perspective, 82 Marq. L. Rev. 759, 780 
(1999).  The statute represents the fruition of the efforts of 
the Wisconsin State Medical Society and the Alliance for the 
Mentally Ill, professional organizations which recognized a need 
for a law that could be applied to those victims of mental 
illness who fell through the cracks under the old statutory 
scheme.  See id. 
¶42  "As with all enactments, we presume good faith on the 
part of the legislature."  Post, 197 Wis. 2d at 308 (citing 
State ex rel. Thomson v. Zimmerman, 264 Wis. 644, 652, 60 N.W.2d 
No. 
01-0374   
 
22 
 
416 (1953)).  By permitting intervention before a mentally ill 
person's condition becomes critical, the legislature has enabled 
the mental health treatment community to break the cycle 
associated with incapacity to choose medication or treatment, 
restore the person to a relatively even keel, prevent serious 
and potentially catastrophic harm, and ultimately reduce the 
amount of time spent in an institutional setting.11  This type of 
"prophylactic intervention" does not violate substantive due 
process.   
¶43 A number of amicus curiae briefs have been filed by 
professional and advocacy organizations, both in support of and 
opposition to the fifth standard, and they cite academic 
research on both sides of the policy choice that the statute 
embodies.  "The fact that studies reaching opposite conclusions 
can be cited on both sides of this issue does not preclude the 
legislature from acting, nor does it compel a finding of 
unconstitutionality."  Post, 197 Wis. 2d at 311. 
¶44 The Supreme Court has cautioned against judicial 
second-guessing of legislative judgments in the area of mental 
health commitments: 
We do not agree with the suggestion that Congress' 
power to legislate in this area depends on the 
research conducted by the psychiatric community.  We 
have 
recognized 
repeatedly 
the 
"uncertainty 
of 
diagnosis in this field and the tentativeness of 
professional judgment.  The only certain thing that 
                                                 
 
11 As we have noted, those committed under the fifth 
standard 
are 
initially 
limited 
to 
30 
days 
of 
inpatient 
treatment.  See  supra, note 10. 
  
No. 
01-0374   
 
23 
 
can be said about the present state of knowledge and 
therapy regarding mental disease is that science has 
not reached finality of judgment . . . . "  The lesson 
we have drawn is not that government may not act in 
the face of this uncertainty, but rather that courts 
should 
pay 
particular 
deference 
to 
reasonable 
legislative judgments. 
Id. (citing Jones, 463 U.S. at 364 n.13 (citations omitted in 
original)). 
 
We 
defer, 
therefore, 
to 
the 
legislature's 
resolution of the conflicting positions of mental health 
advocates and psychiatric professionals.     
¶45 
In 
summary, 
the 
fifth 
standard 
does 
not 
allow 
involuntary commitment upon a finding of mental illness alone, 
and contains an ascertainable standard of commitment, and is 
therefore 
not 
unconstitutionally 
vague 
or 
overbroad.  
Furthermore, the fifth standard does not create a class of 
persons who can be involuntarily committed upon a finding of 
mere mental or emotional harm, and therefore does not violate 
equal protection.  Finally, the fifth standard does not violate 
substantive due process, because the constitution does not 
require proof of imminent physical harm prior to commitment for 
treatment.  Accordingly, the fifth standard of dangerousness for 
involuntary civil commitment, Wis. Stat. § 51.20(1)(a)2.e., is 
constitutional. 
By the Court.—The order of the Milwaukee County Circuit 
Court is affirmed. 
 
 
No.  01-0374.ssa 
 
1 
 
¶46 SHIRLEY S. ABRAHAMSON, CHIEF JUSTICE   (concurring).  
Both mental illness and dangerousness are necessary to satisfy 
the requirements of substantive due process for involuntary 
civil commitment in Wisconsin. 
¶47 The so-called fifth standard was enacted to allow for 
the hospitalization and treatment of individuals with a history 
of mental health treatment who become incapable of making 
rational treatment decisions and refuse treatment.  For such 
individuals, refusing timely treatment could lead to substantial 
mental deterioration.  For family members and friends, a loved 
one's refusal of timely treatment can result in an agonizing and 
helpless vigil as that individual's mental, emotional, and 
physical condition deteriorates.   
¶48 A court must balance the desires of mental health 
professionals, friends, and family members who believe that care 
and treatment are in the best interests of a person who is 
mentally ill, and the constitutional liberty interests of 
individuals to be free from unwanted and unnecessary restraints.  
In recent decades, this balance has been struck by requiring 
proof of mental illness and imminent dangerousness to self or 
others before permitting involuntary civil commitment.12   
¶49 The fifth standard comes perilously close to upsetting 
this balance.  It passes constitutional muster for me only so 
                                                 
12 See O'Connor v. Donaldson, 422 U.S. 563, 573-76 (1975) 
(state cannot confine nondangerous person without more); Lessard 
v. Schmidt, 379 F.Supp. 1376, 1381 (E.D. Wis. 1974), vacated and 
remanded on other grounds, 421 U.S. 957 (1975), reinstated 413 
F.Supp. 1318 (E.D. Wis. 1976) (mandating dangerousness as a 
constitutional prerequisite to involuntary hospitalization). 
No.  01-0374.ssa 
 
2 
 
long as courts require significant evidence of the statutory 
elements, and treatment is in fact provided.  For the reasons 
set forth, I write separately. 
¶50 I am authorized to state that Justices WILLIAM A. 
BABLITCH and ANN WALSH BRADLEY join this opinion. 
 
No.  01-0374.ssa 
 
 
 
1